Privia Health Group, Inc.
−Removed: (“Privia Health”, “we”, “our”, or the “Company”) is a technology-driven, national physician-enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual care settings (the “Privia Platform”).
−Removed: We directly address three of the most pressing issues facing physicians today:
−Removed: the transition to the value-based care (“VBC”) reimbursement model, the ever-increasing administrative requirements to operate a successful medical practice and the need to engage patients using modern user-friendly technology.
−Removed: We seek to accomplish these objectives by entering markets and organizing existing physicians and non-physician clinicians into a unique practice model that combines the advantages of a partnership in a large regional medical group (each, a “Medical Group”) with significant local autonomy for the physicians (collectively, “Privia Physicians”) and non-physician clinicians (collectively “Privia Clinicians” and, together with the Privia Physicians, the “Privia Providers”) joining our Medical Groups.
−Removed: Our Medical Groups are designated as in-network by all major health insurance payers in all of our markets, and all Privia Providers are credentialed with such health insurance payers.
−Removed: Our platform is purpose-built, organizing physicians into cost efficient, value-based and primary-care centric networks bolstered by strong physician governance, and promotes a culture of physician leadership.
−Removed: The Privia Platform is powered by our Privia Technology Solution that integrates both Privia-developed and third-party applications into a seamless interface and workflow that manages all aspects of our Privia Providers’ provision of healthcare services.
+Added: (“Privia Health”, “we”, “our”, or the “Company”) is a technology-driven, national physician-enablement company that collaborates with physician practices, health plans, and health systems to achieve the quadruple aim of better outcomes, lower costs, improved patient experience, and happier and more engaged providers.
+Added: We seek to accomplish the quadruple aim by entering markets and organizing existing physicians and non-physician clinicians into a unique practice model that combines the advantages of a partnership in a large regional medical group (each, a “Medical Group”) with significant provider autonomy for the physicians (collectively, “Privia Physicians”) and non-physician clinicians (collectively “Privia Clinicians” and, together with the Privia Physicians, the “Privia Providers”) joining our Medical Groups.
+Added: We organize physicians into cost efficient, value-based and primary-care centric networks bolstered by strong physician governance, and promote a culture of physician leadership.
+Added: Our platform (the “Privia Platform”) is powered by our Privia Technology Solution that integrates both Privia-developed and third-party applications into a seamless interface and workflow that manages all aspects of our Privia Providers’ provision of healthcare services.
We enhance the patient experience, improve practice economics and influence point of care delivery through investments in data analytics, revenue cycle management (“RCM”), practice and clinical operations and payer alignment.
−Removed: The Privia Platform is designed to succeed across demographic cohorts, acuity levels and reimbursement models, including traditional fee-for-service (“FFS”) Medicare, the Medicare Shared Savings Program (“MSSP”), Medicare Advantage, Medicaid, commercial insurance and other existing and emerging direct contracting programs with payers and employers.
−Removed: We believe that the Privia model is a highly scalable solution to help our nation’s healthcare system achieve the quadruple aim of better outcomes, lower costs, improved patient experience, and happier and more engaged providers.
−Removed: Our customers have affirmed our model, as Privia Health has rapidly become one of the nation’s leading independent physician companies since launching our first Medical Group in 2013.
−Removed: There are three core elements to our physician alignment approach:
−Removed: 1) A focus on maximizing the potential of a physician’s medical practice across the physician’s entire patient panel, with the end goal of succeeding in VBC reimbursement;
−Removed: 2) A highly flexible payer-agnostic approach to address the needs of multiple types of physician practices, from independently owned to hospital employed or hospital affiliated practices;
−Removed: 3) Delivering a profitable model for both Privia and our Privia Physicians, regardless of the reimbursement model, geographic environment or specialty.
−Removed: The intended result of the Privia model is engaged physicians and non-physician clinicians delivering virtual and in-person high quality healthcare to patients with superior clinical outcomes and experiences at lower costs.
−Removed: We believe the Privia Platform is highly scalable, allowing us to both rapidly build density in new geographic markets and guide those markets from FFS to VBC by shifting the reimbursement model and helping our Privia Providers better manage the cost of care through a focus on quality and success-based reimbursement.
−Removed: This model is designed to enable significant growth, with significant revenue visibility, low invested capital and attractive margins.
+Added: The Privia Platform is designed to succeed across demographic cohorts, acuity levels and reimbursement models, including traditional fee-for-service Medicare, the Medicare Shared Savings Program (“MSSP”), Medicare Advantage, Medicaid, commercial insurance and other existing and emerging direct contracting programs with payers and employers.
+Added: We designed the Privia Platform to be scalable, allowing us to grow our presence in new geographic markets and guide those markets from fee-for-service (“FFS”) to value-based care (“VBC”), including commercial risk, by shifting the reimbursement model and helping our Privia Providers better manage the cost of care through a focus on quality and success-based reimbursement.
+Added: Our business model is designed to have meaningful revenue visibility, with low invested capital and attractive margin opportunity.
We believe the Privia Platform aligns with the direction healthcare is headed, including (1) a macro shift towards VBC models that focus on delivering coordinated, high quality care at lower total costs, (2) a greater focus on the patient experience and (3) a focus on optimizing provider workflow and bringing back the joy of practicing medicine.
−Removed: We believe our approach is highly attractive to a broad spectrum of physician practices given our significant value proposition and our comprehensive solution set.
−Removed: We believe our technology-enabled platform is differentiated and well positioned to drive sustainable long-term growth, with attractive margins and attractive returns on invested capital.
+Added: Our value proposition and comprehensive solution set address needs across the spectrum of physician practices.
+Added: We believe our technology-enabled platform is differentiated and well positioned to drive sustainable long-term growth.
The Privia Platform has the following key attributes:
−Removed: • Addresses a Large Total Addressable Market (“TAM”):
−Removed: Targets a large and growing TAM (physician enablement market estimated to be $1.9 trillion, with an ability to serve over 1 million providers in the U.S.).
−Removed: • Purpose-Built to Scale Nationally:
−Removed: Flexible model to enter new markets with multiple types of physician practices (more than 485,000 primary care physicians and more than 535,000 physician specialists in the U.S.).
−Removed: • Powered by the Privia Technology Solution:
−Removed: Comprehensive cloud-based technology-enabled platform designed to optimize provider workflow across the full continuum of reimbursement environments as well as both virtual and in-person care settings (eliminates the need to buy and integrate more than 30 point solutions) .
−Removed: • Establishes Provider Density in Local Markets:
−Removed: Supports a proven expansion strategy resulting in increased relevance with payers and patients (over 1,090 care center locations across 13 states and the District of Columbia, targeting over 160 metropolitan statistical areas (“MPSAs”) located within those geographical markets).
−Removed: • Designed to Transform Care Delivery:
−Removed: Designed to transition care delivery in each market from FFS to VBC and to enhance the care model and ability of Privia Providers to manage higher risk patients (more than $937 million total savings generated across Commercial, Medicare Advantage, Medicare Shared Savings, and Medicaid since 2014;
−Removed: patient NPS of 85).
−Removed: • Demonstrates Physician Value Proposition Consistently:
−Removed: Reduces administrative burden and generally increases provider profitability (96% Privia Provider retention rate over the past five years in addition to a seven-time (2016-2022) HFMA MAP Award recipient for high performance in revenue cycle).
−Removed: • Generates Attractive Financial Results:
−Removed: Has an established scale, diversified revenue mix with no single payer or individual practice concentration, and is profitable and capital efficient with attractive growth ( for the year ended December 31, 2023, approximately $1.66 billion in revenue and more than $2.84 billion total practice collections, high return on invested capital with superior unit economics and high free cash flow conversion ).
−Removed: See “Key Metrics” for a discussion of practice collections.
−Removed: • Led by a Highly Experienced Executive and Physician Leadership Team:
−Removed: Our management team has significant experience leading payer, provider and healthcare information technology organizations.
−Removed: We believe our model is highly scalable.
−Removed: Privia operates in 13 states and the District of Columbia, covering over 160 target MPSAs (including 54 out of the largest 100 MPSAs), not including our planned exit from Delaware.
−Removed: We aim to build relevance in each of our markets with all key constituents (physicians, non-physician clinicians, patients, government programs, commercial payers and employers).
−Removed: Privia started by partnering with small and large independent physician practices focused on primary care, pediatrics, women’s health, and select subspecialties focused on treating chronically ill patients.
−Removed: As of December 31, 2023 we now have more than 4,300 service professionals on our platform who are credentialed and bill for medical services, in both Owned and Non-Owned Medical Groups (as defined below), (“implemented providers”).
−Removed: Once a provider signs an agreement to join Privia, there is a five-to-eight month period on average before that provider is implemented on our platform.
−Removed: This time lag between signing and implementing a provider gives us very high visibility into total practice collections over a forward twelve-month period.
+Added: • Addresses a large and growing total addressable market (“TAM”) of providers
+Added: • Incorporates a flexible model that is purpose-built to scale nationally by facilitating the entrance into new markets with multiple types of physician practices
+Added: • Built on a comprehensive cloud-based technology-enabled platform that is designed to optimize provider workflow across the full continuum of reimbursement environments in virtual and in-person care settings
+Added: • Focused on establishing scaled provider groups across each geographical market, resulting in increased relevance with payers and patients (over 1,200 care center locations across 14 states and the District of Columbia)
+Added: • Designed to transition care delivery in each market from FFS to VBC and to enhance the ability of Privia Providers to manage higher risk patients
+Added: • Reduces administrative burden and generally increases provider profitability for community providers
+Added: • Led by a team with significant experience leading payer, provider and healthcare information technology organizations
+Added: We operate in 14 states and the District of Columbia.
+Added: Generally speaking, we define a market as a geographic area covered by one of our Medical Groups under a single Tax ID Number (“TIN”).
+Added: A market could comprise a single state, a part of a state or a group of multiple states and/or districts.
+Added: We aim to build relationships with key constituents including physicians, non-physician clinicians, patients, government programs, commercial payers and employers.
+Added: As of December 31, 2024, we had 4,789 Privia Providers on the Privia Platform who are credentialed and bill for medical services, in both Owned and Non-Owned Medical Groups (as defined below), (“implemented providers”).
Our implemented providers operate in over 1,200 care center locations.
−Removed: Privia cares for over 4.8 million patients, including approximately 683,000 commercial patients who have selected one of our Medical Groups as their provider of primary care services, as measured at the end of a particular period (“attributed lives”), approximately 155,000 Medicare Advantage attributed lives, 197,000 Medicare Shared Savings / Maryland PCP+ Program attributed lives, and approximately 85,000 Medicaid attributed lives.
−Removed: In addition, we currently have over 224,000 patients aging into Medicare over the next five years.
−Removed: Our confidence in our base business model is based on our belief that the Privia Platform works across all geographies and will allow us to enter many new markets across the country over the coming decades and fundamentally move those markets to VBC.
−Removed: In some instances, we also move into and expand in new and existing markets through our Privia Care Partners model.
−Removed: Privia Care Partners offers a more flexible affiliation model to providers who are looking solely for VBC solutions without the necessity of joining one of our Medical Groups and changing EMR platforms.
−Removed: Providers participating in Privia Care Partners are clinically integrated to allow for joint contracting with payers, and we furnish population health services, reporting and analytics to such providers along with a menu of management services from which providers may choose.
−Removed: As of January 1, 2024, approximately 1,350 providers with approximately 200,000 attributed lives are participating in the Privia Care Partners model.
−Removed: During 2023, several Privia Care Partners’ providers transitioned to our Privia Medical Group model, which demonstrates the flexibility of our operating model and technology platform, as well as the ability to support physicians wherever they are in their transition value-based care.
−Removed: Under our standard Privia Medical Group model, Privia Physicians join the Medical Group in their geographic market as an owner of the Medical Group.
+Added: Privia cares for over 5.2 million patients, including in VBC arrangements approximately 782,000 commercial patients who have selected one of our Medical Groups as their provider of primary care services, as measured at the end of a particular period (“attributed lives”), approximately 185,000 Medicare Advantage attributed lives, 196,000 Medicare Shared Savings / Maryland PCP+ Program attributed lives, and approximately 97,000 Medicaid attributed lives.
+Added: In some instances, we also move into and expand in new and existing markets through our Privia Care Partners model, which offers an affiliation model to providers who are looking solely for VBC solutions.
+Added: For those practices, we furnish population health services, reporting and analytics, along with certain management.
+Added: Under our Privia Medical Group model, Privia Physicians join the Medical Group in their geographic market as an owner of the Medical Group.
We own a majority interest in certain of our Medical Groups (each, an “Owned Medical Group”), with Privia Physicians collectively owning a minority interest, and we own no interest in certain other Medical Groups (each, a “Non-Owned Medical Group”).
−Removed: In those markets in which state regulations do not allow us to own Medical Groups, the Non-Owned Medical Groups are either (a) 100% owned by the Privia Physicians or (b) majority owned, indirectly through a professional entity (“Nominee PC”), by a licensed physician holding a Privia leadership position (such physician leader, a “Nominee Physician” and each such Non-Owned Medical Group owned in this manner, a “Friendly Medical Group”), and in those markets where we partner with health systems, our health system partner owns a majority interest in the Non-Owned Medical Groups, with Privia Physicians owning a minority interest.
−Removed: Our Owned and Non-Owned Medical Group Privia Physicians, who owned their own practices prior to joining Privia, continue to own their historical practice entities (“Affiliated Practices”) but those Affiliated Practices no longer furnish healthcare services and Privia Physicians are contractually obligated to furnish all healthcare services through their Medical Group.
−Removed: The Medical Groups have no ownership in the underlying Affiliated Practices, but the Affiliated Practices do provide certain services to the Medical Groups, such as use of space, non-physician staffing, equipment and supplies.
−Removed: We provide management services to each Medical Group though a local management services organization (each, a “MSO”) established with the objective of maximizing the independence and autonomy of our Privia Physicians, while providing Medical Groups with access to VBC opportunities either directly or through Privia-owned accountable care organizations (each, an “ACO”).
−Removed: We have national committees that distribute quality guidance, and we employ Chief Medical Officers who provide clinical oversight
−Removed: and direction over the clinical affairs of the Owned Medical Groups.
+Added: In those markets in which state regulations do not allow us to own Medical Groups, the Non-Owned Medical Groups may be owned by the Privia Physicians or majority owned indirectly by a licensed physician holding a Privia leadership position (each such Non-Owned Medical Group owned in this manner, a “Friendly Medical Group”) with Privia Physicians collectively owning a minority interest.
+Added: In those markets where we partner with health systems, our health system partner owns a majority interest in the Non-Owned Medical Groups, with Privia Physicians owning a minority interest.
+Added: Privia Physicians furnish healthcare services through our Medical Groups and continue to own their historical practice entities (“Affiliated Practices”), which provide certain services to the Medical Groups, such as use of space, non-physician staffing, equipment and supplies.
+Added: We provide management services to the Medical Groups though local management services organizations (each, an “MSO”), which provide Medical Groups with access to VBC opportunities either directly or through Privia-owned accountable care organizations (each, an “ACO”).
+Added: We have national committees that distribute quality guidance, and we employ Chief Medical Officers who provide clinical oversight and direction over the clinical affairs of the Owned Medical Groups.
Additionally, we hold the provider contracts, maintain the patient records, set reimbursement rates, and negotiate payer contracts on behalf of the Owned Medical Groups.
We principally derive our revenues from the following three sources:
−Removed: (i) FFS-patient care revenue generated from providing healthcare services to patients through Privia Providers of Owned Medical Groups and Friendly Medical Groups, in addition to management and administrative services earned for administrative services provided to Non-Owned Medical Groups (“FFS-administrative services”), (ii) VBC revenue collected on behalf of our Privia Providers in the form of (a) capitated revenue and (b) management and administrative fees, which, at this time, are primarily in the form of shared savings, which includes quality bonuses, and per member per month (“PMPM”) care management fees, and (iii) other revenue from additional services offered by Privia to its Privia Providers or directly to patients or employers.
+Added: (i) FFS-patient care revenue generated from providing healthcare services to patients through Privia Providers of Owned Medical Groups and Friendly Medical Groups, in addition to management and administrative services earned for administrative services provided to Non-Owned Medical Groups (“FFS-administrative services”), (ii) per member per month “PMPM” care management fees, including management and administrative fees, (iii) VBC revenue collected on behalf of our Privia Providers in the form of (a) capitated revenue and shared savings, including quality performance-based bonuses, and (iv) other revenue from additional services offered to Privia Providers or directly to patients or employers, such as concierge services, virtual visits, virtual scribes and coding, clinical trials, behavioral health management, and partnerships with self-insured employers to offer direct primary care to their employees.
The operations of our Owned Medical Groups, owned ACOs, owned MSOs and Friendly Medical Groups are reflected within our consolidated financial results.
−Removed: Privia Health is a technology-driven, national physician-enablement company designed to transform the healthcare delivery experience for physicians and patients, while increasing value to payers.
−Removed: We enter markets, organize providers, drive operational and clinical improvements, and transition the market to VBC.
−Removed: Among many “pain points” in the healthcare market today, providers across the country are spending less time with patients, losing autonomy, and operating with outdated, fragmented point solution technology.
