Thank you everyone for standing by. This is the conference operator. We would like to welcome you to the Skylight Health first quarter 2022 financial results conference call. The results are for the period ending March 31, 2022. As a reminder, all participants are in listen-only mode. After today's speakers conclude the presentation portion of the call, should time permit, they will move to a question and answer period. If you wish to ask a question, you may queue at any time by pressing star then one on your telephone keypad. You'll hear a tone acknowledging your request. To withdraw your question, please press star then two. Should you need assistance during the conference call, you signal an operator by pressing star and zero.
As always, I would like to remind you that listeners are cautioned that today's call and the responses to any questions may contain forward-looking statements, including certain statements which concern long-term earnings objectives. These should be considered in conjunction with the cautionary statements contained in the Skylight Health earnings release and in the company's MD&A and other filings. Forward-looking statements are subject to risks and uncertainties and assumptions. Accordingly, actual performance could differ materially, and undue reliance should not be placed on such statements. Skylight Health does not undertake to update any forward-looking statements except as required. All currencies discussed on this call will be in Canadian dollars unless otherwise stated. This conference call is being recorded today, Tuesday, May 17th, 2022 , at 8:00 A.M., and will be posted to the Skylight Health's website within 24 hours after the conclusion of the call.
I would now like to turn the meeting over to Skylight Health's Chief Executive Officer, Mr. Pradyum Sekar. Please go ahead.
Thank you, Ariel, and a good morning to everyone, and thank you for joining us today for our first quarter conference call for the period ending March 31, 2022. With me this morning, I have Andrew Elinesky, our CFO, who'll hop on in a moment here to walk through the financial performance. Skylight Health is a primary care-focused organization that is committed to changing how healthcare works in the U.S. We operate a multi-state primary care healthcare network comprised of practices providing a range of services from primary care, subspecialty, allied health, laboratory diagnostic testing. Our business model is focused on solving two major issues in U.S. healthcare. First, providing a white knight solution to small and independent primary care practices looking to consolidate within a highly fragmented market and where providers and practices are eagerly looking forward to qualified and supportive buyers.
Through a national platform, we aim to bring scale, efficiency, and improved revenues to these practices. Second, we aim to realign the reimbursement models in these practices to outcome-based care, or more commonly known as value-based care contracting. Our focus with a specific patient population, such as Medicare, is to shift them from a traditional fee-for-service model, where in general, they can generate between CAD 200-CAD 400 a visit to a value-based care contract where some of these full risk total cost of care contracts can generate over CAD 10,000 a year per patient that's paid by the payers and not the patient. This model enables a practice to receive the full healthcare dollar, putting the patient first and allocating expenses accordingly. Value-based care models are designed to manage the growing cost of care while improving on patient health outcomes.
I am proud to reflect on the past 18 months. As we have communicated our goals and objectives, we have now achieved transformative growth through a disciplined acquisition strategy. We have secured a partnership with one of the top health insurers in the country. We have now entered full risk with Medicare Advantage, and we've established our teams with the tools and resources required to organically grow. We now have all the pieces in place and are in a position to execute into 2022. The first quarter was a very busy period for us as a company. Our number one focus was the continued integration and implementation of the systems and tools that are required to successfully operate our network.
Far too often we have seen in these similar acquisition platforms the lack of proper integration and systems to manage that lead to revenue and cost implications, and in some cases, failure to operate. Our experience both as practice managers as well as through the various acquisitions in the last 18 months, has been that certain tools, including tools like a single electronic health record platform, provides us with the visibility and information we need to manage and make objective decisions. It is these systems and tools that in the past, as it now does today, allow us to be flexible and move quickly with business decisions that support rapid growth or changes in our markets to patient volumes and health overall indicators.
I'm happy to announce that we have now completed the launch of athenahealth, our EMR or electronic medical record system, across all practices as of the end of the first quarter. We will begin the implementation process within NeighborMD, who just recently joined our network this month. Further, we've implemented a more robust accounting and financial system, a human resource platform that drives improved engagement and efficiencies on the back end with regards to our overall accounting and reporting workflows. With tools now in place, many of these one-time expenses to launch and implement, as well as cost synergies through workflow improvements, have led to over 40% in cost savings on a pro forma basis. While costs were higher in Q1 this year, as we communicated on the last earnings call, we expect future quarters will continue to see an improving EBITDA margin.
