0001558370-22-002466 | 10-K | XBRL Viewer

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Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 91,413	$ 70,305
Marketable securities	28,005	38,994
Accounts receivable, net of $17,379 and $9,502 of allowances at December 31, 2021 and 2020, respectively	134,557	75,664
Prepaid expenses and other current assets	4,564	5,259
Total current assets	258,539	190,222
Property and equipment, net	5,027	3,400
Operating lease right-of-use assets	7,805	8,668
Goodwill	11,880	11,880
Intangible assets, net	599	1,213
Deferred tax assets	71,274	37,971
Other noncurrent assets	2,941	573
Total assets	358,065	253,927
Current liabilities:
Accounts payable	61,399	43,514
Accrued expenses and other current liabilities	37,425	34,272
Total current liabilities	98,824	77,786
Operating lease noncurrent liabilities	7,419	8,318
Other noncurrent liabilities		876
Total liabilities	106,243	86,980
Commitments and Contingencies (Note 14)
STOCKHOLDERS' EQUITY
Common stock, $0.0001 par value; 1,000,000,000 shares authorized at December 31, 2021 and 2020, respectively; 91,088,781 and 87,054,329 shares issued and outstanding at December 31, 2021 and 2020, respectively	9	9
Additional paid-in capital	255,339	236,139
Treasury stock, at cost, $0.0001 par value; 615,980 shares outstanding at December 31, 2021 and 2020, respectively	(1,009)	(1,009)
Accumulated deficit	(2,424)	(68,193)
Accumulated other comprehensive income (loss)	(93)	1
Total stockholders' equity	251,822	166,947
Total liabilities and stockholders' equity	$ 358,065	$ 253,927

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Allowances for accounts receivable
Allowances for accounts receivable	$ 17,379	$ 9,502
Common stock
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, shares issued (in shares)	91,088,781	87,054,329
Common stock, shares outstanding (in shares)	91,088,781	87,054,329
Treasury stock
Treasury stock, shares outstanding (in shares)	615,980	615,980

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statements of Operations
Revenue	$ 500,621	$ 344,858	$ 229,683
Revenue, type	Service	Service	Service
Cost of services	$ 388,486	$ 274,799	$ 184,178
Cost of services, type	Service	Service	Service
Gross profit	$ 112,135	$ 70,059	$ 45,505
Operating expenses:
Sales and marketing	20,179	15,006	11,901
General and administrative	59,616	46,705	23,927
Total operating expenses	79,795	61,711	35,828
Income from operations	32,340	8,348	9,677
Other income (expense):
Other income (expense), net	(366)	210
Interest income (expense), net	461	121	(58)
Convertible preferred stock warrant valuation adjustment			(18,176)
Total other income (expense), net	95	331	(18,234)
Income (loss) before income taxes	32,435	8,679	(8,557)
Benefit (provision) for income taxes	33,334	37,780	(12)
Net income (loss)	$ 65,769	$ 46,459	$ (8,569)
Net income (loss) per share:
Basic (in dollars per share)	$ 0.74	$ 0.54	$ (0.41)
Diluted (in dollars per share)	$ 0.66	$ 0.47	$ (0.41)
Weighted-average shares used in computing net income (loss) per share:
Basic (in shares)	89,105,562	85,722,670	20,735,202
Diluted (in shares)	100,358,047	99,055,526	20,735,202

Consolidated Statement of Comprehensive Income (Loss) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income (Loss)
Net income (loss)	$ 65,769	$ 46,459	$ (8,569)
Other comprehensive income (loss):
Unrealized gain (loss) on marketable securities	(94)	1
Total other comprehensive income (loss)	(94)	1
Total comprehensive income (loss)	$ 65,675	$ 46,460	$ (8,569)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Consolidated Statements of Changes in Convertible Preferred Stock $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) shares
Increase (Decrease) in Convertible Preferred Stock
Balance at beginning of period \| $	$ 106,237
Balance at beginning of period (in shares) \| shares	65,428,088
Conversion of Convertible Preferred Stock to Common Stock upon initial public offering \| $	$ (106,237)
Conversion of Convertible Preferred Stock to Common Stock upon initial public offering (in shares) \| shares	(65,428,088)

- Definition

Carrying amount, attributable to parent, of an entity's issued and outstanding stock which is not included within permanent equity. Temporary equity is a security with redemption features that are outside the control of the issuer, is not classified as an asset or liability in conformity with GAAP, and is not mandatorily redeemable. Includes any type of security that is redeemable at a fixed or determinable price or on a fixed or determinable date or dates, is redeemable at the option of the holder, or has conditions for redemption which are not solely within the control of the issuer. Includes stock with a put option held by an ESOP and stock redeemable by a holder only in the event of a change in control of the issuer.

+ References + Details

Consolidated Statements of Changes in Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Common Stock	Treasury Stock	Additional Paid in Capital	Accumulated Deficit Cumulative Effect, Period of Adoption, Adjustment [Member]	Accumulated Deficit	Other Comprehensive Income	Cumulative Effect, Period of Adoption, Adjustment [Member]	Total
Balance at beginning of period at Dec. 31, 2018	$ 1	$ (884)	$ 10,622		$ (104,854)			$ (95,115)
Balance at beginning of period (in shares) at Dec. 31, 2018	5,155,407
Increase (Decrease) in Stockholders' Equity (Loss)
Repurchase of common stock		(125)			(60)			(185)
Repurchase of common stock (in shares)	(26,659)
Stock option exercise			6,536					6,536
Stock option exercises (in shares)	6,490,059
Stock-based compensation			5,061					5,061
Conversion of convertible preferred stock to common stock upon initial public offering	$ 7		106,230					106,237
Conversion of convertible preferred stock to common stock upon initial public offering (in shares)	65,428,088
Conversion of convertible preferred stock warrants to common stock warrants upon initial public offering			22,765					22,765
Warrant exercise			62					62
Warrant exercise (in shares)	441,307
Issuance of Common Stock in connection with initial public offering, net of issuance costs of $5.9 million and $3.7 million in offering costs			77,479					77,479
Net income (loss)					(8,569)			(8,569)
Balance at end of period at Dec. 31, 2019	$ 8	(1,009)	228,755	$ (1,169)	(113,483)		$ (1,169)	114,271
Balance at end of period (in shares) at Dec. 31, 2019	84,188,202
Increase (Decrease) in Stockholders' Equity (Loss)
Issuance of employee equity awards, net of shares withheld	$ 1		(5,451)					(5,450)
Issuance of employee equity awards, net of shares withheld (in shares)	2,688,273
Stock-based compensation			(12,821)					(12,821)
Initial public offering costs			(14)					(14)
Warrant exercise			0					0
Warrant exercise (in shares)	177,854
Other comprehensive income (loss)						$ 1		1
Net income (loss)					46,459			46,459
Balance at end of period at Dec. 31, 2020	$ 9	(1,009)	236,139		(68,193)	1		$ 166,947
Balance at end of period (in shares) at Dec. 31, 2020	87,054,329							87,054,329
Increase (Decrease) in Stockholders' Equity (Loss)
Issuance of employee equity awards, net of shares withheld			(14,589)					$ (14,589)
Issuance of employee equity awards, net of shares withheld (in shares)	3,209,461
Stock option exercises (in shares)								3,440,937
Stock-based compensation			33,789					$ 33,789
Warrant exercise			0					0
Warrant exercise (in shares)	824,991
Other comprehensive income (loss)						(94)		(94)
Net income (loss)					65,769			65,769
Balance at end of period at Dec. 31, 2021	$ 9	$ (1,009)	$ 255,339		$ (2,424)	$ (93)		$ 251,822
Balance at end of period (in shares) at Dec. 31, 2021	91,088,781							91,088,781