−Removed: By harnessing a platform built on the foundational principles of talent, tools, and technology, we created a solution for building, scaling and optimizing the performance of both our Owned Medical Groups, through which we provide healthcare services, as well as our managed Non-Owned Medical Groups.
−Removed: Our integrated model and approach seek to reduce the physicians’ administrative burden and help accelerate the transition to VBC.
−Removed: This model creates a differentiated experience that is patient-centric, physician-led and payer-agnostic.
−Removed: As a result, we enable physicians to maintain their legacy practice assets while benefiting from being part of a larger Medical Group supported by a national organization.
−Removed: We are helping to drive the transition to VBC while serving FFS needs with an economically sustainable model that builds physician’s experience and confidence, enabling success with the transition to participate in more advanced VBC programs.
−Removed: Privia Health Operating Model
−Removed: The Privia operating model has the following characteristics:
−Removed: • Proven, scalable, replicable and flexible;
−Removed: • Single Tax-ID Number (“TIN”) Medical Group, primary care-oriented in each local geographic market;
−Removed: • Management services and clinical organization enabled by the Privia Technology Solution;
−Removed: • Market specific strategies—Accountable Care Organizations and ancillary services (e.g., clinical lab, pharmacy and imaging) based on market dynamics.
−Removed: The Privia Platform is powered by the Privia Technology Solution, which optimizes provider workflow across the full continuum of reimbursement arrangements.
−Removed: The platform supports multiple provider types (56 specialties currently represented), enables scalable operations, and delivers patient centric in-person and virtual access to care, attractive quality metrics, and lower cost of care.
−Removed: It efficiently integrates multiple data points to build a single view of the patient, allowing our Privia Providers to serve patients across demographics and medical complexities.
−Removed: Our platform scales across different markets by succeeding in all reimbursement models and delivering next generation VBC capabilities.
−Removed: We seek to continuously enhance the Privia Technology Solution to improve provider well-being and patient satisfaction.
−Removed: At our core, we believe in bringing back to physicians the joy of practicing medicine and the passion for their profession.
−Removed: As a physician-led organization, we know the vital role providers play in improving patient health outcomes while curbing healthcare spending and waste.
−Removed: Privia Health is changing healthcare:
−Removed: We meet providers where they are on the value continuum and partner with health plans, health systems, and employers to align reimbursements to quality, outcomes, and performance.
−Removed: Our model has proven to be successful and replicable across multiple geographies.
−Removed: Our platform is led by top industry talent, exceptional physician leadership, and consists of scalable operations, and end-to-end, cloud based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
−Removed: Our tailored solutions are designed to enable providers to practice medicine efficiently and effectively, thrive in both FFS and VBC environments, and improve the quality of their patient interactions, all of which lead to improved patient outcomes.
−Removed: We further enable our Medical Groups to succeed as the payer, patient and employer needs shift over time in each of our markets.
−Removed: Privia’s goal is to reimagine the approach to managing physician organizations and optimize their performance by creating a platform that caters to their unique needs.
−Removed: We do this through five key elements of our platform:
−Removed: (i) focusing on technology and population health, (ii) establishing a single-TIN Medical Group and governance model in each geographic market, (iii) owning and operating a MSO in each local market, (iv) building ACOs to capture VBC opportunities, and (v) offering a high quality, low cost provider network for purchasers and payers.
+Added: We seek to reimagine the approach to managing physician organizations and optimize their performance by (i) focusing on technology and population health, (ii) establishing a single-TIN Medical Group and governance model in each geographic market, (iii) owning and operating an MSO in each local market, (iv) building ACOs to capture VBC opportunities, and (v) offering a high quality, low cost provider network for purchasers and payers.
Trends impacting the U.S.
2 unchanged sentences
Physicians across the country face tremendous challenges in managing their practices.
−Removed: Care delivery platforms today are not set up to succeed in different reimbursement models as healthcare shifts from FFS to VBC.
−Removed: We believe there is a multi-decade opportunity for primary care led physician groups to address rising healthcare costs, poor outcomes, and succeed in various VBC models.
−Removed: Success and reimbursement in these models are based on managing total cost of care for an underlying patient population and improving various quality metrics.
−Removed: We think these value-based models will evolve differently in terms of program structure and pace of progress depending on geographic market, demographic cohort and payer.
−Removed: However, traditional physician groups face challenges finding ways to lower costs while improving quality and increasing access to care across multiple geographies and patient cohorts.
Physician practices have seen declines in profitability, limited access to capital and strained cash flows as the administrative burden to manage patients has increased.
−Removed: Complexity in payment models and outdated technology has also led to physician burn-out and has hindered physician to patient interactions.
+Added: Complexity in payment models, including changes in reimbursement, and outdated technology has also led to physician burn-out and has hindered physician to patient interactions.
Healthcare insurance companies have narrowed their networks, leading to volume pressures that particularly impact independent practitioners.
Physicians are at the center of these issues and are the key to the solution.
−Removed: A survey of 700+ clinicians, clinical leaders and health care executives conducted by NEJM Catalyst and reported in October 2020 found the following:
−Removed: • 90% see physician burnout as a moderate or serious problem;
−Removed: • 55% mention administrative burden as a top contributor to provider burnout, identifying lack of autonomy/control and the impact of electronic medical records and other IT systems as the biggest factors.
Rising Healthcare Costs
Healthcare spending in the United States reached nearly $4.9 trillion in 2023 or $14,570 per person, according to Centers for Medicare and Medicaid Services (“CMS”), representing approximately 17.6% of U.S.
−Removed: This is more than any other country in the world and twice the OECD average.
National health expenditures are projected to reach $7.7 trillion or 19.7% of GDP by 2032, according to CMS, outpacing both GDP and inflation expectations.
−Removed: Privia’s solutions help rein in healthcare costs, while improving patient experience and provider efficiency.
−Removed: Wasteful Spending
−Removed: A 2019 study by the Journal of American Medical Association estimated that approximately 25% of all healthcare spending is for unnecessary services, excessive administrative costs, fraud and other problems creating waste, implying approximately $760 billion to $935 billion of annual wasteful spending at current levels.
−Removed: In 2020, hospital care accounted for the largest portion of healthcare spending in the United States, representing 30.8% of the total.
−Removed: Proper management of chronic conditions can significantly reduce the incidence of acute episodes, which are the main drivers of trips to the emergency room and hospitalization, particularly among the elderly.
−Removed: Sub-optimal Results
−Removed: Despite high levels of spending, the United States healthcare system struggles to produce better health outcomes and to keep doctors and patients satisfied.
−Removed: Life expectancy in the United States was 77.3 years in 2020, compared to 82.1 years in comparable developed countries, and patient satisfaction with the healthcare system is low, as evidenced by a Net Promoter Score of 35 for the average primary care physician as shown in a WD Partners study conducted in 2019.
−Removed: We build cost efficient primary care delivery networks in each of our markets to align incentives with public and commercial payers.
−Removed: We use our end-to-end, cloud-based technology-enabled platform to identify quality gaps, generate actionable reports and alerts, and automate patient outreach and education, to improve care coordination and reduce wasteful spend.
Transition to VBC
−Removed: There are fundamental challenges and opportunities for improvement in the delivery of healthcare in the United States.
Historically, healthcare delivery has centered on reactive care to acute events, which resulted in the development of an FFS payment model.
By linking payments to volume of encounters and pricing for higher complexity interventions, the FFS model does not reward prevention, but rather unintentionally incentivizes the treatment of acute care episodes as they occur.
−Removed: The trend toward value-based payment systems has been supported at both the patient and policymaker level.
−Removed: We believe there is demand for technology-driven disruption that would shift the healthcare system to a value-based model.
−Removed: Our integrated platform enabled by data and technology has the potential to revolutionize the healthcare industry.
−Removed: As each geographic market evolves in its shift towards VBC, with our experience working in all reimbursement environments, Privia meets providers where they are on their transformative journey and enables them to accelerate and succeed in their transition.
−Removed: Capitated revenue is generated through what is typically known as an “at-risk contract.” At-risk capitation refers to a model in which the Company is entitled to fixed monthly fees from the third-party payer in exchange for providing healthcare services to attributed beneficiaries in Medicare Advantage plans.
−Removed: The fees are typically based on a percentage of the defined premium that payers receive
−Removed: At-risk capitated fees are recorded gross in revenues because the Company is acting as a principal in arranging for, providing, and controlling the managed healthcare services provided to the attributed beneficiaries.
−Removed: The Company is currently renegotiating certain capitated agreements expected to reduce its at-risk capitated lives to increase the probability of positive contribution margin and limit downside financial risk in the midst of prevailing headwinds from higher medical cost trends and other financial and reimbursement pressures on payers and provider organizations, If successful, the Company expects the renegotiated contract would transition approximately 19,900 lives from capitated lives to shared savings lives, effective January 1, 2024.
+Added: With our experience working in all reimbursement environments and expertise in VBC and assisting providers in the transition to VBC, Privia enables providers to accelerate and navigate this transition.
+Added: We accelerate our go-to-market strategy using on the ground market intelligence and a data driven approach to add new practices to our medical group.
+Added: As our Medical Groups grow, we transition our markets to VBC programs as demonstrated by the increase in our attributed risk lives across various programs.
Our Market Opportunity
−Removed: We believe there are approximately 1,000,000 total physicians and providers in the U.S.
−Removed: Our existing provider relationships provides us with significant opportunity to grow in both our existing and new geographies.
−Removed: Our growth strategy is centered on capturing whitespace opportunity in existing markets and entering multiple new markets nationally over the next decade.
−Removed: We operate in 13 states and the District of Columbia, with over 4,300 implemented physicians and providers, covering over 4.8 million patients.
−Removed: We believe we address a market opportunity of more than $1.9 trillion.
−Removed: We understand that healthcare is local and that providers understand the unique needs of their patients and their community.
+Added: Our growth strategy is centered on capturing opportunities in existing markets and entering multiple new markets nationally over the next decade.
+Added: According to Statista, there were approximately 1,000,000 total physicians and providers in the U.S.
+Added: as of May 2024.
+Added: Nephron Research estimated in its December 2024 research report titled “Healthcare Services 2025 Outlook” that the “physician enablement”
+Added: market in which we participate represents up to $2.4 trillion of that total healthcare spend.
+Added: We believe the flexibility of our model uniquely positions us to address this large market opportunity.
+Added: We understand that healthcare is local and that providers have insight into the needs of their patients and their community.
With these issues in mind, Privia has been purpose-built to address a large market opportunity.
−Removed: Unlike peers who focus only on point solutions or narrow patient cohorts, we offer a national platform with localized solutions that meet the needs of physicians, patients and payers.
−Removed: We offer these dedicated providers the benefits of a larger organization while maximizing their independence, existing ownership and affiliation structures.
−Removed: Privia collaborates with an anchor medical group or a health system that has a strong reputation, physician leadership, and interest in embracing and amplifying VBC in its local market.
−Removed: We then develop a network around leading primary care providers and specialists.
+Added: Unlike industry players who focus only on point solutions or narrow patient cohorts, we offer a national platform with localized solutions designed to meet the needs of physicians, patients and payers.
+Added: We offer these dedicated providers the benefits of a larger organization while maintaining significant provider autonomy.
+Added: Privia collaborates with an anchor medical group or a health system that has strong physician leadership and interest in embracing and amplifying VBC in its local market.
+Added: We then develop a network around primary care providers and specialists.
Our goal since inception has been to solve problems physicians face regardless of reimbursement environment or patient type.
−Removed: As such, we are able to deploy our solution across the full healthcare continuum.
−Removed: Our model is designed to succeed across all provider specialties and reimbursement environments and with all payer types.
−Removed: We have demonstrated an ability to expand and scale across diverse geographic markets.
−Removed: We know that consumers want on-demand access to care, providers want a lower burden of administrative work, and payers want to lower total medical cost.
−Removed: Our platform offers an interoperable and user-friendly technology that is designed to meet the needs of patients, providers, and payers and allows us to access a large TAM.
−Removed: For 2020, CMS reported that the private health insurance market represented approximately $2.8 trillion of aggregate healthcare spend in the United States, with Medicare and Medicaid representing approximately $829 billion and $671 billion, respectively.
−Removed: Nephron Research estimated in its January 2021 research report titled “The Dawn of Physician Enablement:
−Removed: Defining Healthcare in the 2020s” that the “physician enablement” market in which we participate represents up to $1.9 trillion of that total healthcare spend.
−Removed: We believe the flexibility of our model uniquely positions us to address this large market opportunity.
−Removed: Privia Health was founded with a mission to improve and transform healthcare in order to enable doctors and their teams to focus on providing patients with high quality healthcare.
−Removed: In 2013, we launched Privia Medical Group with our first practice in Virginia.
−Removed: The following year, we expanded across the Mid-Atlantic region to Maryland and Washington D.C.
−Removed: In 2015, we launched our Georgia and South Texas markets.
−Removed: In 2016, we launched our group in North Texas.
−Removed: That same year, the Washington Post named Privia Health one of the “Top Workplaces” for a second consecutive year.
−Removed: In 2017, The Advisory Board Company listed Privia Health as one of the “Workplaces of the year” for employee engagement.
−Removed: In 2019, we launched our Florida market and in 2020, we launched in Tennessee, started the Privia Pediatrics vertical, and announced a strategic alliance with a prominent children’s hospital in Texas.
−Removed: In 2021, we launched Privia Health in the California market and opened our third Medical Group in the State of Texas.
−Removed: We launched Privia Medical Group in Montana and North Carolina in 2022.
−Removed: In 2023, we launched Privia Quality Network Connecticut, as well as Privia Medical Group Washington and Privia Medical Group South Carolina.
−Removed: In addition, from 2016 to 2022 we received seven consecutive HFMA MAP award for high performance in revenue cycle.
−Removed: From 2015 to 2023, we have averaged a 28% annual growth rate in providers joining our platform, which has resulted in a total attributed lives growth rate of 30%.
−Removed: Total Attributed Lives in Value-Based Programs Growth
−Removed: We define attributed lives as patients that a payer identifies in any VBC program that a Privia Medical Group is specifically responsible for managing.
−Removed: Reimbursement for managing these patients is partially or fully based on controlling the total cost of care and / or improving certain quality metrics.
−Removed: We operate in 13 states and the District of Columbia with over 4,300 implemented providers and more than 1,090 care center locations, targeting over 160 MPSAs (including 54 out of the largest 100 MPSAs), and an addressable population of over 167 million.
−Removed: Under our standard Privia Medical Group model, we establish provider density using an in-market and national sales and marketing team once we enter a market with an anchor medical group or health system.
−Removed: We accelerate our go-to-market strategy using on the ground market intelligence and a data driven approach to add new practices to our medical group.
−Removed: As our medical groups grow, we transition our markets to value-based programs as demonstrated by the increase in our attributed risk lives across various programs.
−Removed: Generally speaking, we define a market as a geographic area covered by one of our Medical Groups under a single TIN or covered by one of our Privia Care Partners.
−Removed: A market could comprise a single state, a part of a state or a group of multiple states and/or districts.
−Removed: We Are Engineered to be Scalable
−Removed: We aim to build relevance in each of our markets with all key constituents (physicians, non-physician clinicians, patients, government programs, commercial payers and employers).
−Removed: Not only do we partner with small and large independent practices focused on primary care, pediatrics, women’s health, and select subspecialties focused on treating chronically ill patients, but we also partner with health systems to both support their current employed or affiliated providers and expand their reach by attracting independent providers in the region into a medical group.
−Removed: We believe the breadth of our approach represents a tremendous opportunity for Privia to provide an alternative physician alignment model to independent provider groups, health systems, and other providers.
−Removed: Our deliberate focus on (i) serving patients across the continuum of care, (ii) succeeding in all reimbursement environments, (iii) aligning with diverse provider groups in a capital efficient manner and (iv) expanding nationally across multiple markets have led us to scale our operations meaningfully since inception.
−Removed: Our current scale, corporate, and technology infrastructure, payer and provider relationships and profitability, allow us to expediently enter and achieve profitability in each new geographic market.
−Removed: The Privia Platform is Designed to Transform the Way Physicians Practice Medicine
−Removed: Privia’s goal is to reimagine the approach to managing physician organizations and optimize their performance by creating a platform that caters to their unique needs.
−Removed: For our Privia Medical Group model, we do this through five key elements of our platform:
−Removed: (i) focusing on technology and population health, (ii) establishing a single-TIN Medical Group and governance model in each geographic market, (iii) owning and operating an MSO in each local market, (iv) building ACOs to capture VBC opportunities, and (v) offering a high quality, low cost provider network for purchasers and payers.
−Removed: Technology and Population Health:
−Removed: Too often technology works against, rather than for, providers and patients.
−Removed: The Privia Technology Solution is designed with our physicians’ and patients’ input to enhance their workflows in both FFS and VBC settings, increasing patient engagement across all stages of a visit, including patient access, pre-visit, at the point of care (both in person and virtual) and post-visit.
−Removed: We seek to optimize our Privia Providers’ technology and marketing so patients can easily find a provider online, schedule an appointment and receive appointment reminders, all of which have been shown to improve patient retention and minimize costly no-shows.