As we expect that Q2 will still carry costs as we transition out of some of these expense items, Q3 will be more reflective of our cost-saving initiatives from a reporting standpoint. We made some exciting announcements over the past few weeks. The first was our joint venture with Collaborative Health Systems or CHS, which is a wholly owned subsidiary of Centene. One of America's largest payers today trading at over a CAD 50 billion market cap. As we've communicated our plans to enter into a JV with a large U.S. payer over the last six months or more, efforts to get here were no small feat, neither for our team nor theirs.
I would like to thank everyone on both sides of the JV for their commitment to getting this done, the time, the effort, and the patience, and the patience from our shareholder base as we worked towards this key milestone. I'll share more on this JV later on this call. The second big announcement was the acquisition of NeighborMD, a primary care group in Florida with nine practices, and more importantly, approximately 2,400 Medicare Advantage lives at full risk, a trailing twelve months revenue of approximately CAD 35 million. Now, it is important to note of the 2,400 lives, roughly 1,200 come from the owned practices and 1,200 from the affiliate practices.
As we look to further establish the affiliates over time, our goal is to continue to grow in an owned model, but of course, learn from Neighbor how we can benefit from an affiliate model as well. This acquisition allows Skylight to both bolster density in one of the largest Medicare markets in the U.S., but also accelerates our plan to full risk into 2022 this year, where originally we were planning it for three-five years out. The acquisition of Neighbor, along with the ability to leverage growth in the Medicare Advantage market, means that we can begin transitioning our Medicare and Medicare Advantage lives in a fee-for-service model in 2022 and 2023. These are with both payers, Humana and CarePlus today, as the contracts come with Neighbor.
Under these agreements, we will move to a capitated model where at full risk we can realize on today's estimates between CAD 10,000-CAD 12,000 per member per year. This is a substantial increase from the CAD 200-CAD 400 a year we might get today on a fee-for-service model alone. Today, we have over 1,000 Medicare lives in Jacksonville alone that can benefit from this program. The medium to long-term goal will be to leverage these contracts with CHS and our JV into full risk contracts into Colorado and Pennsylvania as well. I'll explain more on the economics and how shareholders can look at the impact to revenue and EBITDA after Andrew goes over the financial overview. With that, Andrew, I'll hand it over to you.
Thanks, Prad, and thank you once again to everybody for joining us today. As Prad mentioned, we are very pleased with the company's achievements, both in the last, you know, 18 months and the year so far. The first quarter financial results reflected the impact of the acquisitions that we've made in the last year and a half. They're in line with the investments that we've been making in the business development through our systems and operations as we continue with our plan of growth via acquisitions, optimization, and the expansion of our book of business.
Please note, when I go through the financials here, my comparisons will mainly be with the prior quarter of Q4 of 2021, considering the business only had partial revenues for primary care in Q1 of 2021 due to the timing of our acquisitions mostly occurring post the first quarter last year, which makes Q4 a more comparable quarter to Q1 of this year. Jumping in, revenue came in to just over CAD 7.7 million, and our gross profit came in at just over CAD 3.4 million for the first quarter. This compares to CAD 9.4 million and CAD 5.3 million respectively for the prior quarter. The reduction in revenue can be attributed to two primary reasons, the implementation of our new electronic medical record system, and secondly, the reduction in urgent care visits as COVID-19 cases reduced within the markets.
Our cost of sales were reduced when compared to the prior quarter, but not to offset the difference in revenue, so our gross margin was reduced and came in at 44% versus 57% in the previous quarter. The company expects to see this number improve in the upcoming quarters for this fee-for-service business line as the first quarter was an outlier. Our loss from operations remained relatively flat, which came in at CAD 7.6 million versus CAD 7.7 million in Q4. Despite this reduction in gross margin, the reduction in revenue was offset primarily by savings in salaries and wages, just under CAD 1 million, in office and admin of just about CAD 0.5 million, as well as the lack of asset impairments that were recorded at year-end of CAD 1.4 million.
