Case study R1

The company

R1 RCM (R1) is a publicly-traded company (NASDAQ: RCM) that partners with U.S. healthcare providers to help them manage their revenue cycle more efficiently and cost-effectively. R1’s revenue cycle services and physician advisory services enable healthcare providers to improve financial performance and reinvest capital in patient care and outcomes.

Why we invested

  • Largest, independent, end-to-end revenue cycle provider in the US
  • World-class operating system supported by a fully integrated, proprietary technology platform
  • Strongly positioned in a large and growing market
  • Ability to pursue strategic M&A opportunities in a fragmented sector
Year of Investment


Revenue (FY 2018)




Building a better business

R1’s customers are principally healthcare providers committed to providing access to healthcare for those in need. The company aims to increase its customers’ revenue yield, improve the velocity of payment and reduce the cost of revenue cycle operations, while at the same time improving efficiency, compliance and patient satisfaction. Providers can reinvest cash flow benefits generated by R1 to improve the quality of care and the patient experience at their facilities.

In partnership with Ascension, the largest not-for-profit health system in the U.S., which had previously invested in two TowerBrook portfolio companies in the healthcare industry, we pursued a thesis and targeted potential platform assets in the large and rapidly evolving RCM space.

Prior to TowerBrook’s investment, Ascension had been the foundational customer of R1 (formerly known as Accretive Health). Upon closing of the transaction in February 2016, R1 and Ascension renewed and expanded the scope of their existing commercial services agreement for a 10-year term, adding an incremental c.$8 billion of new net patient revenue (NPR) from Ascension, and more than doubling the company’s NPR under management.


Under TowerBrook and Ascension ownership, R1 RCM, which remains a public company, has scaled from c.3,000 employees in February 2016 to c.17,000 in April 2019, and increased NPR under management from c.$6 billion to c.$31 billion.

The business continues to make investments in human capital and technology to further differentiate its operating capabilities and support its customers’ growth initiatives.

In May 2018, R1 acquired Intermedix, a physician-focused business providing revenue cycle management, practice management and data analytics services to more than 15,000 individual healthcare providers across the U.S. The acquisition of Intermedix accelerated R1’s strategy to integrate revenue cycle across all payment models and care settings.

Values, experience, proven processes, scalable infrastructure and industry-leading technology make R1 RCM a value-added partner for healthcare providers.

In November 2018, R1 RCM announced a partnership with Automation Anywhere, a robotic process automation business, which will allow the company to improve its RPA, cognitive automation and analytics capabilities.