Everside Health Financial Model

Everside operates onsite, nearsite, and virtual primary care health centers for employers. Employers pay a fixed, recurring, multi-year contract fee (replacing utilization-driven fee-for-service). Employees receive free or low-copay access to: primary care, mental health services, chronic condition management, wellness coaching, onsite labs/testing, occupational health, referral management, and pharmacy. A proprietary rules engine ingests medical & Rx claims, clinical & lab data, wellness & risk data, and social determinants to generate a 360-degree patient view and produce actions for patients and providers.

Key differentiators vs. industry:

• Same/next-day appointments vs. 56-day average wait
• 885 average patient panel size vs. 2,200 industry average
• NPS +85 vs. industry average -1.7
• 1.1% medical cost trend vs. 6–7% industry inflation

• 100M+ Americans covered by self-funded plan sponsors in 2021
• Plan sponsor health benefit costs averaged 7.8% of total compensation in 2021
• Average annual family coverage premium (2021): $22,221 total ($16,253 plan sponsor + $5,969 worker)
• 87% of large employers believe health benefit costs will become unsustainable in the next 5–10 years
• Only 10% of plan sponsors currently use value-based care (VBC) solutions; 87% have shown interest
• 73% of plan sponsors plan to engage in VBC programs within the next 5 years (McKinsey survey)

• Fixed, recurring, multi-year contracts with employer plan sponsors
• Fee structure: Per-employee-per-month (PEPM) or per-health-center contract - specific pricing not disclosed in deck
• Channels: Direct B2B sales to self-funded employers (350+ clients as of deck date)
• Delivery models: Onsite health centers (employer-dedicated), nearsite health centers (shared/multi-employer), and virtual care
• Ancillary: Pharmacy, labs/testing embedded in health centers

All figures as of deck date (circa mid-2022 based on context):

• 575K+ patients
• 350+ employer clients
• 375+ health centers
• 400+ employed providers
• 34 U.S. states / 140+ markets
• 1,400+ employees
• NPS +85 (as of July 2022)
• 81% of patients report health improved after using services
• 75% of patients viewed their employer more favorably due to Everside access
• Clinical quality and outcomes metrics at 90th percentile or higher
• 30%+ cost savings for employers
• Best in KLAS: Employer Sponsored Healthcare Services 2022

• Medical cost trend for employers: 1.1% vs. 6–7% industry average
• Employer cost savings: 30%+
• Patient panel size: 885 per provider vs. 2,200 industry average

Moat framing from deck:

• Lower panel sizes enable high-touch, relationship-based care (vs. volume-driven FFS model)
• Proprietary technology rules engine aggregating multi-source patient data (claims, clinical, labs, wellness, social determinants)
• Fixed-contract model aligns incentives with employers to reduce total cost of care (vs. FFS which rewards utilization)
• NPS +85 creates strong patient/employer retention
• Scaled national footprint (375+ health centers, 34 states) is a hard-to-replicate physical asset base
• Named competitors: Not explicitly named in deck

Team:

• Chris Miller, CEO - prior: Trumpet Behavioral Health, DaVita
• Heather Dixon, CFO - prior: Walgreens Boots Alliance, Aetna
• Adam Johnson, Chief Growth & Strategy Officer - prior: Compass, Alight
• Tobias Barker MD, Chief Medical Officer - prior: Mass General Brigham, CVS Health
• Courtney Harwood, CMO - prior: CLEAR, Xerox
• Sampath Narayanan, CIO - prior: Concerto Health, Cognizant
• Allison Velez, Chief People Officer - prior: Optum, DaVita
• Michi Tsuda JD MBA, General Counsel - prior: Greenberg Traurig, Squire Patton Boggs
• Mason Reiner, SVP Innovation & Value Based Care - prior: R Health

• Archetype + why: Employer-sponsored healthcare services revenue model - B2B contracted recurring revenue with a per-health-center / PEPM structure. Closest archetype is a contracted services / recurring revenue 3-statement model with client cohort tracking. Not a pure SaaS ARR model (physical health centers are the delivery unit and carry significant capex/opex), not a pure insurance GWP/loss-ratio model (Everside is not the risk-bearer - the employer is). The correct frame is a health center P&L + employer contract revenue model: revenue is contract fees per client (or per enrolled life), costs are driven by health center count × cost per center and provider headcount × fully loaded cost per provider.

• Forecast horizon & granularity: 5-year annual model (2022–2027) with monthly build for Year 1; given physical build-out cycle, annual granularity is appropriate for Years 2–5.

• Key drivers & assumptions:

• Scenarios (Base / Bull / Bear - which variables flex):
• Base: 350 clients → 600 by Year 5; PEPM $100; gross margin 25%
• Bull: Accelerated employer adoption (73% VBC intent in 5 years); PEPM $120; gross margin 30%; health center utilization improves
• Bear: Employer budget pressure slows new wins; churn rises to 8%; PEPM held flat; new health center openings halved

• Required sheets / outputs:

1. Assumptions - all drivers listed above with scenario toggle
2. Client & Lives Build - cohort-based: new clients × avg lives per client → total enrolled lives per year
3. Revenue - enrolled lives × PEPM × 12; break out onsite vs. nearsite vs. virtual if data becomes available
4. Health Center P&L - revenue per center, direct costs (providers, facility), contribution margin per center
5. Headcount & Opex - providers (panel-size-driven), non-clinical staff (center-count-driven), G&A, sales & marketing
6. Income Statement - revenue, COGS (provider + center costs), gross profit, opex, EBITDA
7. Balance Sheet - capex for health center build-out, working capital, debt (if applicable)
8. Cash Flow Statement - operating CF, capex (growth investment in new centers), free cash flow
9. KPI Dashboard - clients, enrolled lives, health centers, PEPM, revenue/center, gross margin %, EBITDA margin %