Adjusted EBITDA came in at CAD 6.7 million versus CAD 5.1 million for Q4. Normalizing for the impairment of CAD 1.4 million in Q4, EBITDA remained at similar levels compared to that quarter. The company expects this to improve going forward, as it has already realized a large part of integration costs and platform development costs in Q1 of this year, as Brad said. In addition, we expect the synergies and efficiencies from this more robust unified platform will allow for further savings. We also continue to generate strong revenue improvements from our research division, and we're on pace to outperform in the financial year 2022 versus 2021. Based on performance today, the practices remain profitable from an operating model. Where corporate admin expenses related to the public market listings and integrations have been the primary contributors to a negative EBITDA.
As with all integration efforts, the company has seen a major cost reduction over the past few months. Which, as Prad already mentioned, are projecting to be vastly improved compared to this quarter. Moving over to the balance sheet. We closed the quarter with a cash balance of just over CAD 4 million. From Q4, the main changes were CAD 6.5 million spent on operations and investments. Just under CAD 1 million was spent on principal and interest on our lease liabilities. About a CAD 250,000 spent on insurance and another CAD 200,000 spent on dividends for preferred shares. These net outflows were slightly offset by CAD 0.3 million received as part of a legacy business sale.
Subsequent to quarter end, as Prad mentioned, we closed on a CAD 20 million debt facility with FLC Credit Partners, a New York-based lender, and concurrently completed the deal to acquire NeighborMD. As mentioned by Prad, this was for total cash consideration of CAD 8 million. The company drew down CAD 10 million from the facility to pay for the acquisition and the cost of the transactions. The company still has a further CAD 10 million available to draw down from the debt facility to fund future acquisitions. Moving to the outlook for 2022. As Prad mentioned, with the addition of NeighborMD being completed just recently, we're holding off increasing guidance until we get a longer track record of operating the new business.
We do know that there will be a material increase to our revenue starting in Q2, and that the shift of value in 2022 is expected to boost annual per-patient revenue, both by way of increased fee-for-service rates as well as quality and outcome-based payments. As mentioned earlier, we anticipate our operating costs to decrease for the full year in 2022, considering the completion of the build out of our internal infrastructure across all of our clinics and corporate offices. When you align these with further synergies in the pipeline and expected improvements to revenues organically through MA contracting and other efforts, the company continues working towards profitability by the end of this year. With that, I'll turn it back to Prad.
Thanks, Andrew. Our focus going forward is gonna be on really four key areas. One, the continued management and operational efficiencies within our existing practices. Two, the integration of NeighborMD into Skylight. As you can all imagine, it is a fairly large acquisition and we're gonna wanna focus on a successful integration. Three, next steps with the JV as we begin to expand value-based care contracting efforts, both starting with Medicare and Medicare Advantage. Four, the expansion of these MA programs in Florida with both Humana and CarePlus. The two most frequent questions I get from our model is how shareholders can see the benefit from our JV with CHS and what the NeighborMD acquisition means going forward.
I'll take a few minutes here on this call to break down both of these and then end with how we can look at growth in the coming quarters before turning to our Q&A. CHS is an organization that, under the ownership of Centene, provides management and operation services to help primary care groups take on risk with healthcare payers. What this means is that for over 10 years, CHS has been perfecting a recipe that helps providers understand their patients, drive quality improvement programs, and realize the benefits and improved health of their patients via cost savings or shared savings with the payers. Some of these programs also benefit from improved capitated payments that we've discussed before. With CHS, the JV will look to accomplish two fundamental goals. The first is value-based care contracting.
With the experience and size of CHS, Skylight will have a stronger platform to negotiate full risk contracts with payers across multiple markets. This means getting better contracts at better rates, but also a better chance of getting these contracts than if Skylight were to enter these conversations alone. Secondly, the contracts that the JV is able to get at full risk significantly improves the revenue and EBITDA contribution, as I will explain shortly. Poor-performing against these contracts means that we would need to have both downside risk protection and an infrastructure that knows how to keep medical expenses down while focusing on patient quality and care. Since CHS has a recipe for success in the past and currently, Skylight will begin benefiting from this knowledge and access to resources through the JV.