−Removed: On our MyPrivia app, patients can schedule and complete a virtual visit, securely message providers and their care teams, schedule an office appointment, find care options within the Privia network, and access the patient portal.
−Removed: Our technology and tools embed workflow and insights directly into our EMR system so providers can seamlessly assess patients’ health, review their practice performance and provide a superior experience at the point of care (in-person or virtually).
−Removed: Most physician groups deal with an onslaught of disparate information coming from different sources—such as multiple payers and hospitals—resulting in confusion and disorganization for providers at the point of care.
−Removed: Unlike other peers, Privia manages the complexity in the background in order to create a unified workflow and experience for our Medical Groups, Privia Providers, their staff and patients.
−Removed: For example, Privia uses APIs with systems and data exchanges so that our Privia Providers do not need to access other systems during a patient visit.
−Removed: After the visit, our providers follow up with patients using automated education, transitional and chronic care management, care plans, behavioral health and more.
−Removed: We also use patient-satisfaction feedback to continuously improve the patient experience, refine care protocols and increase our Privia Providers’ online visibility.
−Removed: In 2019, we received the HIMSS Innovation Award for our exceptional PRQD program that collects required quality data directly from patients and automatically loads the results into patient records.
−Removed: Our proprietary virtual visit technology is fully integrated into our platform.
−Removed: As of December 31, 2023, our virtual visit platform had logged over 3.0 million visits, conducted by over 4,000 providers, across more than 50 medical specialties.
−Removed: The Privia Technology Solution is the cornerstone to our Medical Groups and ACOs’ ability to succeed across patient demographic cohorts and multiple lines of business (Medicare, Medicare Advantage, MSSP, commercial, etc.).
+Added: As such, we deploy our solution across the healthcare continuum.
+Added: Our model is designed for all provider specialties and reimbursement environments and with all payer types.
+Added: The Privia Platform and Business Model
Single-TIN Medical Group:
−Removed: In each of our Privia Medical Group markets, we establish a primary care centric single-TIN Medical Group that facilitates payer negotiation, clinical integration and alignment of financial incentives.
+Added: In each of our markets, we establish a primary care centric single-TIN Medical Group that facilitates payer negotiation, clinical integration and alignment of financial incentives.
Our Medical Group governance structure allows Privia Providers to build a clinical culture that adapts to consumers’ and a region’s unique and evolving needs.
−Removed: Privia Providers in our Medical Groups collaborate in physician-organized delivery meetings to review performance data, share best practices, create an environment of accountability, and advance evidence-based medicine while maintaining significant autonomy.
+Added: Privia Providers in our Medical Groups collaborate in physician-organized delivery meetings to review performance data, share best practices, create an environment of accountability, and advance evidence-based medicine while maintaining significant provider autonomy.
At the local leadership level, Privia Physicians across different practice locations, or care centers, meet regularly with support from Privia performance team members to drive local population health initiatives, engagement and performance.
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Finally, at the national level, our Privia Physicians receive input from each market and establish priorities for operational improvements and clinical priorities.
−Removed: We believe that this integrated governance structure allows our Privia Physicians to focus on what is most important, taking care of patients, while having a voice in the strategic direction of business operations.
−Removed: The structure also allows previously disconnected providers to share ideas in a broader forum, sharing best practices with each other.
+Added: We believe that this integrated governance structure allows our Privia Physicians to focus on taking care of patients.
+Added: The structure also allows Privia Providers to share ideas in a broader forum, sharing best practices with each other.
Management Services Organization:
−Removed: Privia enables our Privia Providers to focus on their patients, not paperwork.
Our market-level MSOs leverage our scale to reduce administrative work, increase efficiency, and lower direct costs for our Privia Providers.
Our payer contracting team works with multiple private and government payers across markets to construct and participate in VBC programs.
−Removed: As a seven-time recipient of the prestigious HFMA MAP Award, our RCM team meets the high standards for financial results and patient
−Removed: satisfaction.
−Removed: Our team of performance consultants conduct business operations reviews and audits to optimize our Privia Physicians’ finances and productivity.
+Added: Our team of performance consultants conduct business operations reviews and provide advice on optimizing our Privia Physicians’ finances and productivity.
Our procurement team develops opportunities to reduce provider expenses through participation in group purchasing.
Our analytics team enables our Privia Providers to make more data-driven decisions on financial, operational, and clinical initiatives, resulting in same store practice growth across both FFS and VBC programs.
−Removed: Our clinical operations and informatics team ensures the “doctor’s voice” is present in our technology solutions to drive savings and optimize patient outcomes.
+Added: Our clinical operations and informatics team works to include the “doctor’s voice” in our technology solutions to drive savings and optimize patient outcomes.
Our innovative technology improves data security, bolsters the patient-provider relationship, and offers patients a seamless, coordinated experience.
Accountable Care Organizations:
−Removed: Privia has created consistent value across multiple markets and reimbursement models.
−Removed: Our physician-led, local market-based ACOs lower costs, engage patients, reduce inappropriate utilization, and improve coordination and patient quality metrics to drive VBC.
−Removed: Our scale and demonstrated quality metrics allow us to enhance reimbursements for delivering high-quality care.
+Added: Our physician-led, local market-based ACOs aim to lower costs, engage patients, reduce inappropriate utilization, and improve coordination and patient quality metrics to drive VBC.
+Added: Our scale and quality metrics allow us to enhance reimbursements for delivering high-quality care.
The Privia Technology Solution identifies quality gaps, sends patient satisfaction surveys, automates patient outreach and education, and generates reports and alerts to improve care coordination.
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Our integrated tools result in cost savings for Privia Providers in both commercial and federal programs by diverting costly patient encounters.
−Removed: Patients who meet with a Privia Provider annually for wellness and preventive care experience on average 61% lower hospitalizations, 47% lower emergency room visits, and 25% lower risk-adjusted total cost of care.
−Removed: In 2022, Privia operated seven ACOs that delivered high-value, cost-efficient care to more than 163,000 Medicare beneficiaries, achieving shared savings of $131.7 million through the MSSP, a shared savings increase of 31.8% over 2021.
−Removed: Our total annual expenditures were 8% lower than the median MSSP ACO and 19% lower than total FFS Medicare.
−Removed: Our weighted average emergency room utilization was 20% lower than the median MSSP ACO and 27% lower than total FFS Medicare.
+Added: In 2023, Privia operated ten ACOs that delivered care to more than 194,000 Medicare beneficiaries, achieving shared savings of $176.6 million through the MSSP, a shared savings increase of 34.1% over 2022.
+Added: Our per capita expenditures per member per year were 8% lower than the median MSSP ACO and 21% lower than total FFS Medicare.
+Added: On a per capita or rate of use basis, our weighted average realized emergency department visits was 16% lower than the median MSSP ACO and 25% lower than total FFS Medicare;
our weighted average outpatient facility spend was 18% lower than the median MSSP ACO and 33% lower than total FFS Medicare;
−Removed: Our weighted average inpatient facility spend was 12% lower than the median MSSP ACO and 24% lower than total FFS Medicare.
−Removed: Since 2014, we have delivered total shared savings across government programs and commercial payers of more than $937 million, including more than $510 million through participation in the MSSP.
+Added: and our weighted average inpatient facility spend was 14% lower than the median MSSP ACO and 27% lower than total FFS Medicare.
+Added: Since 2014, we have delivered total shared savings across government programs and commercial payers of more than $1.2 billion, including $690 million through participation in the MSSP.
Our approach has been successful across Commercial, Medicare Advantage, MSSP, and Medicaid, from simpler pay-for-performance programs to more complex partial capitation and risk-based programs.
−Removed: Privia expanded its number of ACOs in 2023, with a total of ten ACOs serving over 198,000 Medicare beneficiaries across the District of Columbia and eleven states, including California, Connecticut, Delaware, Florida, Georgia, Maryland, Montana, North Carolina, Tennessee, Texas, and Virginia.
−Removed: Out of the ten ACOs, five were participating in the MSSP Enhanced Track with potential upside and downside financial risk.
−Removed: For the 2024 MSSP performance year, Privia will have nine ACOs participating in the MSSP serving approximately 192,000 Medicare beneficiaries following its planned exit from the Delaware ACO.
+Added: For the 2024 MSSP performance year, Privia had a total of nine ACOs serving over 192,000 Medicare beneficiaries across the District of Columbia and eleven states, including California, Connecticut, Florida, Georgia, Maryland, Montana, North Carolina, Tennessee, Texas, Virginia and Washington state.
+Added: Out of the nine ACOs, five were participating in the MSSP Enhanced Track with potential upside and downside financial risk.
+Added: For the 2025 MSSP performance year, Privia will have nine ACOs participating in the MSSP
+Added: serving approximately 196,000 Medicare beneficiaries.
Five of the nine ACOs are participating in the MSSP Enhanced Track in the 2025 MSSP performance year.
Network for Purchasers and Payers:
−Removed: Privia strives to bring all parts of the care delivery system together for an integrated care plan that is designed to lead to improved outcomes at lower cost.
−Removed: Our Medical Groups enable providers to connect across our platform to better understand the holistic needs of each patient and connect them with other aligned and informed providers to address their individual medical needs.
−Removed: This is accomplished by leveraging data from numerous sources and utilizing provider input based on local knowledge to develop aligned virtual narrow networks that are designed to address the unique needs of government and commercial payers as well as individual employers.
+Added: Our Medical Groups enable providers to connect across our platform to better understand the holistic needs of each patient and connect them with other providers to address their individual medical needs.
+Added: This is accomplished by leveraging data from numerous sources and utilizing provider input based on local knowledge to develop aligned virtual preferred networks that are designed to address the unique needs of government and commercial payers as well as individual employers.
We build these networks within our platform to enhance both the provider and the patient experience by removing administrative burden and enhancing efficient and coordinated patient communication.
−Removed: This capability also allows us to work with forward thinking health systems to increase alignment with employed, affiliated and independent physicians to optimize resource utilization through our cost-effective, clinically aligned model.
+Added: This capability also allows us to work with health systems to increase alignment with employed, affiliated and independent physicians to optimize resource utilization through our model.
+Added: We align incentives with our payer partners by linking performance to rewards and enter into custom contracts serving all demographics and populations across the continuum of care.
+Added: We work with employers to deliver customized medical benefits packages supported by our provider networks.
+Added: Our enhanced primary care model offers quality care to their employees while lowering per-member, per-year costs.
+Added: Our networks connect primary care and specialty providers to coordinate and streamline employee care.
The Privia Technology Solution:
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(i) patient access through various avenues (patient portal, mobile app and search engine optimization), (ii) pre-visit analytics and preparation, (iii) in-person or virtual care delivery and (iv) post visit analytics, care-coordination and reporting.
−Removed: Our technology-enabled platform enables us to scale operations across over 4,300 implemented providers in multiple markets, enhance performance across multiple payer contracts and deliver superior quality care to patients across the demographic spectrum.
−Removed: Our technology-enabled platform supports providers by leveraging machine learning and artificial intelligence to reduce or automate tasks that needlessly create administrative burden.
+Added: Our technology-enabled platform enables us to scale operations across approximately 4,800 implemented providers in multiple markets, enhance performance across multiple payer contracts and deliver superior quality care to patients across the demographic spectrum.
+Added: Our technology-enabled platform supports providers, including by leveraging machine learning and artificial intelligence to reduce or automate certain administrative tasks.
In addition, our technology-enabled platform helps us scale operationally, as our product designers and engineers collaborate closely with clinical and operational teams to optimize workflows as we enter new markets and new payer contracts.
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Patient Access:
−Removed: We optimize practices’ web presence so patients can easily find and schedule an appointment with a provider online and receive appointment reminders to fortify patient retention and avoid costly no-shows.
−Removed: We offer a seamless experience through our mobile app and patient portal that amplifies the patient and provider relationship.
−Removed: Our tools empower patients to access personal health information and stay connected with their providers by equipping physicians with the tools they need to deliver quality, affordable care when, where, and how patients need it.
−Removed: • Capabilities :
−Removed: Practice Websites with Online Reputation Management (ORM) and Search Engine Optimization (SEO), Online Self-Scheduling and Physician Search, Mobile App, Online Check-in, Appointment Reminders, Secure Patient Messaging, 24/7 Nurse Triage Call Center, and 24/7 On-demand Virtual Visits for immediate or primary care.
−Removed: approximately 570 practice websites managed;
−Removed: approximately 2,000 providers on online scheduling;
−Removed: approximately 390,000 distinct mobile app users annually, over 90% mobile and 80% email collection rates;
−Removed: over 75% email open rate.
−Removed: The Privia Platform prepares providers to more efficiently see patients, and facilitates improved outcomes before the patient enters the examination room.
−Removed: Our technology and tools embed insights directly into our EMR so providers can seamlessly assess both patients’ health and practice performance.
+Added: We optimize practices’ web presence so patients can find and schedule an appointment with a provider online and receive appointment reminders.
+Added: We offer a mobile app and patient portal that allow patients to access personal health information and stay connected with their providers.
+Added: by equipping physicians with the tools they need to deliver quality, affordable care when, where, and how patients need it.
+Added: We also provide 24/7 Nurse Triage Call Center and 24/7 On-demand Virtual Visits for immediate or primary care.
+Added: Our technology and tools embed insights directly into our EMR so providers can assess both patients’ health and practice performance.
We acquire data from across the healthcare ecosystem for a single view of the patient.
−Removed: Privia’s solutions preemptively identify opportunities before the patient visit, using huddle reports and patient stratification.
−Removed: Our platform allows providers to proactively identify patient attribution, open quality gaps, open coding gaps, assess patient risk level and determine care management eligibility.
−Removed: • Capabilities:
−Removed: Interoperability, Interface Management, Patient Portal, Online Check-In, Kiosks, Huddle Reports, and Chart Preparation
−Removed: over 1,000 file exchanges with payers per month on average, over 65% patient portal adoption rate
+Added: Privia’s solutions identify opportunities before the patient visit, using huddle reports and patient stratification.
+Added: Our platform allows providers to identify patient attribution, open quality gaps, open coding gaps, assess patient risk level and determine care management eligibility.
During Visit:
−Removed: Whether an appointment is in-person at one of our more than 1,090 care centers or through our leading telehealth platform, our platform ensures a streamlined provider and patient interaction.
−Removed: Privia integrates the quality workflow within the point-of-care in the EMR.
−Removed: Our solutions allow providers and care teams to close quality gaps during the patient visit by leveraging external data and enlisting patients for self-gap closure.
−Removed: The solutions are built on evidence-based guidelines managed by committees of physicians.
−Removed: Furthermore, we prioritize key risk adjustment gaps, recapture prior diagnoses and embed suspect medical conditions within the EMR.
−Removed: • Capabilities :
−Removed: Embedded Virtual Visit Technology, Embedded Quality and Risk Gaps, Referral Decision Support, Virtual Scribes.
−Removed: Average quality score exceeded 85% across all seven ACOs in the MSSP 2022 performance year, and exceeded the quality performance standard to share in savings at the maximum sharing rate
+Added: The Privia Technology Solution integrates workflows designed to allow providers and care teams to close quality gaps, prioritizes key risk adjustment gaps, recaptures prior diagnoses and embeds suspect medical conditions within the EMR.
Between Visits:
−Removed: After the visit, we support treatment with patient education tools, automated standing orders based health event data triggers, transitional and chronic care management, care plans, and more.
−Removed: We also use patient-satisfaction feedback to increase practices’ online visibility.
+Added: We also provide patient education tools, automated standing orders based health event data triggers, transitional and chronic care management, and care plans.
+Added: We use patient-satisfaction feedback to increase practices’ online visibility.
Our system sends secure messages to patients within the patient portal and messages are sent on behalf of the provider and care team.
Our proprietary care team application is integrated within the EMR and patient portal enabling clinical assessments and templates to guide care team’s workflows.
−Removed: Privia Connect, our proprietary provider community application, is a resource hub and training platform for all provider needs.
−Removed: • Capabilities:
−Removed: Patient Portal, Patient Satisfaction Surveys, PRQD, Automated Patient Outreach, Care Plans, Care Management Application, Analytics Platform
−Removed: • Privia conducts approximately 67,000 patient surveys per week
−Removed: • 13% survey response rate
−Removed: • Remediation of any negative feedback commenced within 24 hours
−Removed: • Over 75% email open rate on all emails sent to patients;
−Removed: more than 49,000 gaps closed in 2023
−Removed: • 96% provider adoption of Privia Connect application;
−Removed: ~3,500 self-service knowledge-based articles;
−Removed: over 620 online courses available
+Added: We also provide a resource hub and training platform for Privia Providers.
Virtual Visit Capabilities
−Removed: Legacy telehealth platforms have traditionally offered virtual visits as an isolated encounter between a patient and a medical provider who do not have an existing relationship.
−Removed: In most instances, any clinical notes from the telehealth visit are not integrated into the patient’s primary EMR.
−Removed: This gap in clinical data typically contributes to poor health outcomes and increased healthcare costs.
−Removed: Privia’s proprietary virtual health platform is fully integrated with our patients’ EMR so our primary care providers can readily access data from virtual visits.
+Added: Our virtual health capabilities are fully integrated with our patients’ EMR so our primary care providers can readily access data from virtual visits.
