The talks with a lender group, led by Blue Owl, come as a number of healthcare providers are facing pressure on their profitability after the Centers for Medicare & Medicaid Services changed how patients with pre-existing conditions are risk scored. This change has led to lower revenues despite prevailing costs for the same care, as previously reported.

The Kinderhook Industries-backed primary care service provider had hired Evercore and Kirkland, 9fin reported in August, with lenders banding together with Davis Polk and Houlihan Lokey prior to the negotiations.

The company on 18 October saw a ratings downgrade to CCC+ from B-, as elevated operating costs squeezed its EBITDA margin to 2% in the first half of 2024, down from 8% the same period 2023, according to S&P. As of 30 June 2024, it had roughly $142.3m in cash and an $88m revolver due 2026, the credit rater said.

High medical cost ratios, capex on newly opened locations, and $7.5m annual debt amortization costs under its $750m first-lien term loan due 2028 will put the company in a free cash flow deficit until 2026, S&P said.

Still, it has no major debt maturities until 2028 and can cover expenses for the next couple of years, it said.

The company has a $600m first lien term loan and $150m incremental loan, both due 2028. 

Representatives at Better Health, Kinderhook and Blue Owl did not respond to requests for comment.

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