This means that not only will we be able to look to win contracts, but also improve our performance under them, translating to more contribution to the bottom line, and we'll talk about that here in a minute. While our patients continue to benefit from the improved services, they can now also receive better overall care from their healthcare provider. As shareholders look forward to the future updates from the JV, we expect that they will be in the form of new contracts and opportunities in the near term in the Medicare and Medicare Advantage space, and both teams have already begun working towards these goals and objectives for 2022. Next, I'd like to touch on the NeighborMD acquisition and what this means for Skylight.
Taking on full risk in Medicare Advantage, something that we've communicated as our goal for shifting these fee-for-service practices into value-based care, means materially also growing top-line revenues, but opportunities for improved contributions for EBITDA. Let me take a few minutes to provide at a high level how the Medicare Advantage risk program works. Let's look at a payer like Humana or Centene. In different states, they offer an opportunity to go full risk on Medicare Advantage lives. What this means is that as a provider group, we have an opportunity to receive a capitated fee, plus an upside based on our ability to keep our patients healthier and manage the total cost of care. When I refer to the total cost of care, I'm referring to all healthcare expenses for the patient for the year. This includes hospital costs, clinical costs, specialist costs, drug or pharmaceutical costs.
The payers, based on a benchmark rate, assign a risk score for every patient in our panel. The risk score is determined based on coding that our providers put on the patient based on the level or complexity of care the patient will need. The higher risk or complex the patients, the higher a risk score. The higher a risk, a risk score also means a higher benchmark or an annual expected cost of care. Let's use some numbers here to describe this. As an example, let's assume that in our case, our patients on average have a risk score that sets a benchmark rate of CAD 1,000 per member per month. That means CAD 12,000 per member per year. This is what we as Skylight will receive from the payer.
From this, the payer calculates all the medical costs associated with that panel of patients. This can be done monthly, quarterly, or annually. Let's assume the medical costs are 95%. Skylight would effectively see a gross margin of 5% or CAD 600 per member per year. This is in addition to a monthly capitated rate based on the payer, which is usually CAD 300-CAD 800 per member per year. In effect, Skylight would realize a gross profit contribution of approximately CAD 1,400 per member per year. This differs greatly from a gross profit standpoint from how we report fee-for-service.
The accounting practice for full risk models follows this type of principle, where in a typical fee-for-service model, the gross margins are your revenue, which is your CAD 200-CAD 400 a year, minus your cost of sales, which is typically your providers and other related medical costs. On a fee-for-service model, if you see a 60% gross margin, you'll recognize roughly CAD 240 as a gross margin. Yes, while the contribution percentage is less in a full risk model, the contribution dollar is significantly more. We're talking about CAD 1,400 a year versus CAD 240 a year. On the other hand, while these dollar amounts continue to be significantly larger, this is where we believe as an organization will continue to drive more EBITDA to the bottom line.
As we continue to perform against these contracts and leveraging our JV with CHS, we can also expect to see an improvement to things like medical costs per year. Thereby looking to reduce medical costs, say from 95% to 90% or less than 90%. All of that means direct contribution to the surplus or contribution to Skylight from a gross profit margin improvement. This results in a direct improvement to the patient's health and well-being. Certainly a model where we continue to say we can do well by doing good. As we look to the rest of 2022 and 2023, we can look to expand Humana and CarePlus plans in Jacksonville, where currently we have over 1,000 Medicare lives in traditional fee-for-service.
Further, future organic growth can come from both increasing our patient panels within our existing practices, but also our relationship with CHS to look at other Medicare Advantage plans in the market. We also look forward to our ability to grow and support these growth initiatives. We are cognizant of the current market that we find ourselves in. We recognize that this is a highly bearish market, and we're not alone in having a share price that does not reflect the value and growth that we have brought to the business in the last 18 months. While transformative news unfortunately does not immediately translate into improved shareholder value, know that we are committed and continue to operate our business for growth. We remain focused on growing the top line while remaining as fiscally responsible on costs and focusing on a pathway to profitability.