Our patients can also use the telehealth platform to schedule a virtual visit with a provider of their choice, an in-person follow-up visit or a referral to a specialist.
−Removed: Therefore, our patients do not need to choose between a telehealth visit at their convenience and seeing a trusted provider.
−Removed: At the end of 2019, approximately 250 Privia Providers conducted ~350 virtual visits per week.
−Removed: In March 2020, Privia’s virtual visit volumes increased from ~100 per day to more than 6,000 per day on average without operational disruption and zero downtime on Privia’s proprietary virtual visit platform.
−Removed: Virtual visit volume increased rapidly, from approximately 0.3% of all visits prior to the COVID outbreak to more than 45% by the beginning of April 2020.
−Removed: Privia Providers representing more than 50 medical specialties continued delivering care to patients via our proprietary telehealth platform through 2023.
−Removed: We further launched our 24/7 Virtual Clinic, providing on demand access to Privia Providers for immediate care if a patient’s primary care provider is not available.
−Removed: As of December 31, 2023, over 1.0 million distinct Privia patients have completed over 3.0 million virtual visits.
−Removed: Of all patients seen by a Privia Provider virtually, 94% did not return to the same doctor or another doctor in the same specialty for a follow up visit within seven days.
−Removed: During the year ended December 31, 2023, approximately 10% of our visit volume was delivered virtually across our markets and specialties and we anticipate that to hold steady in the post-COVID 19 PHE landscape.
−Removed: With our virtual visit capability fully embedded in our provider workflows and technology stack, Privia practices across our markets have leveraged the virtual health platform to drive improvements in provider productivity, new patient volume and market share.
−Removed: Our Provider Partnership Approach
−Removed: We are transforming healthcare by empowering physicians.
−Removed: We know that providers are uniquely positioned to reshape healthcare, but they need the right organization, tools, technology, talent and governance to support them.
−Removed: That is where Privia comes in.
−Removed: Our high-performance medical groups, proprietary technology, physician leadership and team-based approach help our providers manage the health of their communities through exceptional patient experiences.
−Removed: We follow a proven process to move providers and markets to value through the following:
−Removed: • High-Performing Medical Groups:
−Removed: Privia forms high performing medical groups in almost all of its markets.
−Removed: Our structure allows providers to practice medicine as part of a larger clinically and financially integrated medical group while maintaining their legacy ownership structure and affiliations.
−Removed: Privia’s top-performing providers work together to optimize utilization and costs, improve the patient experience, and advance population health
−Removed: • Superior Management Services Organization :
−Removed: Privia is a purpose-built organization that arms physicians with key expertise and assistance in crucial practice needs such as contract negotiations, RCM, clinical operations, information technology and administrative support so that physicians can focus on what matters:
−Removed: delivering high-quality care to patients across the continuum of care
−Removed: • Enabling Transition to and Success in VBC:
−Removed: We partner with all provider types across all reimbursement programs including Medicare, Medicare Advantage, Medicaid, and Commercial to successfully navigate the transition to VBC.
−Removed: We enable providers to run a more fulfilling, financially viable practice while providing superior patient experiences
−Removed: • Enhanced Patient Experience :
−Removed: We empower and engage patients with tools and technology, such as our MyPrivia mobile app, patient portal and telehealth capabilities.
−Removed: This approach prioritizes the patient-provider relationship and helps deliver care when, where, and how patients want to connect with their providers
−Removed: • Superior Clinical Quality :
−Removed: Privia enables better clinical quality by putting patient outcome data in front of providers that they never had before and providing additional clinical programs, such as care management and behavioral health.
−Removed: For example, patients who meet with a Privia Provider annually for wellness and preventive care experience 61% lower hospitalizations, 47% lower emergency room visits, and 25% lower risk-adjusted total cost of care.
−Removed: • Delivering Financial Rewards:
−Removed: Ultimately, our model results in significant financial rewards for our providers by (i) enhancing provider efficiency and increasing patient panel sizes, (ii) increasing revenue from FFS and value-based contracts and (iii) reducing overall direct and indirect cost to provide care and manage their practices.
+Added: Virtual visit volume increased rapidly during the COVID-19 pandemic and we continue to offer virtual visits, including through our 24/7 Virtual Clinic.
+Added: As of December 31, 2024, over 1.2 million distinct Privia Health patients have completed over 3.7 million virtual visits.
+Added: Of all patients seen by a Privia Provider virtually, over 90% did not return to the same doctor or another doctor in the same specialty for a follow up visit within seven days.
+Added: During the year ended December 31, 2024, approximately 7% of our visit volume was delivered virtually across our markets and specialties.
Governance and Physician Leadership Culture
−Removed: Our multipurpose governance model includes a local governance structure to meet each market’s needs and continuously improves various aspects of our patient, physician and payer relationships.
+Added: Our multipurpose governance model includes a local governance structure tailored to each market and is intended to improve aspects of our patient, physician and payer relationships.
Privia Physicians hold the majority of board positions in our Owned Medical Groups and ACOs, including sole authority over matters related to the practice of medicine, and we either have exclusive authority over certain strategic issues such as mergers and acquisitions, and termination of our MSA or veto authority relative to certain strategic decision making.
−Removed: The intent being to balance physician leadership on clinical matters while acknowledging that certain matters will require action by Privia given the fact that Privia contributed the capital and intellectual knowledge to establish the Owned Medical Groups and ACOs.
In addition, our National Physician Advisory Council (“NPAC”) brings together the clinical and executive local market leadership across the country to provide valuable input to improve our common technology-enabled platform, physician facing data reporting, common quality initiatives, marketing and product performance.
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As an example, Privia Women’s Health focuses on advancing VBC and performance in women’s health, including participation in building VBC-contracting models with bundled payments and episodes of care, and including remote patient monitoring in pregnancy.
−Removed: The pediatric collaborative successfully brings forward strategies to engage patients and families in continuing pediatric care through continuous education, information, structural changes and innovative ways of keeping patients and family safe including virtual visits, vaccination programs, and triaging for in person visits.
−Removed: Physician culture begins at selection of high performing, well-respected practices in their communities to join Privia, and continues with on boarding and implementation, continuous education on VBC, physician led PODS and participation at both the market and national executive and clinical leadership levels.
−Removed: Privia currently serves over 4.8 million patients across the continuum of care.
−Removed: Our total cost of care framework enables us to provide enhanced care regardless of whether the patient is healthy, early stage chronic, high risk, poly-chronic or a complex case.
−Removed: Our framework focuses on:
−Removed: (i) expanded access through our more than 1,090 care center locations or virtually (ii) proactive referral management (iii) chronic care management and behavioral health and (iv) complex care management and palliative care.
−Removed: Our technology provides an improved patient experience and better outcomes through our MyPrivia app and patient portal, including helpful automated reminders to stay on top of health events, 24/7 virtual immediate care and nurse care advice.
−Removed: As an example, patients who meet with a Privia Provider annually for wellness and preventive care experience 61% lower hospitalizations, 47% lower emergency room visits, and 25% lower risk-adjusted total cost of care.
−Removed: Patients enrolled in Privia’s diabetes program, which focuses on managing blood sugar, blood pressure, kidney disease, and cholesterol, experience 38% lower hospitalizations, 30% lower emergency room visits, and 27% lower risk-adjusted total cost of care than diabetics who do not enroll.
−Removed: • Providers :
−Removed: Transforming healthcare requires innovative, diverse solutions that position providers at the forefront.
−Removed: Privia’s physician-led approach enables providers to practice medicine the way they want with the support they need, thrive in VBC, and stay connected with their patients.
−Removed: We combine talent, tools and technology to ensure that Privia Providers are less burdened with administrative tasks, spend more time with their patients and are rewarded for managing their patients’ cost of care effectively.
−Removed: As a result, the Privia Platform has grown significantly over the past few years, scaling from more than 250 implemented providers in 2014 to over 4,300 implemented providers on the platform today.
−Removed: • Health Systems:
−Removed: Our physician expertise, top talent, and technology helps health systems navigate complex policies, competing priorities, and the changing healthcare landscape.
−Removed: Privia solves these challenges by advancing immediate business goals, aligning physicians, and positioning the health system organization for long-term success in a value-based market.
−Removed: We partner with forward thinking providers to address their most pressing needs by providing:
−Removed: (i) a physician alignment platform for health systems seeking a more efficient model to align and build loyalty with community physicians (ii) a medical group enablement strategy for health systems looking to reduce operating losses from an employed medical group and (iii) a medical group privatization strategy for health systems seeking to eliminate subsidies from a physician employment model.
−Removed: Our flexible, scalable, capital-efficient model generates cost savings and top-line growth in a shifting reimbursement environment.
−Removed: Our team’s vast industry knowledge and experience with health plans (including health system or integrated delivery network owned) and physician groups inform our practice management, VBC, and IT support and implementation.
−Removed: This expertise drives consistency, repeatability, and scalability of workflows, metrics, and outcomes.
−Removed: Our cloud-based technology unites physicians and integrates into health systems’ existing workflows.
−Removed: This seamless data delivery at the point of care increases connectivity, improves care coordination, and provides data to negotiate risk-based payer contracts and engage patients of a health system.
−Removed: We differentiate payers’ benefits and network designs to expand market share and remain competitive.
−Removed: Privia offers tools that enrich the patient experience, optimize utilization, steer care to cost-efficient settings, and embrace value-based contracts.
−Removed: Our high-performance, localized provider networks leverage technology and care coordination to lower the risk of costly patient events and improve health outcomes.
−Removed: Our tools engage patients, close care gaps, and connect primary care providers and specialists to avoid unnecessary patient encounters.
−Removed: We align incentives with our payer partners by linking
−Removed: performance to rewards and enter into innovative custom contracts serving all demographics and populations across the continuum of care.
−Removed: Privia seeks to create significant benefits directly to employers through the improvement of benefit design, simplicity of use and reduced friction with the healthcare system.
−Removed: We deliver high performance networks, custom network design, advanced telehealth capabilities, and patient engagement tools.
−Removed: We work with employers to deliver innovative, customized medical benefits packages supported by our cost-efficient, high-quality provider networks.
−Removed: Our enhanced primary care model offers superior care to their employees while lowering per-member, per-year costs.
−Removed: Our high-performance networks connect primary care and specialty providers to ensure employee care is streamlined, coordinated, and efficient.
−Removed: With 24/7 accessibility and a user-friendly interface, our virtual visits technology can save time, decrease absenteeism, and improve employee satisfaction.
−Removed: Patients can message providers, refill prescriptions, view test results, pay bills, and schedule visits through our mobile app or patient portal.
−Removed: Our Value Proposition
−Removed: Privia is a technology-enabled platform designed to transform the healthcare delivery experience for patients and physicians.
−Removed: We believe that employed and independent providers are seeking an alternative platform to help them navigate and succeed in an environment of shifting reimbursement mechanisms and consolidation among health systems, payers, and other sectors in the healthcare ecosystem.
−Removed: Moreover, the government, patients, and employers continue to expect primary care providers to provide better access, lower total cost, and higher-quality care, which we believe is a powerful trend in our favor.
−Removed: Privia is expanding its technology-enabled platform designed to transform the healthcare delivery experience from a traditional FFS to VBC reimbursement model.
−Removed: We believe that our platform enables us to enter new geographies, establish our primary care centric provider network and move markets toward transformational VBC.
−Removed: We serve patients across demographics and medical complexities and also participate in different reimbursement models.
−Removed: We align our success with that of our Privia Physicians and enable them to maximize the potential of their practices across their entire patient panel.
−Removed: Our proven, flexible platform delivers tailored solutions to secure providers’ futures, regardless of their starting point on the transition to value.
−Removed: At the onset of our relationship, we seek to create value for our Privia Providers through more competitive payer contracts, improved patient volume, strengthened networks, and revenue cycle and productivity gains driven by our technology-enabled platform.
−Removed: Over time, we create incremental value for our Privia Providers by enabling them to succeed in VBC models which are highly aligned with payers.
−Removed: Our technology, training, robust networks and governance structures are foundational components powering our track record of success in programs such as enhanced reimbursement through the MSSP, Medicare Advantage, Medicaid, commercial and other direct payer and employer contracting programs.
−Removed: We align incentives with our Privia Physicians and those who fund healthcare spend by designing our revenue model such that we share in the benefit of our partners achieving better outcomes, regardless of reimbursement environment.
−Removed: Our fees are aligned with our Privia Physician practices’ revenue streams, including both FFS and VBC reimbursements, and particularly the latter as we continue moving into successful long term value-based arrangements.
−Removed: We sign multiyear contracts with our Privia Physicians, creating highly predictable and recurring revenue.
−Removed: This stable revenue stream and our demonstrated ability to scale inform our growth plans as well as our ability to achieve attractive unit economics.
−Removed: Our end-to-end, cloud-based technology-enabled platform improves practice efficiency, patient and provider experiences and healthcare outcomes.
−Removed: Our technology-enabled platform is designed to increase provider workflow efficiency, to enhance patient experience and engagement, achieves lower total cost of care, improves healthcare outcomes and increases revenue for our Privia Physicians’ practices, enabling them to succeed across changing reimbursement environments.
−Removed: In addition, our platform eliminates the need for our Medical Groups to purchase and integrate numerous single-point solutions, thereby removing administrative burden and enhancing overall provider experience.
−Removed: Our platform is designed to improve patient outcomes through superior clinical quality.
−Removed: Privia brings a value-based philosophy of clinical care that leads to higher quality results.
−Removed: Through advanced analytics we identify rising risk and high-risk patients, and ensure that all patients receive the necessary preventive care.
−Removed: We provide additional clinical support to our Privia Providers and patients through an integrated care team model—including nurse care managers, care coordinators, chronic care (such as diabetes), behavioral health, palliative care, and more.
−Removed: Unlike most traditional medical groups, our care team is seamlessly integrated into the entire care experience, working off of the same patient record and integrated into practice workflows, rather than a disconnected third-party vendor.
−Removed: This approach has led to favorable outcomes;
−Removed: for example, patients enrolled in our diabetes management program experience on average 30% lower emergency room visits, 38% lower hospitalizations, and 27% lower cost of care.
−Removed: Privia is also recognized for being in the top 20th percentile of comparable MSSP ACOs nationally in HbA1c control for diabetic patients and in the top 30th percentile for quality measures such as fall risk screening, colorectal cancer screening, and breast cancer screening.
−Removed: We provide the benefit of scale while also offering flexibility with ownership structures .
−Removed: Physicians and providers join our single-TIN Medical Group in geographic markets while maintaining significant autonomy and retaining ownership of their legacy practice assets.
−Removed: Physicians and providers are able to join our platform regardless of whether they are independent, affiliated or employed by a larger provider entity, such as a health system, large medical group, or other captive physician models.
−Removed: Our scale, technology-enabled platform, more competitive payer contracts, leading practice operations and physician governance are designed to enable our Privia Providers’ practices to grow revenue and succeed in VBC reimbursement models.
−Removed: Ability to enter and move markets to VBC:
−Removed: We believe we have demonstrated our ability to establish a market presence in multiple geographies and build cost efficient, high quality provider networks capable of successfully transitioning to VBC.
−Removed: We meet providers where they are in the journey, helping them move forward along the continuum of VBC.
−Removed: Privia enables our Privia Providers to succeed in VBC, and provides additional clinical programs to support patients such as care management, transitional care management, behavioral health, remote-patient monitoring, and palliative care.
−Removed: End-to-end, cloud-based, technology-enabled platform :
−Removed: The Privia Technology Solution integrates key elements of numerous single-point solutions, enabling our practices to succeed in all forms of VBC and FFS reimbursement environments while creating efficiency across the physician workflow and enhancing the patient experience.
−Removed: The Privia Technology Solution utilizes artificial intelligence and machine learning to analyze data, surface suspected medical conditions and close care gaps.
−Removed: Ability to serve all practice, provider and patient types across a variety of reimbursement models:
−Removed: The flexibility of our model gives us the ability to improve operations for a variety of provider types, including primary care, specialists and health system employed and Privia Providers.
−Removed: This positions us to grow into a large market opportunity, consisting of commercial, Medicaid, MSSP and Medicare Advantage as well as direct contracting with private and government payers and employers.
−Removed: Our ability to improve outcomes for practices across various medical specialties ultimately accrues to the benefit of a larger set of patients than if we were focused on one area of care.
−Removed: Privia’s capital-efficient operations are portable and replicable across geographic markets :
−Removed: We generally enter a market with an asset-light operating model and employ a disciplined, uniform approach to market structure and development.
−Removed: We affiliate with market leading provider groups and health systems to form anchor relationships consisting of a single-TIN Medical Group to which we align other independent, affiliated, or employed providers.
−Removed: In contrast to many of our competitors, our model does not rely on buying physician practices or building de-novo medical clinics that require significant capital expenditures nor does it subject us to the costly need to satisfy insurance-based capital requirements.
−Removed: The data we have collected from earlier provider cohorts demonstrate that we consistently improve practice performance in both FFS and VBC metrics over time and inform our expectations for our new markets.
−Removed: As a result, markets see a favorable timeline to profitability and free cash flow contribution.