Consolidated Statements of Changes in Stockholders' Equity (Deficit) (Parenthetical) $ in Millions	12 Months Ended
	Dec. 31, 2019 USD ($)
Statement of Stockholders' Equity [Abstract]
Issuance costs	$ 5.9
Offering costs	$ 3.7

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
OPERATING ACTIVITIES
Net income (loss)	$ 65,769	$ 46,459	$ (8,569)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Deferred tax (benefit) expense	(33,303)	(37,971)	12
Non-cash interest expense	38	75
Depreciation and amortization	1,301	1,906	2,133
Stock-based compensation expense	33,706	12,821	5,061
Bad debt expense	9,783	5,562	1,606
Loss on disposal of property and equipment			1
Change in fair value of warrant liabilities			18,176
Changes in operating assets and liabilities:
Accounts receivable	(68,676)	(35,336)	(25,342)
Prepaid expenses and other current assets	675	(326)	(4,118)
Accounts payable	17,840	25,008	3,501
Accrued expenses and other current liabilities	2,184	17,400	6,385
Other noncurrent assets and liabilities	(3,280)	605	(380)
Net cash provided by (used in) operating activities	26,037	36,203	(1,534)
INVESTING ACTIVITIES
Purchase of property and equipment, net	(2,129)	(1,037)	(2,956)
Purchases of marketable securities	(111,477)	(103,964)
Sale of marketable securities	122,372	64,970
Net cash provided by (used in) continuing operations	8,766	(40,031)	(2,956)
Net cash provided by discontinued operations			200
Net cash provided by (used in) investing activities	8,766	(40,031)	(2,756)
FINANCING ACTIVITIES
Proceeds from issuance of common stock upon initial public offering			81,220
Payment of initial public offering costs		(892)	(2,835)
Proceeds from revolving line of credit			182,025
Repayments made against revolving line of credit			(182,278)
Repurchase of common stock			(185)
Proceeds from exercise of stock options	2,924	2,329	6,536
Payment of employee taxes related to equity awards	(17,966)	(8,930)
Proceeds from contributions to employee stock purchase plan	1,347	1,244
Proceeds from exercise of stock warrants			62
Net cash (used in) financing activities	(13,695)	(6,249)	84,545
Net increase (decrease) in cash and cash equivalents	21,108	(10,077)	80,255
Cash and cash equivalents, beginning of period	70,305	80,382	127
Cash and cash equivalents, end of period	91,413	70,305	80,382
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for interest			176
Cash paid for income taxes, net of refunds received	97
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Additions of property and equipment, net included in accounts payable and accrued expenses	$ 204	$ 24
Deferred initial public offering costs in accounts payable and accrued expenses			906
Non-cash preferred stock warrant conversion to common stock warrant upon IPO			$ (22,765)

Business and Basis of Presentation

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Business and Basis of Presentation

1. Business and Basis of Presentation

Description of Business

Progyny, Inc. (together with its subsidiaries referred to as “Progyny” or the “Company”) was incorporated in the state of Delaware on April 3, 2008, and maintains its corporate headquarters in New York, NY.

Progyny is a provider of a fertility benefits solution and pharmacy benefits solution and operates and manages in one operating segment. The fertility benefits solution consists of a significant service that integrates: (1) the treatment services (“Smart Cycles”) that the Company has designed, (2) access to the Progyny network of high-quality fertility specialists that perform the Smart Cycle treatments and (3) active management of the selective network of high-quality provider clinics, real-time member eligibility and treatment authorization, member-facing digital tools and detailed quarterly reporting supported by the Company’s dedicated account management teams, and end to end comprehensive concierge member support provided by Progyny’s in-house staff of Patient Care Advocates (“PCAs”) (collectively, the “care management services”).

The Company enhanced its fertility benefits solution with the launch of Progyny Rx, its pharmacy benefits solution, effective January 1, 2018. As part of this solution, the Company provides formulary plan design, simplified authorization, assistance with prescription fulfillment, and timely delivery of the medications by the Company’s network of specialty pharmacies, as well as medication administration training, pharmacy support services, and continuing PCA support. As a pharmacy benefits solution provider, Progyny manages the dispensing of pharmaceuticals through the Company’s specialty pharmacy contracts. The pharmacy benefits solution is only available as an add-on service to its fertility benefits solution.

Reverse Stock Split

On October 14, 2019, the shareholders of Progyny approved a one-for-4.5454 reverse stock split of its common and convertible preferred stock. The par value of the common stock and convertible preferred stock was not adjusted as a result of the reverse stock split. Accordingly, the consolidated financial statements and notes retroactively reflect Progyny’s capital structure after giving effect to the reverse stock split.

Initial Public Offering

On October 29, 2019, the Company completed its initial public offering (“IPO”) in which it issued and sold 6,700,000 shares of its common stock at a public offering price of $13.00 per share. As part of the IPO, certain selling stockholders offered and sold an additional 4,800,000 shares (including 1,500,000 shares sold pursuant to the exercise of the underwriters’ over-allotment option), at an equivalent public offering price of $13.00 per share. The Company received net proceeds of $77.6 million from the IPO, after deducting underwriters’ discounts and commissions of $5.9 million and offering costs of $3.6 million. Offering costs were initially capitalized and consisted of fees and expenses incurred in connection with the sale of common stock in the IPO, including legal, accounting, printing and other IPO-related costs. Upon completion of the IPO, these offering costs were reclassified to stockholders’ equity and offset against the proceeds from the offering on the balance sheet. Immediately prior to the completion of the IPO, all shares of convertible preferred stock then outstanding were converted into 65,428,088 shares of common stock on a one-to-one basis, $106.2 million of convertible preferred stock was reclassified to additional paid-in-capital and $7,000 of convertible preferred stock was reclassified to common stock on the Company’s balance sheet.

Basis of Presentation

The accompanying consolidated financial statements include those of the Company and its wholly owned subsidiaries. All intercompany balances and transactions have been eliminated in consolidation. The consolidated financial statements and accompanying notes were prepared in accordance with accounting principles generally accepted in United Sates (“U.S. GAAP”).

Additionally, there are many uncertainties regarding the ongoing coronavirus (“COVID-19”) pandemic, including variants, and the Company is closely monitoring the impact of the pandemic on all aspects of its business, including how it has impacted and may continue to impact its customers and members, its provider network, specialty pharmacy partners, employees, suppliers, vendors, and other business partners. The full extent to which the COVID-19 pandemic will directly or indirectly impact the Company’s business, future results of operations and financial condition will depend on future developments that are highly uncertain and cannot be accurately predicted, including new information that may emerge concerning COVID-19 and variants, the actions taken to contain it or treat its impact, vaccine roll-out efforts and impact, including vaccine hesitancy, break-through cases and the economic impact on local, regional and national markets. The overall disruption of the healthcare and fertility markets and the other risks and uncertainties associated with the pandemic could have a material adverse effect on the Company’s business, financial condition, results of operations and growth prospects. The Company will continue to assess the evolving impact of the COVID-19 pandemic and will make adjustments to its operations as necessary.