We recognize that access to capital is not easy in today's environment, and we're working to be as focused on cash management while ensuring our practices operate to provide the highest quality of care to our patients. Most also believe that a bear market can turn as we have seen in the past, and as such, we will continue to explore all opportunities that allow us as a company to continue to build and benefit our patients and shareholders. It will take patience, it will take elbow grease, and it will take commitment, something that we as executives and a company are committed to.
While we explore all strategic options for the company, we'll continue to leverage a strong pipeline of deal flow, a committed, reliable, and large JV partner, a new debt facility with CAD 10 million still remaining to support growth initiatives, and a commitment to continue moving towards value-based care. We are ready to drive this company forward in 2022 and beyond. With that, Ariel, I'll turn it back to you for any questions.
Thank you. We will now begin the question-and-answer session. To join the question queue, you may press star then one on your telephone keypad. You will hear a tone acknowledging your request. If you are using a speakerphone, please pick up your handset before pressing any keys. To withdraw your question, please press star then two. We will pause for a moment as callers join the queue. Our first question comes from Carl Byrnes of Northland Capital Markets. Please go ahead.
Thanks for the question and congratulations on your progress. You mentioned that pro forma expenses are expected to be 40%-50% lower than what we saw in the first quarter of 2022. Principally, where do you expect those savings to be achieved? Over what time frame do you expect them to be fully achieved? Understanding that or Andrew mentioned that the third quarter would be more reflective with respect to these cost savings. Thanks.
Hey, Carl. Thanks for that. The cost savings that you're gonna see coming as a reduction, both in terms of opportunities to look to right size some of the practice level staffing. You're gonna see some of the changes reflecting some of the corporate investments that we've made as an organization to support the implementation costs of the systems that we've put in place. You'll also see some of those savings come from the cost of implementation of those systems as well. You know, we're also looking at multiple factors of how we invest our capital going forward. You know, one thing I'll commit to continue saying is that on an operational level, the clinics still continue to be generating a positive margin.
It's where we continue to look at investment as a corporate entity where we believe growth will come from the most. You know, now specifically, both with Centene's JV and our, you know, sort of newest welcome partnership with NeighborMD, the ability to look at membership growth in MA offers another opportunity as well, where there's significant organic growth opportunities that can be done also at a alternative cost implementation. Some of these changes happen sort of overall, and we can certainly chat through that as we start to report those changes. These are changes that will also continue to still continue to be evolved and evaluated as we sort of roll forward this year.
Thanks. That's very helpful. One really quick follow-up question. How quickly might you be able to convert the Medicare eligibles to, you know, or MA eligibles rather, in Jacksonville to a full risk? I think you mentioned there's well over 1,000 eligibles in that market. Thanks.
Yeah, of course. Thanks. That answer comes from the health plans, I suppose. Again, one of the things I didn't mention, I should have mentioned, of course, is, you know, along with NeighborMD's, you know, ability to move into full risk, we also have benefited greatly from having some very smart people joining our team that are leading the value-based care efforts now on a national level for Skylight. As part of this transition, you know, each health plan sort of has their own policy for annual enrollment. As I understand it currently, CarePlus has an open enrollment period, which can be enrolled during the course of a calendar year. Some health plans can only enroll during an annual enrollment period, which happens around Q4 of the year.
Our plan right now is, of course, to get our existing practices in Jacksonville onto the same contracts so that, you know, whether that process takes 30 days-60 days or around there, we should be able to start enrolling patients in 2022. As we typically like to say, you know, we like to hold everything off for annual enrollment because that's typically how most payers will do it. I think we can see some enrollment happening in 2022.
Great. Thanks, and congratulations again.
Thanks, Carl.
Our next question comes from Rahul Sarugaser of Raymond James. Please go ahead.
Morning, Prad , Andrew. Thanks so much for those taking our questions. Just looking a little bit at the top line, you identified that EMR implementation and COVID were what affected revenue this quarter. How should we see that playing through into Q2, particularly given COVID, you know, continues to, you know, knock on wood, remain on the decline? Just to extend that question into Q2 revenue, recognizing that you closed the NeighborMD deal on May 6th, is that the date that we should be using for consolidation into the revenue for that quarter?