−Removed: Moreover, our business model gives us flexibility to achieve incremental growth through acquiring minority or majority stakes in our practices and opening de-novo, fully-owned sites of care focused on Medicare Advantage and direct contracting models.
−Removed: Long term, sticky relationships underpin our predictable and profitable operating model :
−Removed: Privia Providers have high average satisfaction with their overall performance on our platform.
−Removed: We have 96% average provider retention over the past five years.
−Removed: The patients that our providers serve are generally happier as well, as evidenced by a net patient satisfaction score of 85 for 2023.
−Removed: Our pipeline of signed providers who have yet to be implemented, high provider satisfaction and retention, and high patient satisfaction all contribute to more than 90% practice collections predictability on a rolling twelve month forward basis.
−Removed: As a result of these relationships and a high level of patient satisfaction, we are profitable and free cash flow positive, with improving unit economics and margins.
−Removed: Highly experienced executive and physician leadership :
−Removed: Our management team has significant experience leading payer, provider and healthcare information technology organizations.
−Removed: We believe that our healthcare experience and physician leadership model are competitive advantages in improving care.
−Removed: Our market leadership is highly regarded with a demonstrated track record of success over decades, combining diverse expertise with a shared passion for transforming the healthcare delivery experience.
−Removed: Our highly engaged national physician advisory council has helped us develop physician leaders nationally as well as in the markets we serve.
−Removed: We elevate the clinical voice at all levels of leadership to ensure our solutions benefit providers and their patients.
+Added: The pediatric collaborative brings forward strategies to engage patients and families in continuing pediatric care through continuous education, information, structural changes and other ways of keeping patients and family safe including virtual visits, vaccination programs, and triaging for in person visits.
Our Growth Strategy
−Removed: Privia operates in 13 states and the District of Columbia, not including our planned exit from Delaware, covering 160 target MPSAs (including 54 out of the largest 100 MPSAs).
−Removed: Privia previously notified CMS that its Delaware ACO will terminate its Participation Agreement with CMS effective March 30, 2024 and will no longer participate in MSSP as of the 2024 performance year.
−Removed: We have over 4,300 implemented provider partners in our existing markets.
−Removed: We believe there are approximately 1,000,000 total physicians and providers in the United States.
−Removed: Our existing provider relationships and market share provides us with significant opportunity to grow in both our existing and new geographies.
−Removed: Our growth strategy is centered on capturing whitespace opportunity in existing markets and entering new markets nationally over the next decade and consists of the following elements.
+Added: Our growth strategy is centered on capturing opportunity in existing markets and entering new markets through the following strategies:
Organic Growth in Existing Practices
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Moving Markets to VBC
−Removed: • Focus on same store growth of patients attributed to value-based contracts in each existing geographic market (e.g.
−Removed: we currently have over 224,000 patients aging into Medicare over the next five years);
+Added: • Focus on same store growth of patients attributed to value-based contracts in each existing geographic market;
• Increase our revenue opportunity on a per patient basis by continuing to improve performance and continuing to take increasing levels of risk in existing value-based programs across commercial, MSSP, Medicare Advantage, Medicaid and other existing and emerging direct payer and employer contracting programs;
−Removed: • Develop new products and programs in partnership with aligned payers that are built with and around the Privia network of physicians and providers.
+Added: • Develop new products and programs in partnership with aligned payers that are built with and around our network of physicians and providers.
White Space Opportunities in Existing Markets
• We intend to add primary care and specialist practices in existing markets to enhance growth.
−Removed: Our data-driven approach allows us to efficiently identify primary care and specialist provider groups that would benefit from our platform;
+Added: Our data-driven approach allows us to identify primary care and specialist provider groups that we believe may benefit from our platform;
• Expand Privia Women’s Health and Privia Pediatrics platforms;
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• Expand relationships with self-insured employers, businesses, schools, universities, and third-party administrators seeking population health and virtual care solutions;
−Removed: This includes leveraging our 24/7 Virtual Clinic, our care coordination and high-risk chronic care management programs, and our technology-enabled platform to deliver highly tailored, scalable solutions;
• Continue to pursue direct contracting opportunities, including direct primary care and onsite / near-site clinics fully integrated with our local Privia networks;
• Expand our clinical research program by designing and executing on clinical trials across multiple therapeutic areas.
−Removed: Privia currently participates in clinical trials of heart failure, COPD, diabetes, and COVID vaccine and treatment trials.
New Market Development
−Removed: • Privia’s in-market operating structure and ability to serve providers wherever they are on their transition to VBC is designed to benefit each of the approximately one million U.S.
−Removed: • We believe our solution is applicable across all 50 states;
−Removed: • Our data-driven market selection process identifies attractive expansion opportunities and informs our approach to opening new geographies;
−Removed: • We prioritize markets with some or all of the following characteristics:
−Removed: • High provider density
−Removed: • High patient density
−Removed: • Demographic tailwinds, such as an aging population
−Removed: • Multiple potential medical group partners
−Removed: • Presence of value-oriented health systems
−Removed: • Payers seeking and aligned to high value scaled physician organizations
−Removed: • We evaluate the broader market landscape for attractive opportunities on a continuous basis and proactively develop relationships before committing to enter a market;
−Removed: • Due to our active and ongoing new market reviews and evaluations, when we enter a new market, we are able to move quickly and efficiently to capture and maximize the opportunity;
−Removed: • We have a longstanding track record of successful, profitable expansion that we will leverage to execute on our robust pipeline of new market opportunities.
+Added: • Our data-driven market selection process identifies expansion opportunities and informs our approach to opening new geographies;
+Added: • We evaluate the broader market landscape for opportunities on a continuous basis and proactively develop relationships before committing to enter a market.
Acquisitions and Investments in Full Service Care Models
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Our provider recruitment team assists our existing practices in hiring new providers, from sourcing through onboarding.
−Removed: • Consumer sales and marketing —As our medical groups grow in each market, we look to transition the market to value-based programs by increasing the patient panels of our providers and adding attributed risk lives across various value-based programs.
+Added: • Consumer sales and marketing —As our medical groups grow in each market, we look to transition the market to value-based programs by increasing the patient panels of our providers and adding attributed risk lives across various VBC programs.
Our marketing and communications team operates our brand management, enterprise web presence and care center websites, and creates other forms of patient communication and engagement materials.
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healthcare industry.
−Removed: We face competition in each geographic market from a variety of community-based healthcare provider organizations, including large physician practices, independent physician associations, hospitals and health systems, physician-hospital organizations as well as emerging companies acquiring and rolling up specialty physician practices.
+Added: We face competition in each geographic market from a variety of community-based healthcare provider organizations, including large physician practices, independent physician associations, hospitals and health systems, physician-hospital organizations as well as emerging companies, vertically integrated healthcare companies, and private equity firms acquiring and rolling up specialty physician practices.
In addition, nationally, we face competition for talent, resources, physicians, and payer contracts from existing and emerging companies in the physician enablement industry segment.
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We expect to face increasing competition, both from current competitors, who may be well established and enjoy greater resources or other strategic advantages to compete for some or all key stakeholders in our markets, as well as new entrants into our market.
−Removed: Given the size of the healthcare industry, we expect additional competition, including potentially from new companies, smaller emerging companies which could introduce new solutions and services, as well as other incumbent players in the healthcare industry or from broader industry who could develop their own offerings and may have substantial resources and relationships to leverage.
+Added: Given the size of the healthcare industry, we expect additional competition, including potentially from new companies, smaller emerging companies which could introduce new solutions and services, as well as other incumbent players in the healthcare industry, private equity firms or from broader industry players who could develop their own offerings and may have substantial resources and relationships to leverage.
With the emergence of new technologies and market entrants, we expect to face increasing competition over time, which we believe will generally increase awareness of the need for modernized care models and other innovative solutions.
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We also use encryption techniques for data at rest and in transit.
−Removed: For additional information on risks associated with our intellectual property and information technology systems, see “Risk Factors—Risks Related to Intellectual Property” and “Risk Factors—Risks Related to Our Business and Our Industry.”
+Added: For additional information on risks associated with our intellectual property and information technology systems, see “Risk Factors—Technology, Cybersecurity and Privacy Risks.”
Government Regulations
−Removed: Our operations, those of our Owned Medical Groups, Non-Owned Medical Groups, and Privia Providers are subject to extensive federal, state and local governmental laws and regulations.
−Removed: These laws and regulations require us to meet various standards relating to, among other things, claim submission, coding and reports to government payment programs, dispensing of pharmaceuticals, the provision, structure and compensation of physicians for ancillary services, such as laboratory, radiology and imaging services, physical therapy, and similar services, the management of physician services, personnel qualifications, creation, ownership and maintenance of health and business records, reporting and evaluating the quality of health care services, the assumption of insurance risk, the provision of covered services, allowable forms of payments to non-physicians and acceptable legal structures for the provision of healthcare services.
−Removed: If any of our operations or those of our Owned Medical Groups, Non-Owned Medical Groups, or Privia Providers are found to violate applicable laws or regulations, that could have a material adverse effect on our business, results of operations, financial condition, cash flows, reputation and stock price, including:
−Removed: • suspension or termination of our participation in federal health care programs and/or commercial payment programs;
−Removed: • refunds of overpayments and other amounts received in violation of law or applicable payment program requirements dating back to the applicable statute of limitation periods;
−Removed: • loss of our Privia Providers’ licenses required to furnish healthcare services, prescribe or administer pharmaceuticals, or furnish ancillary services in the states in which we operate;
−Removed: • criminal or civil liability, fines, damages or monetary penalties for violations of healthcare fraud and abuse laws, including the federal Anti-Kickback Statute, Civil Monetary Penalties Law of the Social Security Act, Stark Law, the Health Insurance Portability and Accountability Act (“HIPAA”), the civil False Claims Act (“FCA”) and/or state analogs to these federal enforcement authorities, or other regulatory requirements;
−Removed: • enforcement actions by governmental agencies and/or state law claims for monetary damages by patients who believe their health information has been used, disclosed or not properly safeguarded in violation of federal or state patient privacy laws, including the regulations implementing HIPAA and similar state privacy and security laws;
−Removed: • mandated changes to our practices or procedures that significantly increase operating expenses, decrease our revenue, or make our model less attractive to our Privia Providers;
−Removed: • imposition of and compliance with corporate integrity agreements that could subject us to ongoing audits and reporting requirements as well as increased scrutiny of our billing and business practices which could lead to potential fines, increased operational expenses and reduce our overall growth;
−Removed: • termination of various relationships and/or contracts related to our business, including joint venture arrangements, contracts with payers, real estate leases and our various agreements with Owned Medical Groups, Non-Owned Medical Groups, Privia Physicians and their Affiliated Practices;
−Removed: • changes in and reinterpretation of rules and laws by a regulatory agency or court, such as state corporate practice of medicine and fee-splitting laws, that could affect the structure and management of our business and our Medical Groups;
−Removed: • negative adjustments to government payment models including, physician compensation under Medicare Part B, shared savings under MSSP, payment opportunities under Medicare Advantage programs, Medicaid and other state and federal payment program;
−Removed: • harm to our reputation, which could negatively impact our business relationships, the terms of payer contracts, our ability to attract and retain patients and Privia Providers, our ability to obtain financing and our access to new business opportunities, among other things.
+Added: Our operations, those of our Owned Medical Groups, Non-Owned Medical Groups, and Privia Providers are subject to extensive and complex laws and regulations at the federal, state and local levels relating to, among other issues, billing and coding for, and documentation of, services and properly handling overpayments;
+Added: relationships with physicians and other referral sources and referral recipients, including, for example, state or attorney general notice or approval requirements for certain relationships;
+Added: restrictions related to multi-specialty practices;
+Added: appropriateness and adequacy of medical care;
+Added: quality of medical equipment and services;
+Added: patient, workforce, and public safety;
+Added: qualifications and supervision of, and reimbursement for services provided by, medical and support personnel;
+Added: the provision of services via telehealth, including technological standards and coverage restrictions or other limitations on reimbursement;
+Added: the confidentiality, maintenance, interoperability, exchange, and security of medical records and other health-related and personal information, including data breach, ransomware and identity theft issues;
+Added: the development and use of artificial intelligence and other predictive algorithms, including those used in clinical decision support tools;
+Added: restrictions on the provision of medical care, including reproductive care;
+Added: permitting, facility and personnel licensure, certification and accreditation requirements;
+Added: enrollment standards and requirements for participation in government healthcare programs;
+Added: corporate practice of medicine and fee-splitting;
+Added: consumer disclosures and price transparency;
+Added: the distribution, maintenance and dispensing of pharmaceuticals and controlled substances;
+Added: relationships between healthcare providers and drug and medical device companies;
+Added: debt collection, balance billing and billing for out of network services;
+Added: communications with patients and consumers;
+Added: advertising and marketing;
+Added: operating policies and procedures;
+Added: activities regarding competitors;
+Added: insurance and the assumption of financial risk by healthcare entities, including allowable types of financial risk;
+Added: addition of facilities and services;
+Added: and environmental protections.
+Added: If any of our operations or those of our Owned Medical Groups, Non-Owned Medical Groups, or Privia Providers fail to comply with these or other applicable laws and regulations, which are subject to change, any such failure could result in liabilities, including civil penalties, money damages, lapses in reimbursement, loss of facility licenses, accreditations, or certifications, revocation of billing privileges, exclusion of one or more entities and/or facilities from participation in the Medicare, Medicaid and other federal and state health care programs, termination of various relationships or contracts, lawsuits and criminal penalties.
+Added: Medicare and Medicaid payments may be suspended pending even an investigation of what the government determines to be a credible allegation of fraud.
+Added: We could also be required to make changes to our business model and/or practices, which could increase operating expenses, negatively affect our business relationships, and decrease access to new business opportunities.
+Added: In addition, different interpretations or enforcement of, or amendments to, these and other laws and regulations in the future could subject current or past practices to allegations of impropriety or illegality or could require us to make changes in our operations, facilities, equipment, personnel, services, capital expenditures and operating expenses.
+Added: The costs of compliance with, and the other burdens imposed by, these and other laws or regulatory actions may increase operational costs, result in interruptions or delays in the availability of systems and/or result in a decline in patient volume or Privia Provider or Medical Group attrition.
+Added: Any action against us for violation of these laws or regulations, even if we successfully defend against it, could cause us to incur significant legal expenses, divert our management’s attention from the operation of our business or result in reputational harm.
We expect that our industry will continue to be subject to substantial regulation, the scope and effect of which are difficult to predict.
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In addition, commercial payers could require pre-payment audits of claims, which can negatively affect cash flow, or terminate contracts for repeated deficiencies.
−Removed: Depending on the nature of risk borne by our Medical Groups, state insurance regulators may require us to register as an insurance company.
−Removed: We have not registered as such in any of the states in which we operate and do not believe such is currently necessary.
−Removed: This is an evolving area of the law and could change rapidly.
−Removed: Additionally, as our Owned and Non-Owned Medical Groups assume more risk from employers and payers, our operations could cause us to become subject to such insurance regulation.
−Removed: Such an outcome could significantly increase our regulatory burden in affected states while increasing our operational costs.
−Removed: Likewise, state corporate practice of medicine prohibitions could require risk bearing contracts to be held exclusively by the Non-Owned Medical Groups, which we do not own, or could require that such contracts be held exclusively in certain state-recognized legal constructs such as Texas’ non-profit health organization, which, would limit our ability to own or control such contracts while increasing our operational costs to manage such contracts.
+Added: Furthermore, if a state in which we currently operate, or in which we seek to expand, views the participation of the Company or its Medical Groups in risk-sharing arrangements as the assumption of insurance risk, the arrangement may fall within the purview of state insurance or managed care laws and regulations, and we or the Medical Group may be required to obtain a state insurance or managed care license or similar registration.
+Added: These laws and regulations may subject the entity involved to oversight by state regulators, including through periodic reporting or audits, and requirements for financial reserves.
+Added: Some of these laws may be vague and state regulators may have interpretations that differ from ours.
+Added: Even if a state regulatory agency does not directly oversee the transfer of risk by a payer to a downstream entity, the state may require the licensed payer to include certain oversight mechanisms in payer contracts, which could increase our or our Medical Groups’ administrative costs and have an adverse effect on our business, cash flows or results of operations.
+Added: If we or our Medical Groups fail to comply with insurance laws and regulations, including licensure and oversight requirements, we may be required to make changes to our operations and could be subject to civil and/or criminal penalties, denial of future licensure applications and termination of payer contracts.
+Added: These laws and regulations may affect the operation of, for example, ACOs, direct primary care programs, provider-sponsored organizations, independent practice associations, and provider capitation models.
+Added: At the state level, our ability to conduct business and the structure of our operations depends on each state’s laws, regulations, and policies governing, among other issues, the corporate practice of medicine, fee-splitting, and the assumption of financial risk.
Corporate Practice and Fee-Splitting Laws
−Removed: We generate material revenue in a number of different geographic markets with different legal requirements on how we operate our business.
−Removed: Our approach to each market is tailored to address that state’s healthcare laws, especially state corporate practice of medicine and fee splitting prohibitions.
−Removed: The laws and regulations relating to our operations vary from state to state and many states prohibit general business corporations, such as us, from practicing medicine, controlling physicians’ medical decisions or engaging in certain practices or relationships with physicians such as splitting professional fees with physicians.