Segment Information

Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker (“CODM”), or decision-making group, in making decisions on how to allocate resources and assess performance. The Company operates and manages in one operating segment, providing fertility and pharmacy benefits solutions. The Company defines its CODM as its Chief Executive Officer and its President. All long-lived assets are located in the United States and all revenue is attributed to the United States. Since the Company operates in one operating segment, all required financial segment information can be found in the consolidated financial statements.

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP generally requires management to make estimates and assumptions that affect the reported amount of certain assets, liabilities, revenue, and expenses, and the related disclosure of contingent assets and liabilities. Such estimates include, but are not limited to, the determination of accrued receivables related to revenue recognition, accrued claims payable, allowance for doubtful accounts, stock-based compensation, convertible preferred stock warrant liabilities, lease liabilities, and accounting for income taxes. Management bases its estimates on historical experience and on various other assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Cash and Cash Equivalents and Marketable Securities

Cash and cash equivalents are stated at fair value. The Company considers all highly liquid investments purchased with original maturities of three months or less at the time of purchase to be cash equivalents. Marketable securities, primarily consisting of U.S. Government and agency securities with original maturities greater than three months but less than one year when purchased, are classified as available-for-sale, and are stated at fair value. Unrealized gains and losses on marketable securities are excluded from earnings and reported as a component of other comprehensive income (loss).

Revenue Recognition

Revenue is recognized when control of the promised goods or services is transferred to clients in an amount that reflects the consideration the Company expects to be entitled to in exchange for those goods or services.

The Company applies the following five-step model to recognize revenue from contracts with clients:

●

Identification of the contract, or contracts, with a client

●

Identification of the performance obligations in the contract

●

Determination of the transaction price

●

Allocation of the transaction price to the performance obligations in the contract

●

Recognition of revenue when, or as, a performance obligation is satisfied

Progyny’s contracts typically have a stated term of three years and include contractual termination options after the first year, allowing the client to terminate the contract with 30 to 90 days’ notice.

Fertility Benefits Solution Revenue

Progyny primarily generates revenue through its fertility benefits solution, in which Progyny provides self-insured enterprise entities (‘‘clients’’) and their employees and partners (together, ‘‘members’’) with fertility benefits. As part of the fertility benefits solution, Progyny provides access to effective and cost-efficient fertility treatments, referred to as Smart Cycles, as well as other related services. Smart Cycles are proprietary treatment bundles that include certain medical services available to members through Progyny’s proprietary, credentialed network of provider clinics. In addition to access to Progyny’s Smart Cycle treatment bundles and access to Progyny’s network of provider clinics, the fertility benefits solution includes other comprehensive services, which Progyny refers to as care management services, such as active management of the provider clinic network, real-time member eligibility and treatment authorization, member-facing digital tools throughout the Smart Cycle and detailed quarterly reporting all supported by client facing account management and end-to-end comprehensive member support provided by Progyny’s in house staff of PCAs.

The promises within Progyny’s fertility benefits contract with a client represent a single performance obligation because Progyny provides a significant service of integrating the Progyny designed Smart Cycles and access to the fertility treatment services provided by provider clinics with the other comprehensive services into the combined fertility benefits solution that the client contracted to receive. Progyny’s fertility benefits solution is a stand-ready obligation that is satisfied over the contract term.

Progyny’s contracts include the following sources of consideration, which are all variable: a per employee per month (‘‘PEPM’’) administration fee (in most, but not all contracts) and a fixed rate per Smart Cycle. The PEPM administration fee is allocated between the fertility benefits solution and the pharmacy benefits solution based on standalone selling price, estimated using an expected cost-plus margin method. The Company allocates the variable consideration related to the fixed rate per Smart Cycle to the distinct period during which the related services were performed as those fees relate specifically to the Company’s efforts to provide its fertility benefits solution to its clients in the period and represents the consideration the Company is entitled to for the fertility benefit services provided. As a result, the fixed rate per Smart Cycle is included in the transaction price and recognized in the period in which the Smart Cycle is provided to the member.

Progyny’s contracts also include potential service level agreement refunds related to outcome-based service metrics. These service level refunds, which are determined based on results of a full plan year, if met, are based on a percentage of the PEPM fee paid by clients. The Company estimates the variable consideration related to the total PEPM administration fee, less estimated refunds related to service level agreements, and recognizes the amounts allocated to

the fertility benefits solution ratably over the contract term. Progyny’s estimate of service level agreement refunds, have not historically resulted in significant adjustments to the transaction price.

Clients are typically invoiced on a monthly basis for the PEPM administration fee. Progyny invoices its clients and members for their respective portions of the fixed rate per Smart Cycle bundle when all treatment services within a Smart Cycle are completed by the provider clinic. Once an invoice is issued, payment terms are typically between 30 to 60 days.

The Company assesses whether it is the principal or the agent for each arrangement with a client, since fertility treatment services are provided by a third party—the provider clinics. The Company is the principal in its arrangements with clients and therefore presents revenue gross of the amounts paid to the provider clinics because Progyny controls the specified service (the fertility benefits solution) before it is transferred to the client. Progyny integrates the fertility treatment services provided by the provider clinics into the overall fertility benefits solution that the client contracted to receive. In addition, Progyny defines the scope of the potential services to be performed by the provider clinics and monitors the performance of the provider clinics. Furthermore, Progyny is primarily responsible for fulfilling the promise to the client and has discretion in setting the pricing, as Progyny separately negotiates agreements with the provider clinics, which establish pricing for each treatment service. Pricing of services from provider clinics is independent from the fees charged to clients.

Pharmacy Benefits Solution Revenue

For clients that have the fertility benefits solution, Progyny offers, as an add-on, its pharmacy benefits solution, which is a separate, fully integrated pharmacy benefit. As part of the pharmacy benefits solution, Progyny provides care management services, which include Progyny’s formulary plan design, prescription fulfillment, simplified authorization and timely delivery of the medications used during treatment through Progyny’s network of specialty pharmacies, and clinical services consisting of member assessments, UnPack It calls, telephone support, online education, medication administration training, pharmacy support services and continuing PCA support.

The pharmacy-related promises represent a single performance obligation because Progyny provides a significant service of integrating the formulary plan design, prescription fulfillment, clinical services and PCA support into the combined pharmacy benefits solution that the client contracted to receive. The pharmacy benefits solution is a stand-ready obligation that is satisfied over the contract term.

Progyny’s contracts include the following sources of consideration, all of which are variable: a PEPM administration fee (in most, but not all contracts) and a fixed fee per fertility drug. As described above, the PEPM administration fee, less estimated refunds related to service level agreements, is allocated to the pharmacy benefits solution and recognized ratably over the contract term. The Company allocates the variable consideration related to the fixed fee per fertility drug to the distinct period during which the related services were performed, as those fees relate specifically to the Company’s efforts to provide its pharmacy benefits solution to clients in the period and represents the consideration the Company is entitled to for the pharmacy benefit services provided. As a result, the fixed fee per fertility drug is included in the transaction price and recognized in the period in which the Company is entitled to consideration from a client, which is when a prescription is filled and delivered to the members.