Thanks, Rahul. Let me answer the first half of that, and I'll turn it over to Andrew there for comments on the second part. With regards to the first part. I'm sorry. I need notes here, Rahul. I'm gonna be the guy that asks you to. Yeah, okay. I'm sorry. EMR rollout. I apologize. Let's talk about the two separately. athenahealth's EMR, I consider that more of a one-time reduction in patient volume.
As you can imagine, when you're shifting a new computer system that all the providers are documenting and charting on and patients are being scheduled on, we probably are going to reduce our daily patient volume because providers will take a little, you know, take a little longer with a new system in charting and documenting, but also in terms of registering patients and show up on time and so forth. Sort of start to finish, there's going to be a small reduction in that, and that's what we saw through February and into a bit of March as we rolled out Florida and Colorado.
You know, from that point forward, we've seen the patient volumes come back in terms of the day, which means our providers have, you know, started to take on a little bit more comfortability with the new system and their ability to sort of manage and practices' ability to manage that patient flow. I don't think that impact continues on in Q2 and beyond. In terms of the COVID-19 visits, that's something that we're just, you know, mindful of. Of course, you know, when you look at past six months, September, October, November were probably the heightened piece of the overall volume that would've come into urgent care with the Omicron variant.
As that has shifted away January, February, you know, our ability to now adjust our numbers and look at where we see healthcare from a, you know, non-pandemic model reflects something that we're seeing today. What you're seeing in lower urgent care visits, you're starting to see in primary care visits. Again, why we believe it's so important to be positioned in the primary care sector. Patients are starting to come back now that they're not so fearful of exposure. You know, that's comments on that. Andrew, I'll hand it back to you for the other piece.
Thanks. As with regards to your question about NeighborMD, Rahul, we closed on the 6th, but the effective date of the transaction was Monday the 2nd . Effectively, we're getting the benefit of the entire month of May. You can count on basically two-thirds of the quarter to show up in the Q2 results for us.
Perfect. Great. Thanks for that clarity. Now my second question is, of course, you know, with the execution of the Centene deal harking back to the ACO acquisition, you guys are building a good infrastructure for conversion of patients towards managed care. Thanks, Prad, for that color where you know, you essentially outlined for us, you know, what that looks like. All of this said, I would assume that it's gonna take a little bit of time for all of this to flow through, you know, executing contracts, so on and so forth. Do you have an internal estimate of when you expect, you know, a material inflection on revenue as a result of these converted patients?
Rahul, like I said, there's two components to that. On the Medicare Advantage side, depending on some of the health plans and the ability to enroll during the course of the year, we might see some enrollment happening in 2022. Typically, with most things Medicare, be it Medicare traditional through the ACO or Medicare Advantage, they tend to follow calendar year patterns. Whatever efforts we put into place this year gets reflected in sort of Q1 2023.
If I were to be more conservative and refer to when I believe we will have a greater inflection outside of the revenue contribution that's coming from the acquisitions we're making, but more specifically related to the organic enrollment of our current patients, you're probably looking safe to say Q1 2023 is when you'll see those lives moving into a capitated full risk model, as well as the ACO REACH that will kick off in January 2023.
Great. That's all from me today, and thanks again for taking our questions. Best of luck with the next quarter.
Thanks, Rahul.
Our next question comes from Yue Ma of Research Capital Corporation. Please go ahead.
Hey, good morning, Prad and Andrew. I have a couple of questions. Firstly, in terms of the company's acquisition pipeline, I was wondering if you could talk about what type of transactions we should expect going forward in terms of the size, strategic reasons, et cetera. Any color would be helpful. Secondly, can you please clarify the value-based care program on the company's gross margin? 'Cause I noticed in the press release under financial highlights, the third bullet states VBC models yield a higher gross margin. However, under outlook, it discussed the gross margin in full risk models will be much lower than in a FFS model. I just wonder if you can clarify that. That's all for me. Thank you.