−Removed: In states where impermissible, we do not own the Non-Owned Medical Groups and instead furnish certain management services to them and, where allowed, may have a physician or non-physician appointee on the governing board of the Non-Owned Medical Group.
−Removed: In states where permissible, we own a majority interest in the Owned Medical Group, but, even in such markets, we contractually ensure that all clinical decisions are restricted to licensed physicians, including patient decision making, supervision, diagnosis, etc.
−Removed: To our Owned Medical Groups and the Non-Owned Medical Groups, we provide a comprehensive suite of administrative services in exchange for the payment of a management fee by such Medical Groups.
−Removed: Similar to state fraud and abuse laws, state corporate practice and fee splitting prohibitions range from limited regulatory guidance, judicial opinions and enforcement activity (e.g., Tennessee) to very well-developed and broad prohibitions (e.g., Texas).
−Removed: In all such cases, these prohibitions are subject to new and more expansive interpretations by the courts and regulatory bodies, which are often difficult to anticipate.
−Removed: Other parties may assert that, despite the way we are structured, we could be engaged in the corporate practice of medicine or unlawful fee-splitting.
−Removed: Were such allegations to be asserted successfully before the appropriate judicial or administrative forums, we could be subject to adverse judicial or administrative penalties, certain contracts could be determined to be unenforceable, including accompanying restrictive covenants, and we may be required to restructure our contractual arrangements.
−Removed: Likewise, such laws limit future opportunities in certain markets by limiting our potential strategies for entering such markets.
−Removed: We operate a single Owned Medical Group that furnishes healthcare services through our Privia Providers in the Commonwealth of Virginia, the State of Maryland, and the District of Columbia, and we operate two Owned Medical Groups in the State of Georgia, one for adult healthcare services and one for pediatric healthcare services.
−Removed: All of our Owned Medical Groups are structured as limited liability companies, and in all of these Owned Medical Groups, a Privia-owned entity owns, at all times, at least 51% of the membership interest in the Owned Medical Group.
−Removed: The remaining 49% of the membership interest in each of the Owned Medical Group is owned by Privia Physicians licensed in the applicable state in which their Affiliated Practice location is located.
−Removed: The District of Columbia has no direct prohibition on the corporate practice of medicine.
−Removed: While Maryland does not have a statutory ban on the corporate practice of medicine, the prohibition has been recognized by implication from its Medical Practice Act which, among other things, requires that no person practice medicine without a valid license.
−Removed: Since corporations are incapable of obtaining a medical license, corporations are incapable of practicing medicine in Maryland.
−Removed: However, Maryland does not apply its corporate practice of medicine prohibition to certain legal entities, including limited liability companies, which is how all of our Owned Medical Groups are structured.
−Removed: Likewise, Virginia and Georgia allow a limited liability company to furnish healthcare services though employed physicians, physician owners and independent contracted physicians.
−Removed: Nonetheless, to protect the underlying interests of the corporate practice of medicine prohibition, we further ensure that Privia Physicians are solely and exclusively in control of all aspects of the practice of medicine and the provision of professional physician
−Removed: services through the Owned Medical Groups, including, without limitation, decisions regarding professional medical judgment, diagnosis and treatment of patients, supervisory responsibility for all Privia Clinicians, supervision of all unlicensed individuals to whom the Privia Physician delegates non-discretionary duties and any other individual, whether employed by the Medical Group or an independent contractor of the Medical Group, regardless of licensure status, providing any service to a patient of a Privia Physician.
−Removed: This safeguard is built into each Owned Medical Group’s operating agreement as well as the Privia Physician’s Physician Member Services Agreement with the Owned Medical Group.
−Removed: In states that actively enforce, broadly define or do not recognize an applicable exception to the corporate practice of medicine prohibition, such as Texas and Tennessee, our relationship may be either:
−Removed: (a) a contractual relationship with our Non-Owned Medical Groups, whereby our most significant rights are generally set forth in our MSAs, or (b) a relationship whereby our Friendly Medical Groups are majority owned, directly or indirectly, by a Nominee Physician in compliance with corporate practice of medicine prohibitions.
−Removed: Our Medical Groups in Tennessee and West Texas are Friendly Medical Groups, with each being majority owned by Nominee PC owned by a Nominee Physician.
−Removed: If a jurisdiction’s prohibition on the corporate practice of medicine is interpreted in a manner that is inconsistent with our practices, we would be required to restructure or terminate our arrangements with our Friendly Medical Groups and could result in additional penalties, damages and fines.
−Removed: We provide administrative services through our local MSOs for our Medical Groups.
−Removed: Although the structure of administrative fees can implicate limitations under state corporate practice of medicine prohibitions, our administrative services specifically reserve services that would constitute the practice of medicine with the Medical Group.
−Removed: The structure of administrative fees can also implicate state fee splitting prohibitions.
−Removed: Fee splitting prohibitions generally prohibit licensed physicians from sharing fees for healthcare services with lay persons.
−Removed: The scope of these laws generally range from a narrow reading limiting violations to the payment for referring work to a physician to broad prohibitions that limit percentage management fees or other variable fee arrangements.
−Removed: Tennessee, for instance, once strictly prohibited all percentage management fees;
−Removed: however, the statute was amended to allow percentage administrative fees so long as such fees are reasonably related to the services or goods furnished to the physician.
−Removed: Maryland’s law is essentially identical to Tennessee’s law.
−Removed: While Florida prohibits percentage administrative fees for certain services furnished by a management company to a physician, we have worked with our partner and outside counsel to develop a compliant percentage fee arrangement for certain services in Florida.
−Removed: Similarly, although North Carolina does not prohibit percentage based management fees in physician arrangements specifically by statute, the North Carolina Medical Board has taken the position that a physician cannot share revenue on a percentage basis with a non-physician.
−Removed: Accordingly, we have adopted a fixed administrative fee schedule based upon the Privia Physicians’ collections for health care services.
−Removed: Although Texas has a fee splitting prohibition, percentage fees for companies that charge management fees are not expressly forbidden.
−Removed: Similarly, California courts have found that management fees based on a percentage of revenue do not violate the state’s various fee splitting prohibitions so long as the services are commensurate with the value of management services furnished to the physicians.
−Removed: Although Georgia and the District of Columbia each has a fee splitting prohibition, each is limited to a physician paying for the referral of patients or other business.
−Removed: Georgia courts have consistently taken the position that the fee splitting prohibition is not violated when a physician pays collections over to a for-profit corporation or business for the provision of goods or services.
−Removed: Virginia’s fee splitting law is similar in scope to Georgia’s but is further limited to payments between licensed physicians.
−Removed: Violations of the corporate practice of medicine prohibition vary by state and may result in Privia Physicians being subject to disciplinary action, as well as to forfeiture of revenues from payers for services rendered.
−Removed: For lay entities such as us, violations may also bring both civil and, in more extreme cases, criminal liability for engaging in the practice of medicine without a license.
−Removed: Any allegations or findings that we have violated these laws could have a material adverse impact on our business, results of operations and financial condition, including adversely impacting our relationship with Privia Physicians and our ability to recruit new physicians into affected Owned or Non-Owned Medical Groups (including Friendly Medical Groups).
−Removed: Federal Anti-Kickback Statute
−Removed: The federal Anti-Kickback Statute prohibits, among other things, knowingly and willfully offering, paying, soliciting or receiving remuneration, directly or indirectly, in cash or kind, to induce or reward either the referral of an individual for, or the purchase, order or recommendation of, any good or service, for which payment may be made under federal health care program, including the Medicare and Medicaid programs.
−Removed: Federal criminal penalties for the violation of the federal Anti-Kickback Statute include imprisonment, fines and exclusion from future participation in the federal health care programs, including Medicare and Medicaid.
−Removed: Violations of the federal Anti-Kickback Statute are punishable by imprisonment for up to ten years and/or significant per kickback.
−Removed: Larger fines can be imposed upon corporations under the provisions of the U.S.
−Removed: Sentencing Guidelines and the Alternate Fines Statute.
−Removed: Individuals and entities convicted of violating the federal Anti-Kickback Statute are subject to mandatory exclusion from participation in Medicare, Medicaid and other federal health care programs for a minimum of five years.
−Removed: In addition, entities may be subject to additional civil penalties per violation, repayments of up to three times the total payments between the parties to the arrangement and suspension from future participation in Medicare and Medicaid.
−Removed: Court decisions have held that the statute may be violated even if only one purpose of remuneration is to induce referrals.
−Removed: That is, even if a business arrangement is for a legitimate purpose, it can still be found to violate the Anti-Kickback Statute if a secondary purpose is
−Removed: to induce referrals.
−Removed: In addition, a person or entity does not need to have actual knowledge of the federal Anti-Kickback Statute or have the specific intent to violate it in order to have committed a violation.
−Removed: The Anti-Kickback Statute only requires that the government establish the requisite criminal intent.
−Removed: In addition, the ACA amended the federal Anti-Kickback Statute to provide that any claims for items or services resulting from a violation of the federal Anti-Kickback Statute are considered false or fraudulent for purposes of the FCA.
−Removed: The federal Anti-Kickback Statute includes statutory exceptions and regulatory safe harbors that protect certain arrangements.
−Removed: However, transactions and arrangements that do not satisfy all elements of a relevant safe harbor do not necessarily violate the law.
−Removed: When an arrangement does not satisfy a safe harbor, the arrangement must be evaluated on a case-by-case basis in light of the parties’ intent and the arrangement’s potential for abuse.
−Removed: Arrangements that do not satisfy a safe harbor may be subject to greater scrutiny by enforcement agencies.
−Removed: In addition, prosecutors have started using other general fraud laws to address situations that would have violated the Anti-Kickback Statute but were structured to carve out federal health care programs to avoid the scope of such statutory schemes
−Removed: We enter into several arrangements, some of which do not satisfy all elements of a relevant safe harbor and accordingly could be subject to scrutiny by the OIG:
−Removed: • Joint ventures .
−Removed: We wholly own all of our subsidiaries except for our Owned Medical Groups, six of our MSOs, and one ACO where we have majority ownership.
−Removed: • Privia Physician Agreements .
−Removed: We enter into a number of different types of agreements with Privia Physicians, including physician member services agreements, physician leadership agreements, physician consultation arrangements, physician services agreements, and recruitment of physicians into our Owned and Non-Owned Medical Groups.
−Removed: • Management Services Agreements .
−Removed: We enter into MSAs with each of our Owned and Non-Owned Medical Groups and our ACOs.
−Removed: Most of our MSAs are structured as a percentage of collections generated by our Privia Providers, or, if with an ACO, as a percentage of realized savings.
−Removed: Further, in certain of our markets, the management services organization is owned, in part, by Privia Physicians or health system partners, which could result in increased scrutiny from the OIG in the event that safeguards built into such arrangements are found insufficient to protect against inappropriate utilization.
−Removed: • Service Agreements with Privia Physician’s Affiliated Practices .
−Removed: Our Owned and Non-Owned Medical Groups procure certain services, such as access to space, equipment and non-physician personnel from our Privia Physicians’ Affiliated Practices.
−Removed: Certain of our MSAs include the payment of rebates from management fees previously paid in the event that certain conditions occur.
−Removed: • Sales forces and patient recruitment .
−Removed: The OIG has expressed concern regarding the use of non-employed sales forces to recruit or facilitate the recruiting of patients or referrals, especially when the sales agent is compensated in a manner that provides rewards or incentives on a volume or value basis.
−Removed: Accordingly, commissions or per-patient based compensation methodologies are closely scrutinized by federal agencies.
−Removed: We employ our own sales force and attempt to meet the Anti-Kickback Safe Harbor for Bona Fide Employment;
−Removed: however, in limited instances we use external companies to assist with certain aspects of these efforts.
−Removed: If any of our business transactions or arrangements, including those described above, were found to violate the federal Anti-Kickback Statute, we could face, among other things, criminal, civil or administrative sanctions, including possible exclusion from participation in Medicare, Medicaid and other state and federal health care programs.
−Removed: Any findings that we have violated these laws could have a material adverse impact on our business, results of operations, financial condition, cash flows, reputation and stock price.
−Removed: In November 2020, CMS and the OIG issued final regulations creating a number of safe harbors for care coordination activities and value-based arrangements.
−Removed: These new safe harbors allow, among other things, certain outcomes based payments, care coordination arrangements, the provision of telehealth technologies and arrangements for patient engagement to be structured in such a matter as to avoid scrutiny under the Anti-Kickback Statute.
−Removed: Although the health care industry is still trying to determine what business models will benefit from such arrangements, we expect that such safe harbors will give us more protection as we continue to implement new strategies to better coordinate patient care.
−Removed: Further, we anticipate that the greater flexibility and certainty allowed by the final regulations could give rise to more competition for physicians in our various markets and may make competitors more attractive to our physicians with less integrated and operationally cheaper business models.
−Removed: Although the pace of the CMS’ modernization of health care regulations has slowed under the Biden administration, every annual payment update from CMS includes substantive changes in regulations that potentially impact our business, operations and financial condition, such regulatory changes, changes in law or judicial decisions changing interpretations of existing laws or regulations may
−Removed: cause OIG, CMS or other regulators to change the parameters of rules and regulations that we must follow and thus impact our business, results of operations and financial condition.
−Removed: The Stark Law prohibits a physician (as defined by statute) who has a financial relationship, or who has an immediate family member who has a financial relationship, with entities providing certain Designated Health Services, or DHS, from referring Medicare patients to such entities for the furnishing of DHS, unless an exception applies.
−Removed: Although uncertainty exists, federal agencies and at least one court have taken the position that the Stark Law also applies to Medicaid.
−Removed: DHS is defined to include clinical laboratory services, physical therapy services, occupational therapy services, radiology services including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services, radiation therapy services and supplies, durable medical equipment and supplies, parenteral and enteral nutrients, equipment, and supplies, prosthetics, orthotics and prosthetic devices and supplies, home health services, outpatient prescription drugs, inpatient and outpatient hospital services and outpatient speech-language pathology services.
−Removed: The types of financial arrangements between a physician and an entity providing DHS that trigger the self-referral prohibitions of the Stark Law are broad and include direct and indirect ownership and investment interests and compensation arrangements.
−Removed: The Stark Law prohibits any entity providing DHS that has received a prohibited referral from presenting, or causing to be presented, a claim or billing for the services arising out of the prohibited referral.
−Removed: Similarly, the Stark Law prohibits an entity from “furnishing” a DHS to another entity in which it has a financial relationship when that entity bills for the service.
−Removed: The Stark Law also prohibits self-referrals within an organization by its own physicians, although broad exceptions exist that cover employed physicians and those referring DHS pursuant to the in-office ancillary services exception so long as certain standards are satisfied.
−Removed: The prohibition applies regardless of the reasons for the financial relationship and the referral.
−Removed: Unlike the federal Anti-Kickback Statute, the Stark Law is a strict liability violation where unlawful intent need not be demonstrated.
−Removed: If the Stark Law is implicated, the financial relationship must fully satisfy a Stark Law exception.
−Removed: If an exception is not satisfied, then the parties to the arrangement have violated the Stark Law.
−Removed: Sanctions for violation of the Stark Law include denial of payment for claims for services provided in violation of the prohibition, refunds of amounts collected in violation of the prohibition, a civil penalty for each service arising out of the prohibited referral, a civil penalty against parties that enter into a scheme to circumvent the Stark Law prohibition, civil assessment of up to three times the amount claimed and potential exclusion from the federal health care programs, including Medicare and Medicaid.
−Removed: Amounts collected on claims related to prohibited referrals must be reported and refunded generally within 60 days after the date on which the overpayment was identified.
−Removed: Furthermore, Stark Law violations and failure to return overpayments in a timely manner can form the basis for FCA liability, as further discussed herein.
−Removed: If CMS or other regulatory or enforcement authorities determine that claims have been submitted for referrals by our Privia Physicians that violate the Stark Law, we would be subject to the penalties described above.
−Removed: In addition, it might be necessary to restructure existing compensation agreements with our physicians and/or Owned or Non-Owned Medical Groups.
−Removed: Any such penalties and restructuring or other required actions could have a material adverse effect on our business, results of operations, financial condition and cash flows.
−Removed: In November 2020, CMS issued a sweeping set of regulations that introduce significant new value-based terminology, safe harbors and exceptions to the Stark Law.
−Removed: Additionally, CMS made some changes to certain existing exceptions to the Stark Law, including the definition of group practice, effective January 1, 2022 but which required us to restructure how we account for DHS in compensating physicians in certain markets where we offer centralized DHS.
−Removed: Although the health care industry is still trying to determine what business models will benefit from the changes to the Stark Law, we expect that the new exceptions will give us more protection as we continue to implement new strategies to better coordinate patient care.
−Removed: Further, we anticipate that the greater flexibility and certainty allowed by the final regulations could give rise to more competition for physicians in our various markets and may make competitors more attractive to our physicians by offering less integrated and operationally cheaper business models.
−Removed: Those or other changes implemented by CMS may impact our business, results of operations and financial condition.