As stated above, clients are invoiced on a monthly basis for the PEPM administration fee. Progyny invoices the client and the member for their respective portions of the fixed fee per fertility drug, when the prescription services are completed by the specialty pharmacies. Once an invoice is issued, payment terms are typically between 30 to 60 days.

The Company assesses whether it is the principal or the agent for each arrangement with a client, as prescription fulfillment and clinical services are provided by a third party—the specialty pharmacies. The Company is the principal in its arrangements with clients, and therefore presents revenue gross of the amounts paid to the specialty pharmacies. Progyny controls the specified service (the pharmacy benefits solution) before it is transferred to the client. Progyny integrates the prescription fulfillment and clinical services provided by the pharmacies and PCAs into the overall pharmacy benefits solution that the client contracted to receive. In addition, Progyny defines the scope of the potential services to be performed by the specialty pharmacies and monitors the performance of the specialty

pharmacies. Furthermore, Progyny is primarily responsible for fulfilling the promise to the client and has discretion in setting the pricing, as Progyny separately negotiates agreements with pharmacies, which establish pricing for each drug. Pricing of fertility drugs is independent from the fees charged to clients.

The Company does not disclose the transaction price allocated to remaining performance obligations because all of the transaction price is variable and is allocated to the distinct periods to which the services relate, as discussed above. The remaining contract term is typically less than one year, due to the client’s contractual termination options.

Accrued Receivable and Accrued Claims Payable

Accrued receivables are estimated based on historical experience for those fertility benefit services provided but for which a claim has not been received from the provider clinic at the end of the reporting period, which includes assumptions regarding the lag between authorization date and service date as well as estimates for changes and cancellations of services. At the same time, cost of services and accrued claims payables are estimated based on the amount to be paid to the provider clinic and expected gross margin on fertility benefit services. Estimates are adjusted to actual at the time of billing. Adjustments to original estimates have not been material.

As of December 31, 2021 and 2020, accrued receivables were $30.2 million and $28.2 million, respectively. Accrued receivables are included within accounts receivable in the consolidated balance sheet.

Accrued claims payable of $20.0 million and $22.8 million as of December 31, 2021 and 2020, respectively, are included within accrued expenses and other current liabilities in the consolidated balance sheet. Claims payable are generally paid within 30 days based on contractual terms.

As of December 31, 2021 and December 31, 2020, unbilled receivables, which represent claims received and approved but unbilled at the end of the reporting period, were $23.7 million and $16.4 million, respectively. Unbilled receivables are typically billed to clients within 30 days of the approved claim based on the contractual billing schedule agreed upon with the client. Unbilled receivables are included in accounts receivable in the consolidated balance sheet.

Accounts Receivable and Allowance for Doubtful Accounts

The accounts receivable balance primarily includes amounts due from clients and members. As a result of the adoption of ASU 2016-13 – Financial Instruments – Credit Losses (Topic 326), beginning January 1, 2020, the Company estimates the allowance for doubtful accounts based on the lifetime expected credit losses for the client and member receivable pools, respectively. Under this current expected credit losses model, the Company determines the allowance for doubtful accounts based on factors such as the age of the receivable balance, historical experience, current economic conditions, and reasonable and supportable forecasts of future economic conditions. The new standard required a change in timing of loss recognition where an allowance for credit losses is now applied at the time the asset is recognized. Prior to the adoption of ASU 2016-13, credit losses were determined based upon historical bad debts, current receivables balances, and the age of the receivables balances. Expected credit losses are recorded as general and administrative expenses on the statements of operations. The Company adopted ASU 2016-13 as of January 1, 2020, using the modified retrospective transition method, which resulted in a cumulative-effect adjustment to accumulated deficit of $1.2 million. As a result, periods prior to the adoption date continue to be reported under the historical accounting guidance. The following table provides a summary of the activity in this allowance (in thousands):


	Years Ended December 31, 2021, 2020 and 2019

December 31, 2021	Balance at Beginning of Period		ASU 2016-13 Adoption Adjustment		Charged to Costs and Expenses		Write-offs		Balance at End of Period
Allowance for doubtful accounts	$	9,502	$	—	$	9,783	$	(1,906)	$	17,379

December 31, 2020
Allowance for doubtful accounts	$	2,771	$	1,169	$	5,562	$	—	$	9,502

December 31, 2019
Allowance for doubtful accounts	$	1,175	$	—	$	1,606	$	(10)	$	2,771

Cost of Services

Fertility Benefit Services

Fertility benefit services costs include: (1) fees paid to provider clinics within the Company’s network, labs and anesthesiologists; (2) costs incurred (including salaries, bonuses, benefits, stock-based compensation, other related costs, and an allocation of general overhead, depreciation and amortization) for those employees associated with care management service functions: Provider Account Management, PCA, Provider Relations and Claims Processing teams; and (3) related information technology support costs. Contracts with provider clinics are typically for a term of one to two years.

Pharmacy Benefit Services

Pharmacy benefit services costs include: (1) the fees for prescription drugs dispensed and clinical services provided during the reporting period by specialty pharmacy partners; (2) costs incurred (including salaries, bonuses, benefits, stock-based compensation, other related costs, and an allocation of general overhead, depreciation and amortization) for those employees associated with care management service functions: PCA, Provider Relations and Claims Processing teams; and (3) related information technology support costs. Contracts with the specialty pharmacies are typically for a term of one year.

In the specialty pharmacy contracts, the contractual fees of prescription drugs sold includes the cost of the prescription drugs purchased and shipped to members by the Company’s specialty mail service dispensing pharmacies, net of any volume-related or other discounts.

Vendor rebates

The Company receives a rebate on formulations purchased and dispensed by the Company’s specialty pharmacies. The Company’s contractual arrangements with pharmacy program partners provide for the Company to receive a discount (or rebate) from established list prices paid subsequent to dispensing when products are purchased indirectly from a pharmacy program partners (such as through a specialty pharmacy). These rebates are recognized as a reduction of cost of services when prescriptions are dispensed and are generally estimated and billed to manufacturers within 20 days after the end of each month. The effect of adjustments resulting from the reconciliation of rebates recognized to the amounts billed and collected has not been material to the Company’s results of operations.

Concentration of Credit Risk and Off-Balance-Sheet Risk

Financial instruments that potentially subject the Company to concentrations of credit risk consists primarily of cash and cash equivalents, marketable securities, and accounts receivable.

The Company invests its cash and cash equivalents and marketable securities with highly rated financial institutions and management believes that the financial risks associated with its cash equivalents are minimal.

Substantially all of the Company’s cash is maintained with one financial institution with a high credit standing. From time to time, such deposits may exceed federally insured limits.

The Company regularly reviews the outstanding account receivable balances and makes estimates of the lifetime expected credit losses based upon consideration of factors such as the age of the receivable balance, historical experience, current economic conditions, and reasonable and supportable forecasts of future economic conditions. In addition, the Company periodically evaluates the financial condition of its clients to manage credit risk related to accounts receivable. As of December 31, 2021, two entities accounted for 24% and 11% each, or a combined 35% of total receivables. Two entities accounted for 14% each, or a combined 28% total receivables as of December 31, 2020.