Yeah. Thanks, Toby . Let me maybe start with your second question first, and then I'll flip back to your first question. With regards to the gross margin, you know, certainly, you're right, the gross margins in a fee-for-service model will be higher. Let's look at two variables. One is percentage of gross margin, second one is value of gross margin. Percentage of gross margin will be higher in a fee-for-service model, as will typically be reported in a full risk capitated model. That is just something that we'll follow industry standards on and most likely look to segment in future earnings so that you can also track those two independently.
While the percentage is higher, call it, I'm just gonna use round numbers here, 60% fee-for-service, say 10%, full- risk capitation. Now, let's look at the dollar value. If your annual value per patient revenue is approximately CAD 400 a year, 60% would be, you know, CAD 200 and odd dollars. If you look at a fully capitated model at CAD 12,000 a year, your gross margin value is CAD 1,200. While the percentage is lower, the dollar value is significantly greater. On the same patient load to operate and run the business, you've got more capital available to you from the premium, from the full risk contract.
Of course, there's opportunities to improve that margin on the full risk contract based on your ability to keep your patients healthier and your ability to overall have a lower cost of expense with regards to their medical expenses. Again, we'll clarify that in future earnings as we look to segment those out. The second question on the acquisition pipeline, I don't think anything changes materially for us in terms of our acquisition pipeline continues to be robust. We've always communicated that. As you can tell, sometimes we work on larger deals, sometimes there's smaller deals. We're much more specific and strategic now on how we evaluate these transactions. You know, we're not necessarily looking at, you know, just Medicare Advantage or any of those lines.
We continue to keep our focus on the primary care practices where we think we can have the most impact to the health of the patient post-acquisition by being able to leverage now, at least in the state of Florida, and then eventually in the states of Colorado and Pennsylvania as well, our ability to bring better contracts through these full risk arrangements or traditional MSO arrangements, so that we have more capital to focus on the patient's health as opposed to just in a fee-for-service model. We'll continue to remain, I'll call it disciplined in the same acquisition pipeline that we have.
you know, while we have deals that we continue to keep evaluating, you know, we're also gonna communicate that our number one goal at this point in time will be the integration of Neighbor successfully and their teams and bringing them onto the Skylight network and culture and so forth. Hopefully that answers those questions.
Yep, that's very helpful. Thank you. That's all from me.
Thanks, Toby.
Our next question comes from Rob Goff of Echelon Wealth Partners. Please go ahead.
Good morning, and thank you for taking my question. Also, thank you for putting forth the per member revenue economics and the margins. Could you perhaps talk to the risk management disciplines associated with those gross margins and any variability that has been seen in the past?
Yeah, I definitely appreciate that question, Rob. When you're looking at forecasting out your risk, and of course, keep in mind, I'm very glad for having the team at Neighbor coming on board with Skylight because we leverage not only their experience over the last five years in successfully operating under these contracts, but also their ability to accurately, in most, you know, cases, beat their expected savings rate that they had forecasted. There could be some variance, of course, when you're looking at medical expenses, especially with new patient populations or with population of patients that you don't have a lot of time with or size with. This reduces as the density of the population becomes bigger, you start to spread that risk over more patients.
Overall, from a percentage standpoint, you know, what Neighbor has been able to do successfully is effectively, you know, call it, beat out their expected savings rate based on their original expectation of what they forecast. So far what we've seen is to the positive. You know, like I said, our goal is to get it down to a margin where it's significantly lower than where the current benchmark might be at, and allows us to see that growth. The leverage that we can continue to keep impacting here will both be, you know, accurately coding our patients to the cost of care that matches what their conditions are and what they are expected to receive as treatments for their conditions.
Secondly, really putting a robust infrastructure, I should say, sort of expanding on a robust infrastructure that we have today in Florida through Neighbor around the areas of care management and overall cost management of these patients by being able to have a better impact on their lives in and out of our practices.
Okay. Thank you. Perhaps could you also talk to the affiliate model within Neighbor, in terms of as it stands and in terms of do you look to expand that as an area of growth?