−Removed: We and our Owned or Non-Owned Medical Groups have entered into several types of financial relationships with Privia Physicians, either directly or indirectly, including MSAs, physician member services agreements, physician consulting agreements, physician services agreements, physician leadership agreements and support services agreements.
−Removed: In structuring such arrangements, we generally rely upon the personal services exception or the in-office ancillary services exception.
−Removed: If our Owned or Non-Owned Medical Groups were to bill for DHS referred by our Privia Physicians and the underlying relationship between the Owned or Non-Owned Medical Groups and the referring physician was found to not satisfy an exception to the Stark Law, our Owned or Non-Owned Medical Groups could be required to restructure their relationships with Privia Physicians, face civil penalties, pay substantial fines, return as overpayments any reimbursement from Medicare received for such DHS or otherwise experience a material adverse effect, including loss of reputation, inability to recruit additional practices, loss of revenue, and increased costs of operations.
−Removed: This prohibition also limits how we may pursue physician opportunities in the future.
−Removed: For example, were we to pursue a physician practice acquisition strategy, the Stark Law would limit both how we structure such acquisitions and our range of purchase prices for such acquisitions.
−Removed: Fraud and Abuse under State Law
+Added: At the state level, our ability to conduct business and the structure of our operations depends on each state’s laws, regulations, and policies governing, among other issues, the corporate practice of medicine, fee-splitting, and the assumption of financial risk.
+Added: In several states, laws and regulations, guidance from professional licensing boards or state attorneys general and judicial doctrines prohibit corporations and other entities not owned by physicians or other permitted health professionals from practicing medicine and other professions.
+Added: These laws and doctrines have been interpreted in some states to prohibit entities not owned by permitted professionals from employing physicians and other professionals and to prohibit such entities from undertaking activities that could be seen as exercising control over healthcare provider professional judgment.
+Added: Some states also have adopted restrictions on direct or indirect payments to, or entering into fee-splitting arrangements with, physicians and unlicensed persons or business entities.
+Added: These restrictions vary by state and are often vague and subject to interpretation by state medical boards, state attorneys general and other regulatory authorities.
+Added: We attempt to structure our arrangements with healthcare providers to comply with applicable state law.
+Added: However, we cannot provide assurance that governmental officials responsible for enforcing these laws will not assert that we, or transactions in which we are involved, violate these laws.
+Added: These laws may also be interpreted by courts in a manner inconsistent with our interpretations.
+Added: Possible sanctions for violations of these restrictions include loss of a physician’s license and civil and criminal penalties.
+Added: In addition, agreements between the Company and physicians may be considered void and unenforceable, our MSAs and management fees could be adversely affected, and we may be required to restructure the Company’s relationships with Medical Groups and Privia Physicians, any of which could have a material adverse effect on our business, financial condition and results of operations.
+Added: Federal Anti-Kickback Statute, Stark Law and Similar State Laws
+Added: Some healthcare laws apply to the financial relationships we have or our Medical Groups have with physicians and others who either refer or influence the referral of patients to our Medical Groups and Privia Physicians or who are the recipients of referrals.
+Added: The federal Anti-Kickback Statute, for example, is a criminal law that prohibits, among other things, the solicitation, receipt, offering or payment of any remuneration with the intent of generating referrals or orders for services or items that may be paid for by a federal healthcare program.
+Added: The OIG has enacted safe harbor regulations that outline practices deemed protected from prosecution under the federal Anti-Kickback Statute.
+Added: While we and our Medical Groups endeavor to comply with applicable safe harbors, certain current arrangements, including joint ventures and financial relationships with physicians and other referral sources and persons and entities to which our Medical Groups refer patients, may not qualify for safe harbor protection.
+Added: Failure to qualify for a safe harbor does not mean the arrangement necessarily violates the federal Anti-Kickback Statute, but may subject the arrangement to greater scrutiny.
+Added: The Stark Law is a strict liability civil law that prohibits physicians from making referrals for “designated health services” payable by Medicare or Medicaid to entities with which the physician or an immediate family member of the physician has a financial relationship, unless an exception applies.
+Added: Allegations of violations of the federal Anti-Kickback Statute may also be brought under the federal Civil Monetary Penalty Law, which requires a lower burden of proof than other fraud and abuse laws.
+Added: The Stark Law further prohibits entities that have received such referrals from filing claims with Medicare (or billing another individual, entity or third party payor) for those referred services.
+Added: The financial relationships of our Medical Groups with referring physicians and their immediate family members must comply with the Stark Law.
+Added: We and our Medical Groups attempt to structure those relationships to meet an exception to or otherwise comply with the Stark Law, but the regulations implementing the Stark Law, including the requirements to meet exceptions, are detailed and complex.
+Added: We do not always have the benefit of significant regulatory or judicial interpretation of the Stark Law and its implementing regulations.
+Added: Additionally, violations of the federal Anti-Kickback Statute or Stark Law, improper billing for services to federal healthcare programs, or improper retention of overpayments from federal healthcare programs may be the basis for finding a violation under the federal False Claims Act (the “FCA”), either under a suit brought by the government or by a private person under a qui tam, or “whistleblower,” suit.
Many states have also passed anti-kickback statutes and physician self-referral prohibitions similar to the federal Anti-Kickback Statute and the Stark Law.
However, in many of the states we operate, these state self-referral prohibitions are often drafted broadly to cover all payers (i.e., not restricted to Medicare and other federal health care programs) or certain programs within the state such as the state Medicaid program or state workers’ compensation program.
−Removed: Generally, however, the exceptions or exemptions under state fraud and abuse laws, are less robust and developed than their federal counter parts.
−Removed: Nonetheless, if such laws are found to apply to our relationships with our Medical Groups, or our Medical Groups’ relationships with Privia Physicians, including Privia Physicians who may hold our publicly traded stock, and for which no applicable exception exists, we may be required to terminate or restructure our relationships with these Privia Physicians and could be subject to criminal, civil and administrative sanctions, refund requirements and exclusions from government health care programs, including Medicare and Medicaid, which could have a material adverse effect on our business, results of operations, financial condition, cash flows, reputation and stock price.
−Removed: Maryland, for example, has adopted the Maryland Patient Referral Law, which puts a number of additional restrictions on group practices trying to furnish “designated services” in the State of Maryland regardless of the payer for such “designated services.” Notably, Maryland has adopted an equivalent exception to the Stark Law’s in-office ancillary services exception, which, among other things requires that the Owned Medical Group employ the person furnishing the services and such must be performed in a location of the Owned Medical Group.
−Removed: Tennessee’s self-referral law derives from the early American Medical Association actions relative to self-referrals rather than the Stark Law;
−Removed: however, generally, Tennessee’s law does not prohibit referrals from a physician to an entity at which the physician performs services or an entity that meets a demonstrated need in the community.
−Removed: In Texas, the Texas Patient Solicitation Act, while similarly worded to the Federal Anti-Kickback Statute, applies to all payers, not just federal or state health care programs.
−Removed: However, the establishment of the medical necessity of the referral and the patient’s consent to treatment generally is sufficient to avoid prosecution under the Texas statute.
−Removed: Florida has the Patient Anti-Brokering Act, which is essentially a state anti-kickback statute and a state self-referral prohibition.
−Removed: Finally, California’s anti-kickback statute is not limited to federal healthcare program business, or even to referrals of patients or healthcare business;
−Removed: however, California law provides a broad exception to the extent that such remuneration is commensurate with the value of services received.
−Removed: In each of our geographic markets, we rely upon experienced health care attorneys licensed in the state to assist us in complying with state law.
−Removed: Similarly, states have beneficiary inducement prohibitions and consumer protection laws that may be triggered by the offering of inducements, incentives and other forms of remuneration to patients and prospective patients.
−Removed: States also may limit the types of marketing activities that we, our Medical Groups and our Privia Physicians may take targeted towards patients.
−Removed: Violations of such laws range from civil to criminal and could have a material adverse effect on our business, results of operations and financial condition.
−Removed: The False Claims Act
−Removed: The federal FCA is a means of policing false bills or false requests for payment in the healthcare delivery system.
−Removed: Among other things, the FCA authorizes the imposition of up to three times the government’s damages and significant per claim civil penalties on any “person” (including an individual, organization or company) who, among other acts:
−Removed: • knowingly presents or causes to be presented to the federal government a false or fraudulent claim for payment or approval;
−Removed: • knowingly makes, uses or causes to be made or used a false record or statement material to a false or fraudulent claim;
−Removed: • knowingly makes, uses or causes to be made or used a false record or statement material to an obligation to pay the government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the federal government;
−Removed: • conspires to commit the above acts.
−Removed: In addition, amendments to the FCA and Social Security Act impose severe penalties for the knowing and improper retention of overpayments collected from federal health care programs.
−Removed: Under these provisions, within 60 days of identifying and quantifying an overpayment, a provider is required to notify CMS or the Medicare Administrative Contractor of the overpayment and the reason for it and return the overpayment.
−Removed: An overpayment impermissibly retained could subject us to liability under the FCA, exclusion from government healthcare programs and penalties under the federal Civil Monetary Penalty statute.
−Removed: As a result of these provisions, our procedures for identifying and processing overpayments may be subject to greater scrutiny.
−Removed: The penalties for a violation of the FCA can be significant and are subject to annual adjustments for inflation, plus up to three times the amount of damages caused by each false claim, which can be as much as the amounts received directly or indirectly from the federal health care program for each such false claim.
−Removed: Further, FCA cases are filed under seal to give the government an opportunity to review, investigate and intervene in the case.
−Removed: FCA cases may remain under seal for extended periods of time while the defendant in the case is unaware of the complaint and any resulting investigation.
−Removed: The federal government has used the FCA to prosecute a wide variety of alleged false claims and fraud allegedly perpetrated against federal health care programs, including Medicare and Medicaid, including but not limited to coding errors, submission of false Medicare enrollment information, billing for services not rendered, the submission of false cost or other reports, billing for services at a higher payment rate than appropriate, billing under a comprehensive code as well as under one or more component codes included in the comprehensive code, billing for care that is not considered medically necessary and false reporting of risk-adjusted diagnostic codes to Medicare Advantage plans.
−Removed: The ACA provides that claims tainted by a violation of the federal Anti-Kickback Statute are false for purposes of the FCA.
−Removed: Some courts have held that filing claims or failing to refund amounts collected in violation of the Stark Law can form the basis for liability under the FCA.
−Removed: In addition to the provisions of the FCA, which provide for civil enforcement, the federal government can use several criminal statutes to prosecute persons who are alleged to have submitted false or fraudulent claims for payment to the federal government.
−Removed: Any allegations or findings that we have violated the FCA could have a material adverse impact on our business, results of operations, reputation, growth and financial condition.
−Removed: In addition to the FCA, the various states in which we operate have adopted their own analogs of the FCA.
−Removed: States are becoming increasingly active in using their false claims laws to police the same activities listed above, particularly with regard to Medicaid FFS and Managed Medicaid programs.
−Removed: Civil Monetary Penalties Statute
−Removed: The Civil Monetary Penalties Statute, 42 U.S.C.
−Removed: § 1320a-7a, authorizes the imposition of civil monetary penalties, assessments and exclusion against an individual or entity based on a variety of prohibited conduct, including, but not limited to:
−Removed: • presenting, or causing to be presented, claims for payment to Medicare, Medicaid or other third-party payers that the individual or entity knows or should know are for an item or service that was not provided as claimed or is false or fraudulent;
−Removed: • offering remuneration to a federal health care program beneficiary that the individual or entity knows or should know is likely to influence the beneficiary to order or receive health care items or services from a particular provider;
−Removed: • arranging contracts with an entity or individual excluded from participation in the federal health care programs;
−Removed: • violating the federal Anti-Kickback Statute;
−Removed: • making, using or causing to be made or used a false record or statement material to a false or fraudulent claim for payment for items and services furnished under a federal health care program;
−Removed: • making, using or causing to be made any false statement, omission or misrepresentation of a material fact in any application, bid or contract to participate or enroll as a provider of services or a supplier under a federal health care program;
−Removed: • failing to report and return an overpayment owed to the federal government.
−Removed: Substantial civil monetary penalties may be imposed under the federal Civil Monetary Penalties Law and may vary depending on the underlying violation.
−Removed: In addition, an assessment of not more than three times the total amount claimed for each item or service may also apply and a violator may be subject to exclusion from federal health care programs.
−Removed: We could be exposed to a wide range of allegations to which the federal Civil Monetary Penalties Law would apply.
−Removed: Although we strive to perform monthly exclusion database checks on our employees, Privia Physicians and certain vendors using government databases to confirm that these individuals have not been excluded from federal programs, should an individual become excluded and we fail to detect it, a federal agency could require us to refund amounts attributable to all claims or services performed or sufficiently linked to an excluded individual.
−Removed: Likewise, our patient facing initiatives, which can include additional care coordination to patients not otherwise covered under traditional Medicare, could be alleged to be intended to influence the patient’s choice of provider in obtaining services or the amount or types of services sought.
−Removed: Thus, we cannot foreclose the possibility that we will face allegations subject to the Civil Monetary Penalties Law with the potential for a material adverse impact on our business, results of operations and financial condition.
−Removed: Privacy and Security
−Removed: The federal regulations promulgated under the authority of HIPAA require covered entities to provide certain protections to patients and their health information.
−Removed: The HIPAA privacy and security regulations extensively regulate the use and disclosure of PHI and require covered entities, which include health plans, health care clearinghouses, employers that provide self-funded or self-administered health insurance benefits, healthcare providers and their business associates, to implement and maintain administrative, physical and technical safeguards to protect the security of such information.
−Removed: Additional security requirements apply to electronic PHI.
−Removed: These regulations also provide patients with substantive rights with respect to their health information.
−Removed: The HIPAA privacy and security regulations also require covered entities to enter into written agreements with certain contractors, known as business associates, to whom we disclose PHI.
−Removed: Covered entities may be subject to penalties for, among other activities,
−Removed: failing to enter into a business associate agreement where required by law or as a result of a business associate violating HIPAA, if the business associate is found to be an agent of the covered entity and acting within the scope of the agency.
−Removed: Business associates are also directly subject to liability under certain HIPAA privacy and security regulations.
−Removed: In instances where we act as a business associate to a covered entity, there is the potential for additional liability beyond our status as a covered entity.
−Removed: Covered entities must notify affected individuals of breaches of unsecured PHI without unreasonable delay but no later than 60 days after discovery of the breach by a covered entity or its agents.
−Removed: Reporting must also be made to the HHS Office for Civil Rights and, for breaches of unsecured PHI involving more than 500 residents of a state or jurisdiction, to the media.
−Removed: All impermissible uses or disclosures of unsecured PHI are presumed to be breaches unless the covered entity or business associate establishes that there is a low probability the PHI has been compromised.
−Removed: Various state laws and regulations may also require us to notify affected individuals in the event of a data breach involving personal information without regard to the probability of the information being compromised.
−Removed: For instance, California and Virginia have adopted comprehensive information security laws that grant residents of those states to considerably more rights and control over their information, including PHI, than granted under HIPAA.
−Removed: As an employer that offers self-insured health benefits, we are a covered entity under HIPAA.
−Removed: Further, in the provision of management services to our Medical Groups, we are a business associate to those practices.
−Removed: Our Medical Groups are all covered entities as well.
−Removed: Further, our Owned and Non-Owned Medical Groups act as an affiliated covered entity under HIPAA, which, among other things allow them to operate a single set of privacy and security standards, a single notice of privacy practices, appoint a single privacy and security officer, and imposes on them joint and several liability relative to any violations of HIPAA.
−Removed: Violations of HIPAA by providers like us, including, but not limited to, failing to implement appropriate administrative, physical and technical safeguards, have resulted in enforcement actions and in some cases triggered settlement payments or civil monetary penalties.
−Removed: Penalties for impermissible use or disclosure of PHI were increased by the Health Information Technology for Economic and Clinical Health Act (“ HITECH Act”) by imposing tiered penalties of more than $50,000 per violation and up to $1.5 million per year for identical violations, adjusted annually for inflation.
−Removed: In addition, HIPAA provides for criminal penalties of up to $250,000 and ten years in prison, with the severest penalties for obtaining and disclosing PHI with the intent to sell, transfer or use such information for commercial advantage, personal gain or malicious harm.
−Removed: Further, state attorneys general may bring civil actions seeking either injunction or damages in response to violations of the HIPAA privacy and security regulations that threaten the privacy of state residents.
−Removed: There can be no assurance that we will not be the subject of an investigation (arising out of a reportable breach incident, audit or otherwise) alleging non-compliance with HIPAA regulations in our maintenance of PHI.
−Removed: We are also subject to a provision of the federal 21st Century Cures Act that is intended to facilitate the appropriate exchange of health information.
−Removed: In May 2020, the United States Department of Health and Human Services Office of the National Coordinator for Health Information Technology and CMS issued complementary new rules that are intended to clarify provisions of the 21st Century Cures Act regarding interoperability and information blocking and create significant new requirements for healthcare industry participants.
−Removed: Numerous other federal and state laws and regulations protect the confidentiality, privacy, availability, integrity and security of health information and other types of personal information.
−Removed: State statutes and regulations vary from state to state and these laws and regulations in many cases are more restrictive than HIPAA and its implementing rules.