Property and Equipment

Property and equipment consist of computer equipment, machinery and equipment, furniture and fixtures, leasehold improvements, and capitalized software development costs. The assets are stated at cost less accumulated depreciation. Depreciation is calculated using the straight-line method based on estimated useful lives and in the case of leasehold improvements, the shorter of the useful life or the remaining term of the lease (see Note 5).

Goodwill and Intangible Assets

Goodwill represents the excess of the consideration transferred over the fair value of the assets acquired and liabilities assumed in a business combination. Other intangible assets consist of trademarks, physician network, and the websites acquired in the Fertility Authority acquisition. Goodwill, including other definite-lived intangible assets, are carried at their initial acquisition date fair value less any impairment. Other intangible assets are recorded at fair value at the date of acquisition, less accumulated amortization. Amortization is calculated using the straight-line method based on estimated useful lives.

Goodwill is reviewed for impairment annually as of October 1st of each year or when an interim triggering event has occurred indicating potential impairment. Events or changes in circumstances which could trigger an impairment review, which are assessed at the reporting unit level, include significant changes in the manner of the Company’s use of the acquired assets or the strategy for the Company’s overall business, significant negative industry or economic trends, significant underperformance relative to historical or projected future results of operations, a significant adverse change in the business climate, an adverse action or assessment by a regulator, unanticipated competition or a loss of key personnel. The Company has the option to first assess qualitative factors to determine whether the existence of events or circumstances leads to a determination that it is more likely than not that the fair value of the reporting unit is less than its carrying amount. If, after assessing the totality of events or circumstances, an entity determines it is not more likely than not that the fair value of the reporting unit is less than its carrying amount, then additional impairment testing is not required. However, if an entity concludes otherwise, then it is required to perform the first of a two-step impairment test.

The first step involves comparing the estimated fair value of the reporting unit with its respective book value, including goodwill. If the estimated fair value exceeds book value, goodwill is considered not to be impaired and no additional steps are necessary. If the carrying amount of goodwill exceeds the implied fair value of the goodwill, an impairment loss is recognized in an amount equal to the excess.

The Company tests for goodwill impairment for each reporting unit, which is at the operating segment or one level below the operating segment. This analysis requires us to make a series of assumptions to (1) evaluate whether any impairment exists and (2) measure the amount of impairment. There was no impairment of goodwill or intangible assets for the years ended December 31, 2021, 2020, and 2019.

Impairment of Long-Lived Assets

Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of such assets or asset groups may not be recoverable. In such instances, the recoverability of assets to be held and used is measured first by a comparison of the carrying amount of an asset group to future undiscounted net

cash flows expected to be generated by the assets. If such assets are considered to be impaired, an impairment loss would be recognized if the carrying amount of the asset exceeds the fair value of the asset or asset group. The fair value is determined based on valuation techniques such as a comparison to fair values of similar assets or using a discounted cash flow analysis. There were no impairments recorded for the years ended December 31, 2021, 2020 and 2019.

Leases

On January 1, 2020, the Company adopted ASU 2016-02, Leases (Topic 842) using the modified retrospective transition method, which applies the provisions of the standard at the effective date without adjusting comparative periods presented. As a result, periods prior to the adoption date continue to be reported under the historical lease accounting guidance. In addition, the Company elected the package of practical expedients permitted under the transition guidance within the new standard, which allowed the Company not to reassess (i) whether any expired or existing contracts contained leases, (ii) the lease classification for any expired or existing leases, and (iii) initial direct costs for existing leases. The Company also elected not to reassess lease terms for existing leases using hindsight and to account for each separate lease and non-lease component as a single lease component. As a result of the adoption of the new leasing guidance, the Company recorded right-of-use assets and lease liabilities of $9.5 million and $9.9 million, respectively. The adoption of the standard did not materially impact the Company’s statement of operations or statement of cash flows for the year ended December 31, 2020.

The Company determines if an arrangement is a lease at inception. Operating leases are included in operating lease right-of-use assets, accrued expenses and other current liabilities, and operating lease noncurrent liabilities on the consolidated balance sheets. As of December 31, 2021 and 2020, the Company has no financing lease arrangements.

In accordance with ASC 842, the Company records a right-of-use asset (“ROU”) and lease liability in connection with its operating leases. Operating lease ROU assets and operating lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. To determine the present value of lease payments, the Company utilizes the rate implicit in the lease, if available. If the rate implicit in the lease is not readily determinable, the Company uses its secured incremental borrowing rate to determine the present value of the lease payments. The determination of the Company’s incremental borrowing rate requires judgment and is primarily based on publicly available information for companies within the same industry and with similar credit profiles. The rate is then adjusted for the lease term and other specific terms included in the Company’s lease arrangements. The incremental borrowing rate is subsequently reassessed upon a modification to the lease arrangement. The operating lease ROU asset also includes any lease payments made prior to commencement date and excludes lease incentives and initial direct costs incurred. ROU assets are subsequently assessed for impairment in accordance with the Company’s accounting policy for long-lived assets.

Stock-Based Compensation

The Company accounts for stock-based compensation awards in accordance with FASB ASC Topic 718, Compensation—Stock Compensation (ASC 718). ASC 718 requires all stock-based payments, including restricted stock units and grants of stock options, to be recognized in the consolidated statements of operations based on their respective fair values. For non-employee awards, a measurement date is normally reached when performance is completed, and the fair value is remeasured as the awards vest. The fair value of the Company’s restricted stock units has been determined utilizing the closing market price of the Company’s common stock on the date of the grant.

The fair value of the Company’s stock options and stock purchased under the employee stock purchase plan has been determined using the Black-Scholes option-pricing model, which requires the input of subjective assumptions, including (i) the expected stock price volatility, (ii) the expected term of the award, (iii) the risk-free interest rate and (iv) expected dividends. Due to the lack of historical and implied volatility data of the Company’s common stock, the expected stock price volatility has been estimated based on the historical volatilities of the daily closing prices of a specified group of companies in Progyny’s industry for a period equal to the expected term of the option. Progyny selected companies with comparable characteristics to the Company, including enterprise value, risk profiles and position within the industry, that have historical share price information sufficient to meet the expected term of the stock

options. The expected term of the options granted represents the period of time that options granted are expected to be outstanding and is calculated using the simplified method, which is the mid-point between the vesting date and the end of the contractual term for each option. For non-employee service-based and performance-based awards, the expected term is estimated based on the remaining contractual term of such awards. The risk-free interest rate is based on the yield of zero-coupon, U.S. Treasury securities for the period that is consistent with the expected term of the stock option. The Company has not paid, and does not anticipate paying, cash dividends on its shares of common stock; therefore, the expected dividend yield is zero.

The Company’s stock-based awards are subject to either service-based or performance-based vesting conditions. The Company recognizes compensation expense for service-based awards over the vesting period of the award on a straight-line basis. Compensation expense related to awards with performance-based vesting conditions is recognized when achievement of the performance condition is considered probable over the requisite service period.