Yeah, of course. Now, just always keeping in mind our model has always been an owned clinic model, the affiliate piece for us, you know, is a piece that came along with the acquisition, not something necessarily that we had to increase our value of acquisition to acquire. I think it's a great model. The affiliate models are, of course, you know, relationships with third party providers that we do not own in their practice, and so we basically manage their Medicare Advantage or they participate in our Medicare Advantage contracts. You know, receive the benefit of the surplus and cap payments while we receive a percentage of that as well for providing and managing that risk. It's a model that is similar to other healthcare players like agilon health and a few other ones.
You know, in the case of saying an affiliate model is as sticky as an own model would be a little bit, you know, in our minds we wouldn't do that. An affiliate model has options over time, and so that's one of the reasons why part of our approach to the integration is also assessing the performance of the affiliates, looking at who might be stickier, where we wanna consider these affiliates long-term. Certainly, there's an opportunity through the affiliates to look at anyone that's looking to exit. They've now got a partner in their management team that effectively they could exit into. As we look at the affiliates going long term, certainly, an opportunity for us to build a business without the layer of operational needs.
If it continues to show promise, I don't see why we wouldn't be looking to grow the affiliate program. Again, you know, with the NeighborMD team coming on board, there is a team that's now driving those efforts forward, managing those relationships, and so we'll look to leverage at least what we can in the near term, to be able to see the sustenance of that program.
Very good. Thank you, and good luck.
Thanks, Rob.
Our next question comes from Frank Takkinen of Lake Street Capital Markets. Please go ahead.
Hey, guys. Thanks for taking my questions. I wanted to start with integration. How long do you expect the NeighborMD integration process to take? And do you feel the balance sheet has provided the adequate liquidity to get there? I think I've got you guys at about CAD 5 million cash on the balance sheet as we consider the CAD 2 million or so you'll receive for working capital purposes for the first CAD 10 million tranche from the debt facility that was established. How long integration, and do you have the adequate liquidity to get there?
Yeah. Frank, we're looking at our gate plan is 90 days. What'll probably stretch that 90-day mark might just be things like athenahealth's implementation or maybe some of the system implementation. You know, some of these things just have sometimes their own timelines attached with them. As quickly as we can, operationally and organizationally, the integration has already begun. We've already integrated in aspects of their business from day one, and we had a fairly good chance to understand the company prior to acquisition and work with many of the team members. From areas like human resources to revenue cycle management, even regional leadership and operations, these teams are starting to now integrate.
With our integration plan in place, and like I said, we have strong team members on both sides, we're looking forward to call it a 90-day out integration period. I'm sorry, let me address the second part.
Okay.
Yeah, regarding the balance sheet. Yeah, I mean, you know, while Neighbor does have, you know, a cost expense attached with it, we did see a significant portion of those costs come off prior to closing the acquisition, and just decisions that we didn't need to have in terms of Skylight's infrastructure and what we possess from an overall infrastructure standpoint, systems, people, resources, et cetera. There are significant opportunities to continue to move towards some cost savings within Neighbor that we can look to hopefully achieve within this 90-day period. You know, the answer for me, like everything else, is it's cash management and, you know, we're gonna be working hard to be able to get there. Andrew, I don't know if you wanna add any more to that.
I think the only thing I'd add, Frank, is just really about the working capital. Although we acquired Neighbor on a cashless basis, there was receivables that came with that, receivables and payables. But it did give us a working capital to handle and deal with, which is, you know, some acquisitions we've made, we do not acquire the receivables, for example, or we cut off the working capital. This was done with and including the working capital. So we, you know, we do have the ability to kinda manage that alongside our own working capital. We intend to do that over that integration period.
Okay. That's helpful. Congrats on all progress. I'll stop there. Thanks.
Thank you.
Thanks, Frank.
This concludes today's question and answer session. I would like to turn the conference back over to Mr. Sekar for any closing remarks.
Thanks, Ariel. Again, I really appreciate everybody's time in participating in today's call. As always, we hope we're able to convey some of the excitement we have about Skylight and our prospects going forward. You can always learn more on our website, skylighthealthgroup.com, more information about our company and, of course, contact details should you wish to reach out to us. Wish everybody a great day, and we look forward to speaking to you again soon. Thank you.
This concludes today's conference call. You may disconnect your lines. Thank you for participating, and have a pleasant day.