−Removed: The scope of these laws can be expansive affecting numerous activities that we may engage in from data capture and storage, use of data for clinical research activities, to how we communicate with our patients.
−Removed: These laws and regulations are often uncertain, contradictory, and subject to changes or differing interpretations, and we expect new laws, rules and regulations regarding privacy, data protection, and information security to be proposed and enacted in the future.
−Removed: In the event that new data security laws are implemented, we may not be able to timely comply with such requirements, or such requirements may not be compatible with our current processes.
−Removed: Changing our processes could be time consuming and expensive, and failure to timely implement required changes could subject us to liability for non-compliance.
−Removed: Some states, such as California and Virginia, also afford private rights of action to individuals whose personal information has been subject to a data breach.
−Removed: This complex, dynamic legal landscape regarding privacy, data protection, and information security creates significant compliance issues for us and potentially restricts our ability to collect, use and disclose data and exposes us to additional expense, adverse publicity and liability.
+Added: however, the exceptions or exemptions under state fraud and abuse laws, are less robust and developed than their federal counter parts.
+Added: If we, our Medical Groups or participants in our ACOs fail to comply with these or other applicable laws and regulations, which are subject to change, any such failure could result in significant penalties, adversely impact our business, results of operations, financial condition and/or result in reputational harm.
+Added: Data Protection
+Added: The data protection landscape is rapidly evolving, and the Company, its Medical Groups and ACO participants, are and may become subject to numerous state and federal laws, requirements and regulations governing the collection, use, disclosure, retention and security of health-related and other personal information.
+Added: For example, the HIPAA privacy and security regulations extensively regulate the use and disclosure of personal health information (“PHI”) and require covered entities, including healthcare providers and health plans, and vendors (known as “business associates”) that perform certain services that involve creating, receiving, maintaining or transmitting PHI on behalf of covered entities or other business associates, to implement administrative, physical and technical safeguards to protect the privacy and security of PHI.
+Added: These laws are complex and subject to change and interpretation, and our approach to compliance with such laws may include reliance on safe harbors or other regulatory rules, including those related to organized healthcare arrangements, which are themselves complex, require resources and investment to manage ongoing compliance, and are subject to change and interpretation, particularly in the current regulatory environment.
+Added: In addition to HIPAA, there are numerous other laws, regulations, and legislative and regulatory initiatives at the federal and state levels governing the confidentiality, privacy, availability, integrity and security of health-related information and other types of personal information.
+Added: In many cases, the state laws are more restrictive or impose more obligations than, and may not be preempted by, the HIPAA privacy and security regulations.
+Added: State laws vary in scope, may apply to employees and business contacts in addition to patients, and may be subject to new and varying interpretations by courts and government agencies, creating complex compliance issues and potentially resulting in exposure to additional expense, adverse publicity and liability.
+Added: The potential effects of these laws are far-reaching and may require the Company, its Medical Groups, and their third-party service and technology vendors to modify data use, storage, transmission and processing practices and policies, or our approach to compliance with other similar laws, and to incur substantial costs and expenses in order to comply.
+Added: Failure to comply with these and any other comprehensive privacy laws passed at the state or federal level may result in regulatory enforcement action and reputational harm.
+Added: We expect that new or modified laws, regulations, regulatory guidance and industry standards concerning privacy, data protection and information security, including those related to specific types of personal data, will continue to be proposed and enacted in various jurisdictions, which could impact our operations and cause us to incur substantial costs.
Healthcare Reform
−Removed: In March 2010, broad healthcare reform legislation was enacted in the United States through the ACA.
−Removed: Although many of the provisions of the ACA did not take effect immediately and continue to be implemented, and some have been and may be modified before or during their implementation, the reforms could continue to have an impact on our business in a number of ways.
−Removed: Since its enactment, there have been judicial, executive and Congressional challenges to certain aspects of the ACA.
−Removed: On June 17, 2021, the U.S.
−Removed: Supreme Court dismissed the most recent judicial challenge to the ACA brought by several states without specifically ruling on the constitutionality of the ACA.
−Removed: Prior to the Supreme Court’s decision, President Biden issued an executive order initiating a special enrollment period from February 15, 2021 through August 15, 2021 for purposes of obtaining health insurance coverage through the ACA marketplace.
−Removed: The executive order also instructed certain governmental agencies to review and reconsider their existing policies and rules that limit access to healthcare.
−Removed: We cannot predict how employers, commercial payers or persons buying insurance might react to federal and state healthcare reform legislation, whether already enacted or enacted in the future, nor can we predict what form many of these regulations will take before implementation.
−Removed: As part of the Federal government’s omnibus funding legislation passed at the end of 2022, Congress again reduced Medicare’s scheduled reductions to physician reimbursement, which went from a scheduled 8.5% reimbursement cut to a 2% cut in physician reimbursement in 2023 and at least a 1.25% reimbursement cut in 2024.
−Removed: In addition, Congress extended the 5% bonus payment for Advanced Alternative Payment Models, including Accountable Care Organizations, which was scheduled to expire at the end of 2022, for one year at a bonus rate of 3.5%.
−Removed: These continued cuts to reimbursement especially at a time when physicians are experiencing inflated costs, including labor costs, create a financial challenge to physicians practices.
−Removed: Although such cuts may ultimately provide an opportunity for companies such as ours by increasing the pool of physicians looking to associate with larger partners, in the short term, such reimbursement costs could negatively impact our earnings and reduce the amount of compensation available to our Privia Providers.
−Removed: In addition, the American Rescue Plan Act of 2021, signed into law March 11, 2021, included a number of provisions intended to shore up the ACA, including lower premiums for insurance purchased through the exchange marketplace, premium tax credits for insurance purchased by individuals on the exchange marketplace and providing significant subsidies for states that have not yet expanded their Medicaid programs under the ACA.
−Removed: These changes as well as other administrative changes such as extending enrollment periods for 2021 and increasing navigator funding may ultimately decrease our Medical Groups’ uninsured patient populations but at the same time, such changes may move patient populations from higher reimbursed commercial insurance to lower reimbursed exchange marketplace coverage.
−Removed: Although it is too early to determine the likely cumulative effect of these changes, such changes could negatively impact both our revenue and the revenue of our Medical Groups.
−Removed: While there may be significant changes to the healthcare environment in the future, the specific changes and their timing are not yet apparent.
−Removed: As a result, there is considerable uncertainty regarding the future with respect to the exchanges and other core aspects of the current health care marketplace.
−Removed: Future elections may create conditions for Congress to adopt new federal coverage programs that may disrupt our current commercial payer revenue streams.
−Removed: While specific changes and their timing are not yet apparent, such changes could lower our reimbursement rates or increase our expenses.
−Removed: Any failure to successfully implement strategic initiatives that respond to future legislative, regulatory, and executive changes could have a material adverse effect on our business, results of operations and financial condition.
−Removed: Risk Bearing Provider Regulation
−Removed: Certain of the states where we currently operate or may choose to operate in the future regulate what types of risk a provider can take and from what types of entities without triggering state insurance laws.
−Removed: For example, state direct primary care laws may allow a provider to assume risk for primary care services but if the provider assumes risks for other services, such as facility services or specialty services, the provider may be subject to state insurance laws.
−Removed: State insurance laws may impose conditions on the operations and financial condition of risk bearing providers such as our Owned and Non-Owned Medical Groups, or ACOs.
−Removed: These regulations can include capital requirements, licensing or certification, governance controls and other similar matters.
−Removed: While these regulations have not had a material impact on our business to date, as we continue to expand and move more physician services to value based, these rules may require additional resources and capitalization and add complexity to our business.
−Removed: Other Regulations
−Removed: Our Owned and Non-Owned Medical Groups’ operations are subject to various state hazardous waste and non-hazardous medical waste disposal laws, state law requirements for licensure of ancillary services such as lab services, pharmacy services, and operation of radiological producing equipment, federal Clinical Laboratory Improvement Amendments of 1988, Occupational Safety and Health Administration standards, including the Bloodborne Pathogens Standards, Drug Enforcement Administration standards for administering and prescribing controlled substances and distributing drug samples, reporting financial relationships with drug, biologicals and medical device companies and numerous other federal, state and local laws governing the day-to-day provision of medical services by our Affiliated Provider.
−Removed: These regulatory requirements apply to both our practices and our providers.
−Removed: Any allegations or findings that we or our providers have violated any of these laws or regulations could have a material adverse impact on our business, results of operations and financial condition.
−Removed: Further, federal and state law in each state we currently operate are increasingly imposing oversight, reporting requirements, and other safeguards on our providers that prescribe opioids and other pain medicine.
−Removed: Texas, for instance, has adopted a number of amendments to existing laws and regulatory changes to limit prescription sizes, frequency, and requiring providers to access the Prescription Drug Monitoring Program before prescribing or dispensing controlled substances.
−Removed: In addition, federal and state investigators have increased enforcement efforts relative to inappropriate opioid prescribing patterns by providers.
−Removed: Although the burden of such compliance is largely on the Affiliated Provider, any failure to comply with such legal and regulatory requirements could adversely impact our business, results of operations, reputation and financial condition.
−Removed: Term and Termination
−Removed: The term of our strategic anchor partnership arrangement is typically between five to ten years and automatically renews unless either the anchor partner or we decide not to renew.
−Removed: These agreements further have other custom rights, non-solicitation, exclusivity, termination and post termination provisions terms that are unique to each situation.
−Removed: We also build in unwind provisions that typically allow us to continue to operate in a market after termination of our underlying relationship with an anchor group.
−Removed: The term of our in-market new provider physician member services agreements and support services agreement is typically three years and automatically renews unless either the practice or we decide not to renew.
−Removed: These agreements could also have other specific provisions and terms that may be unique to each agreement.
−Removed: Payer Relationships
−Removed: We understand that individuals and employer groups are facing unprecedented rising healthcare costs.
−Removed: Our robust medical economics team supports creative narrow network designs that deliver high-quality care at a lower cost.
−Removed: We leverage data and provider input to enable them to grow their patient base and influence how care is delivered.
−Removed: Ultimately, our networks enable providers to connect with new patient populations, create custom contracts that provide greater value, and further integrate with their community.
−Removed: We partner with a large and diverse set of payer groups nationally and in each of our markets to form provider networks, lower cost of care, and construct bespoke contracts to help both providers and payers achieve their objectives in a mutually aligned manner.
+Added: The healthcare industry has been and continues to be impacted by healthcare reform efforts.
+Added: For example, the Affordable Care Act affects how healthcare services are covered, delivered and reimbursed and expanded health insurance coverage through a combination of public program expansion and private sector health insurance reforms.
+Added: Changes in the law’s implementation, subsequent legislation and regulations, state initiatives and other factors, including potential changes to or repeal of the Affordable Care Act as a result of changes in the political landscape, have and may continue to affect the number of individuals that elect to obtain public or private health insurance or the scope of such coverage.
+Added: Reductions in the number of insured individuals or the scope of insurance coverage may have an adverse effect on our business.
+Added: In addition, Medicare and Medicaid policies are subject to change, including as a result of changes in the presidential administration and Congress.
+Added: Legislation and administrative actions at the federal level may impact funding for, or the structure of, the Medicaid or Medicare program, and may shape administration of the Medicaid program at the state level and Medicare Advantage Programs.
+Added: Other recent health reform initiatives and proposals at the federal and state levels include those focused on price transparency and out-of-network charges as well as pharmacy and pharmacy benefit manager reform efforts, which may impact prices, the relationships between hospitals, patients, payers, and providers, total cost of care and patient outcomes, and lead to further uncertainty in other participants in the healthcare industry, including employers.
General Corporate Information
Privia Health Group, Inc.
−Removed: PRVA) (“we”, “our”, the “Company”) was incorporated in Delaware in 2016 and became the sole shareholder of PH Group Holdings Corp.
−Removed: (“PH Holdings”) effective August 11, 2016.
+Added: PRVA) was incorporated in Delaware in 2016.
Our Telephone number is (571) 366-8850.
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The information contained on, or that can be accessed through, our website is not incorporated by reference into this filing and you should not consider any information contained on, or that can be accessed through, our website as part of this filing.
−Removed: We are a holding company and all of our business operations are conducted through our subsidiaries and affiliated medical groups.
Our Annual Reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and, if applicable, amendments to those reports filed or furnished pursuant to Section 13(a) of the Securities Exchange Act of 1934, as amended, are available free of charge on or through the Privia Health Investor Relations website at ir.priviahealth.com., as soon as reasonably practicable after we electronically file such material with, or furnish it to, the Securities and Exchange Commission, or the SEC.
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We use these channels to communicate with investors and the public about our Company, our products and services, and other matters.
−Removed: Therefore, we encourage investors, the media, and others interested in our Company to review the information we make public in these locations, as such information could be deemed to be material information.
−Removed: Information on or that can be accessed through our websites is not part of this Annual Report on Form 10-K, and the inclusion of our website addresses are inactive textual references only.
+Added: Therefore, we encourage investors, the media, and others interested in our Company to
+Added: review the information we make public in these locations, as such information could be deemed to be material information.
+Added: Information on or that can be accessed through our websites is not part of this Annual Report on Form 10-K, and the website addresses are included as inactive textual references only.
Human Capital Resources
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While certain employees work onsite, the majority of our workforce is either remote or a blend of in-office and remote.
−Removed: Our flexible workforce strategy allows us to hire the best possible talent irrespective of geographic constraints across many functional roles.
+Added: Our flexible workforce strategy allows us to hire the qualified talent irrespective of geographic constraints across many functional roles.
Our internal systems and processes are designed to ensure our remote employees are productive, contribute meaningfully, and are able to exceed expectations in their roles.
−Removed: This has enabled us to successfully continue to operate through the restrictions imposed by the COVID-19 pandemic.
Talent Development and Engagement
At Privia Health, we value all of our employees and the exceptional talent they bring to our organization, in order to support our physicians, providers, care center staff, and patients.
−Removed: One of our strategic corporate goals is to grow and develop our diverse workforce, and we have established ongoing leadership development and retention programs intended to support employees in their career progression.
+Added: One of our strategic corporate goals is to grow and develop our workforce, and we have established ongoing leadership development and retention programs intended to support employees in their career progression.
This includes an Emerging Leaders Program, a Manager Onboarding program, individual coaching, and ad hoc formal and informal training sessions.
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Our goal is to comprehensively support our employees, no matter who they are or where they are in life.
−Removed: To further this goal, Privia has introduced nationwide access to virtual mental healthcare as well as coverage for gender affirmation procedures, fertility treatment and pregnancy care management for plan participants.
+Added: To further this goal, Privia has introduced nationwide access to virtual mental healthcare as well as comprehensive medical coverage for plan participants.
Our Employee Assistance Program (“EAP”) provides support to all employees and their family members who may be experiencing times of crisis.
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In addition to these on-demand services, we also offer Mental Health First Aid certification so our managers can recognize and respond to a person experiencing a mental health emergency.
−Removed: Diversity, Equity and Inclusion
−Removed: Our mission is to develop and retain the best and brightest talent from diverse backgrounds.
−Removed: We strive for equitable treatment and in doing so, remove barriers and level the playing field so that each and every employee has the opportunity to be successful in their role.
−Removed: We regularly scrutinize our job descriptions, education and experience requirements, and physical demands to ensure we are not creating any unnecessary barriers for qualified applicants.
−Removed: Annually, the People Operations team reviews and enhances our policies, processes, and benefits to address a variety of opportunities including, but not limited to, universal parental leave, transgender workplace transition guidance and a gender-neutral dress code.
−Removed: We champion and seek to continually improve the representation of all members of the populations we serve within our workforce.
−Removed: We provide all of our employees with the tools, resources, and accommodations they need to be successful, and we have cultivated an inclusive work environment that values this representation and encourages creativity and innovation.
+Added: Put People First
+Added: Privia Health employees are committed to improving patient care through their support of the physicians, providers, and care center staff.
+Added: The Nominating and Corporate Governance Committee assists our Board of Directors in its oversight of talent management, including corporate culture, employee experience, recruiting, retention, attrition, career development and progression, succession, and employee relations.
+Added: Privia Health has been honored to be named a Top Workplace for the last three years by Energage locally and nationally both as a large-size company and a healthcare organization.
+Added: In 2024, we earned additional culture excellence awards from other organizations, highlighting our efforts in employee appreciation, our culture of respect, belonging, and continuous learning , employee well-being, professional development, purpose and values, leadership, innovation, compensation and benefits, and work-life flexibility.
Serving Our Communities
We encourage and actively support our employees who want to have a meaningful and positive impact on their communities and charitable causes by giving their time, talents and resources.
−Removed: The Company supported various charitable organizations throughout the year, focused on heart health, food disparities across our geographies, and holiday donations for underserved communities.
−Removed: In an effort to make a greater impact, will be focusing corporate charitable giving on healthcare organizations and those that benefit historically underserved and underrepresented communities nationally.
−Removed: In 2024, we will continue to maximize our impact and give back to the communities in which we serve.
+Added: The Company supported various charitable organizations throughout the year, focused on heart health, food disparities across our geographies, and holiday donations for certain communities.
Additionally, we have a task force that is activated in advance of weather events or impending natural disasters.
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Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.