Common Stock Valuation

Prior to the Company’s IPO on October 29, 2019, the Company had historically granted stock options at exercise prices equal to the fair value as determined by the Board of Directors on the date of grant. Prior to the IPO and in the absence of a public trading market, the Board of Directors, with input from management, exercised significant judgement and considered numerous objective and subjective factors to determine the fair value of the Company’s common stock as of the date of each stock option grant, including:

●

the Company’s financial performance

●

the rights, preferences and privileges of the convertible preferred stock relative to those of the common stock; and

●

general economic and financial conditions, and the trends specific to the markets in which the Company operates

In addition, the Board of Directors considered the independent valuations completed by a third-party valuation consultant. The valuations of the Company’s common stock were determined in accordance with the guidelines outlined in the American Institute of Certified Public Accountants Practice Aid, Valuation of Privately-Held-Company Equity Securities Issued as Compensation. In performing these valuations, the Board of Directors considered a variety of relevant factors and valuation methodologies in accordance with the guidelines. Following the IPO, the Board of Directors determines the fair market value for all common stock grants based on the closing market price of the common stock, on the date of grant, as reported by Nasdaq.

Income Taxes

The Company accounts for income taxes in accordance with FASB ASC Topic 740, Income Taxes (“ASC 740”), including updates in ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which the Company adopted as of January 1, 2021. Deferred income taxes are recorded for the expected tax consequences of temporary differences between the tax basis of assets and liabilities for financial reporting purposes and amounts recognized for income tax purposes. The Company periodically reviews the recoverability of deferred tax assets recorded on the consolidated balance sheet and provides valuation allowances as deemed necessary to reduce such deferred tax assets to the amount that will, more likely than not, be realized. Income tax expense consists of taxes currently payable and changes in deferred tax assets and liabilities calculated according to local tax rules.

Significant judgment is required in determining any valuation allowance recorded against deferred tax assets. In assessing the need for a valuation allowance, the Company considers all available evidence for each jurisdiction including past operating results, estimates of future taxable income and the feasibility of ongoing tax planning strategies. In the event the Company changes its determination as to the amount of deferred tax assets that can be realized, the Company will adjust its valuation allowance with a corresponding impact to income tax expense in the period in which such determination is made.

The amount of deferred tax provided is calculated using tax rates enacted at the balance sheet date. The impact of tax law changes is recognized in periods when the change is enacted.

A two-step approach is applied pursuant to ASC 740 in the recognition and measurement of uncertain tax positions taken or expected to be taken in a tax return. The first step is to determine if the weight of available evidence indicates that it is more likely than not that the tax position will be sustained in an audit, including resolution of any related appeals or litigation processes. The second step is to measure the tax benefit as the largest amount that is more than 50% likely to be realized upon ultimate settlement.

The Company’s policy is to recognize interest and penalty expenses associated with uncertain tax positions as a component of income tax expense in the consolidated statements of operations and comprehensive (loss) income. As of December 31, 2021, 2020 and 2019, the Company had no significant accrued interest or penalties related to uncertain tax positions and no amounts have been recognized in the Company’s consolidated statements of operations.

Fair Value of Financial Instruments and Fair Value Measurements

The Company determines the fair value of financial assets and liabilities using the fair value hierarchy established in the accounting standards. The hierarchy describes three levels of inputs that may be used to measure fair value, as follows:

Level 1—Quoted prices in active markets for identical assets and liabilities.

Level 2—Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Assets and liabilities measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurements. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires management to make judgments and consider factors specific to the asset or liability.

The carrying amounts of certain of the Company’s financial instruments, including cash equivalents, marketable securities, accounts receivable and accounts payable approximate fair value due to their short maturities.

Net Income (Loss) per Share

Basic net income (loss) per share is calculated by dividing the net income (loss) by the weighted-average number of shares of common stock outstanding for the period.

For the year ended December 31, 2019, the Company’s convertible preferred stock was entitled to receive noncumulative dividends, prior and in preference to any declaration or payment of any dividend on common stock and thereafter participate pro rata on an as-converted basis with the common stockholders in any distributions to common stockholders and were therefore considered to be participating securities. As a result, the Company calculated the net loss per share using the two-class method. Accordingly, the net loss attributable to common stockholders is derived from the net loss for the period.

Diluted net income (loss) per share is computed by dividing the diluted net income (loss) by the weighted average number of common shares outstanding for the period, including potential dilutive common shares assuming dilutive effect of outstanding common stock options, restricted stock units, shares issuable under the employee stock purchase program and common stock warrants. In periods when the Company has incurred a net loss, diluted net loss per

share is the same as basic net loss per share because dilutive common shares are not assumed to have been issued if their effect is anti-dilutive.

Recently Adopted Accounting Pronouncements

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. The standard is intended to simplify the accounting for income taxes by removing certain exceptions to the general principles in Topic 740, as well as improve consistent application of and simplify GAAP for other areas of Topic 740 by clarifying and amending existing guidance. The Company adopted this standard as of January 1, 2021. The adoption of this standard did not have a material impact on the Company’s consolidated financial statements.

Accounting Pronouncements Issued but Not Yet Adopted

In May 2021, the FASB issued ASU No. 2021-04 (“ASU 2021-04”) “Earnings Per Share (Topic 260), Debt-Modifications and Extinguishments (Subtopic 470-50), Compensation- Stock Compensation (Topic 718), and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815- 40)” which provides guidance on modifications or exchanges of a freestanding equity-classified written call options that are not within the scope of another Topic, such as warrants. The new standard will be effective for the Company for the fiscal year beginning January 1, 2022 and should be applied prospectively to modifications or exchanges occurring on or after this date. The Company currently does not expect the adoption of the new standard to have a material effect on its consolidated financial statements, however, this impact will depend on the terms of written call options, such as warrants, or financings issued or modified in the future.

Revenue

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Revenue

3. Revenue

Disaggregated revenue

The following table disaggregates revenue by service (in thousands):


	Year Ended
	December 31,
	2021		2020		2019
Revenue
Fertility benefit services revenue	$	355,616	$	253,556	$	189,618
Pharmacy benefit services revenue		145,005		91,302		40,065
Total revenue	$	500,621	$	344,858	$	229,683

Concentration of Major Clients

For the year ended December 31, 2021, two clients accounted for 19% and 15%, or a combined 34%, of total revenue. For the year ended December 31, 2020, two clients accounted for 18% and 17%, or a combined 35%, of total revenue. No other clients accounted for more than 10% for the years ended December 31, 2021 and 2020. For the year ended December 31, 2019, three clients accounted for 16%, 15%, and 10%, or a combined 41%, of total revenue.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Fair Value of Financial Instruments

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

4. Fair Value of Financial Instruments

As of December 31, 2021 and 2020, the Company had $93.7 million and $66.3 million, respectively, in financial assets held in money market accounts and $28.0 million and $39.0 million, respectively held in marketable securities, including U.S. treasury bills. All were classified as Level 1 in the fair value hierarchy. The Company measured these assets at fair value. The Company classified these assets as Level 1 because the values of these assets are determined using unadjusted quoted prices in active markets for identical assets.

During the year ended December 31, 2021, the Company had gross realized losses related to marketable securities and money market accounts of $0.4 million included within earnings. The gross realized gains for the period as well as the gross realized gains and losses for the year ended December 31, 2020 were not significant. During the year ended December 31, 2021, the Company reclassified $0.4 million of net unrealized holding losses out of other comprehensive loss and into earnings. The amount reclassified out of other comprehensive income for the year ended December 31, 2020 was not significant. The total gains and losses for marketable securities and money market accounts in other comprehensive income (loss) as of December 31, 2021 and 2020 were not significant.

During the years ended December 31, 2021 and December 31, 2020, the Company did not maintain any assets or liabilities classified as Level 2 or Level 3 in the fair value hierarchy.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Property and Equipment, Net

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

5. Property and Equipment, Net

Property and equipment consist of the following (in thousands):


	Estimated
	Useful Life	December 31,
	(in years)	2021		2020
Machinery and equipment	3-5	$	95	$	95
Computers and hardware	3		1,023		660
Leasehold improvements	lease term		3,110		3,074
Furniture and fixtures	7		453		452
Capitalized software	3		2,909		995
Property and equipment, gross			7,590		5,276
Less: accumulated depreciation			(2,563)		(1,876)
Total property and equipment, net		$	5,027	$	3,400

Depreciation expense was approximately $0.7 million for the years ended December 31, 2021, 2020 and 2019.

During the year ended December 31, 2021, the Company capitalized $0.1 million in stock-based compensation expense related to the development of internal-use software.

Intangible Assets, Net

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets, Net

6. Intangible Assets, Net

Intangible assets consist of the following (in thousands):


	Estimated
	Useful Life	December 31,
	(in years)	2021		2020
Trademarks	8	$	4,000	$	4,000
Physician Network	6		3,500		3,500
Website	5		2,000		2,000
Intangible assets, gross			9,500		9,500
Less: accumulated amortization			(8,901)		(8,287)
Total intangible assets, net		$	599	$	1,213

Amortization expense was $0.6 million, $1.2 million, and $1.5 million for the years ended December 31, 2021, 2020 and 2019, respectively.

As of December 31, 2021, the future amortization expense of other intangible assets is as follows (in thousands):


Year ending December 31:
2022	$	500
2023		99
Thereafter		—
Total	$	599

Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Leases

7. Leases

In September 2019, the Company’s sublease agreement for its corporate headquarters in New York, NY commenced and will expire in May 2029. Pursuant to the sublease, the Company will pay the base rent of approximately $1.3 million per annum through the end of the fifth lease year and approximately $1.4 million per annum thereafter through the expiration date.

The Company recognizes lease expense on a straight-line basis over the lease term. Lease expense for the Company’s operating leases was $1.3 million for the years ended December 31, 2021 and 2020.

Cash outflows from operating activities attributable to the operating leases for the years ended December 31, 2021 and 2020 was $1.3 million and $0.8 million, respectively.

Information related to the Company’s leases is as follows (in thousands):


	Balance Sheet Location	December 31, 2021
Operating Leases
Right-of-use asset	Operating lease right-of-use assets	$	7,805
Short-term lease liabilities	Accrued expenses and other current liabilities	$	1,231
Long-term lease liabilities	Operating lease noncurrent liabilities	$	7,419

Other information
Weighted average remaining lease term, operating lease			7.4 years
Weighted average discount rate, operating lease			4.29%

Future minimum facility lease payments as of December 31, 2021, are as follows (in thousands):


	Balance at December 31, 2021
Year Ending December 31:
2022	$	1,286
2023		1,286
2024		1,326
2025		1,407
2026		1,407
Thereafter		3,400
Total undiscounted lease payments	$	10,112
Less: imputed interest		1,462
Present value of lease liabilities	$	8,650
Less: current portion of operating lease liabilities		1,231
Operating lease noncurrent liabilities	$	7,419

Rent expense under the operating leases was approximately $1.2 million for the year ended December 31, 2019. The terms of the facility lease provide for rental payments on a monthly basis and on a graduated scale.

February 2022 Lease Agreement

In February 2022, the Company entered into a lease agreement for additional space in its corporate offices in New York, New York, consisting of a 24,099 square foot office and a 21,262 square foot office, and also for continued occupancy of the 25,212 square foot office after the expiration of the current sublease. For the 24,099 square foot office, the Company will pay the base rent of approximately $1.4 million per year starting in the fourth quarter of 2023 for five years and approximately $1.5 million per year thereafter through the first quarter of 2035, the expiration date. For the 21,262 square foot office, the Company will pay the base rent of approximately $1.3 million starting in the first quarter of 2025 for five years and approximately $1.4 million per year thereafter through the first quarter of 2035, the expiration date. For the current 25,212 square foot office, the Company will pay the base rent of approximately $1.6 million per year beginning in June 2029 through the first quarter of 2035, the expiration date.

Accrued Expenses and Other Current Liabilities

12 Months Ended

Dec. 31, 2021

Accrued Liabilities and Other Liabilities [Abstract]

Accrued Expenses and Other Current Liabilities

8. Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consist of the following (in thousands):


	December 31,
	2021		2020
Accrued claims payable	$	19,998	$	22,799
Accrued compensation		10,089		5,087
Accrued commission		3,092		1,334
Operating lease current liabilities		1,231		1,231
Professional fees		843		1,216
Other		2,172		2,605
Total accrued expenses and other current liabilities	$	37,425	$	34,272

Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Debt

9. Debt

In June 2018, the Company entered into a loan agreement with Silicon Valley Bank for a revolving line of credit up to $15.0 million based upon an advance rate of 80% on “eligible” accounts receivable to fund its working capital and other general corporate needs, which was amended in April 2019, January 2020, June 2020, and February 2021 (“SVB Line of Credit”). Eligible accounts receivable was defined in the loan agreement as accounts billed with aging 90 days or less and excluded accounts receivable due for member copayments, coinsurance, and deductibles. The SVB Line of Credit matured in June 2021.

The Company was required to pay a revolving line commitment fee of $225,000 in three equal annual installments of $75,000 starting on the one-year anniversary of the revolving line. The Company made the first installment payment of $75,000 in June 2019 and accrued this cost monthly. When the Company held unrestricted cash balances greater than $5.0 million, interest accrued at a floating rate per annum equal to the greater of prime rate or 4.75%. If the unrestricted cash balance was less than $5.0 million, interest accrued at a floating rate per annum equal to the greater of prime rate plus 0.5% or 4.75%, with interest payable monthly. Interest was paid based upon the borrowed funds.

The SVB Line of Credit contained customary affirmative covenants, financial covenants, as well as negative covenants that, among other things, restricted the Company’s ability to incur additional indebtedness (including guarantees of certain obligations); create liens; engage in mergers, consolidations, liquidations and dissolutions; sell assets; maintain collateral; pay dividends or make other payments in respect of capital stock; make acquisitions; make investments, loans and advances; enter into transactions with affiliates; make payments with respect to or modify subordinated debt instruments; and enter into agreements with negative pledge clauses or clauses restricting subsidiary distributions. The financial covenant requires the Company to achieve a specified minimum quarterly revenue as defined by the SVB Line of Credit. The Company was in compliance with all requirements and its covenant of the revolving credit facility as of December 31, 2020.

The Company had $0 drawn on the SVB Line of Credit as of December 31, 2020 and 2019. The Company recorded interest expense on the SVB Line of Credit of $38,000, $75,000 and $213,000 during the years ended December 31, 2021, 2020 and 2019, respectively.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI http://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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+ Details

Stockholders' Equity

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Stockholders' Equity

10. Stockholders’ Equity

Common Stock

The holders of common stock are entitled to one vote for each share held of record on all matters submitted to a vote of the stockholders. The common stock confers upon its holders the right to receive dividends out of any assets legally available, when and as declared by the Board of Directors.

In August 2019, the Company repurchased 26,659 shares of common stock at an average price per share of $6.91 pursuant to its contractual right of first refusal for offers made by third parties to acquire outstanding shares from existing stockholders. The repurchased shares were recorded as treasury shares.

The Company had 615,980 shares of treasury stock as of December 31, 2021, 2020 and 2019.

Common Stock Warrants

In connection with the IPO on October 25, 2019, all outstanding convertible preferred warrants were converted to common stock warrants. As of December 31, 2021 and 2020, the Company had 565,351 and 1,419,415 common stock warrants outstanding, respectively.

For the year ended December 31, 2021, 854,065 common stock warrants were exercised for 824,991 shares at a weighted average exercise price of $1.73. For the year ended December 31, 2020, 188,449 common stock warrants were exercised for 177,854 shares of common stock at a weighted average exercise price of $1.73. The Company did not recognize compensation expense relating to the common stock warrants for the years ended December 31, 2021, 2020 and 2019 as they were all fully vested.

Stock Incentive Plan

In October 2019, the Company’s Board of Directors and stockholders adopted and approved the 2019 Equity Incentive Plan, as amended (the “2019 Plan”), as the successor to continuation of the Company’s 2017 Equity Incentive Plan, as amended (the “2017 Plan”). No further grants were made under the 2017 Plan from the date that the 2019 Plan became effective. Initially, the maximum number of shares issuable under the 2019 Plan will not exceed 19,198,875 shares of common stock, which is the sum of 1) 2,640,031 new shares and 2) an additional number of shares not to exceed 16,558,844 consisting of (a) shares that remained available for the issuance of awards under the 2017 Plan immediately prior to the effective date of the 2019 Plan and (b) shares of common stock subject to outstanding stock options or other stock awards granted under the 2017 Plan that, on or after the date the 2019 Plan became effective, terminate, expire or are cancelled prior to exercise or settlement; are forfeited or repurchased because of the failure to vest; or are reacquired or withheld (or not issued) to satisfy a tax withholding obligation or the purchase or exercise price, if any, as such shares become available from time to time.

Under the Company’s 2017 Plan and consistent with the Company’s prior 2008 Equity Incentive Plan, options and other stock awards to purchase shares of common stock may be granted to employees, directors, and consultants. Incentive stock options are granted to employees and non-statutory stock options are granted to consultants and directors at an exercise price not less than 100% of the fair value (as determined by the Board of Directors) of the Company’s common stock on the date of grant. The exercise price of options granted to stockholders who hold 10% or more of the Company’s common stock on the option grant date shall not be less than 110% of the fair value of the Company’s common stock on the date of grant for both incentive and non-qualified stock option grants. These options generally vest over four years and expire ten years from the date of grant. Stock option grants may be exercisable upon grant, and any unvested shares purchased are subject to repurchase. There were no unvested shares subject to repurchase as of December 31, 2021 and 2020.

As of December 31, 2021 and 2020, 4,160,618 and 5,287,341 shares of common stock, respectively, remained available for future grants under the 2019 Plan. Under the 2019 Plan, subject to any adjustments necessary to implement any capitalization adjustments, an annual increase to the number of shares issuable is automatically added on January 1 of each year for a period of ten years commencing on January 1, 2020 and ending on (and including) January 1, 2029, in an amount equal to 4% of the total number of shares of common stock outstanding on December 31 of the preceding year.

Stock Options

Stock options are exercisable based on the terms and conditions outlined in the applicable award agreement. Stock options generally vest over four years and typically expire ten years from the date of grant. A summary of the Company’s stock option activity for the year ended December 31, 2021 is as follows:


				Weighted
		Weighted		Average
		Average		Remaining	Aggregate
	Number of	Grant Date		Contractual	Intrinsic
	Shares	Fair Value		Life (Years)	Value
					(In thousands)
Outstanding at December 31, 2020	13,384,301	$	5.03	7.7	$	500,053
Granted	5,290,216		30.60
Exercised	(3,440,937)		2.93
Forfeited	(303,639)		13.56
Cancelled	(5,928)		9.15
Outstanding at December 31, 2021	14,924,013	$	25.11	7.9	$	439,557

Exercisable at December 31, 2020	7,343,948	$	2.02	7.1	$	396,496

Exercisable at December 31, 2021	6,694,592	$	4.21	6.6	$	308,893

The total intrinsic value of options exercised was $175.0 million, $79.6 million, and $50.8 million for the years ended December 31, 2021, 2020, and 2019, respectively.

The weighted average grant date fair value of options granted was $30.60, $26.56, and $2.68 in the years ended December 31, 2021, 2020, and 2019, respectively.

The total grant date fair value of options vested was $16.0 million, $9.3 million, and $2.8 million in the years ended December 31, 2021, 2020, and 2019, respectively.

The total unrecognized compensation cost related to unvested options was approximately $164.2 million at December 31, 2021. The weighted-average remaining recognition period is approximately 3.6 years.

Certain assumptions used in the option-pricing model for options granted to employees, directors, and non-employees are as follows:


	Year Ended December 31
	2021	2020	2019
Expected term (in years)	3.00 - 6.11	5.50 - 6.11	5.63 - 6.28
Risk-free interest rate	0.6% - 1.4%	0.3% - 1.7%	1.5% - 2.5%
Expected volatility	52.4% - 59.5%	49.2% - 54.7%	48.6% - 49.0%
Expected dividend rate	—	—	—

Restricted Stock Units

During the year ended December 31, 2020, the Company began granting restricted stock units under the 2019 Equity Incentive Plan. Restricted stock units vest based on the terms outlined in the applicable award agreement, which is generally over a period of 4 years. A summary of the Company’s restricted stock unit activity is as follows:


			Weighted
	Number		Average
	of		Grant Date
	Shares		Fair Value

Outstanding at December 31, 2020	489,067	$	25.47
Granted	1,517,075	$	58.13
Vested	(201,916)	$	26.48
Forfeited	(38,708)	$	32.75
Outstanding at December 31, 2021	1,765,518	$	53.25

The total intrinsic value of restricted stock units vested was $11.1 million and $1.4 million for the years ended December 31, 2021 and 2020, respectively.

The weighted-average grant date fair value of restricted stock units granted was $58.13 and $25.46 for the years ended December 31, 2021 and 2020, respectively.

The total fair value of restricted stock units vested was $0.2 million for the year ended December 31, 2021. For the year ended December 31, 2020, the total fair value of restricted stock units vested was not significant.

The total unrecognized compensation cost related to unvested restricted stock units was approximately $86.5 million at December 31, 2021. The weighted-average remaining recognition period is approximately 3.6 years.

January 2022 Executive Equity Grants

On November 4, 2021, the Company announced that David Schlanger will transition to the role of Executive Chairman, effective as of January 1, 2022, and will continue to serve as a director. In connection with this transition, the Company entered into an amended and restated employment agreement with Mr. Schlanger, effective as of January 1, 2022. Pursuant to this agreement, Mr. Schlanger received an equity award for fiscal year 2022 comprised of 333,000 non-qualified stock options and 84,000 restricted stock units, in each case vesting as to 25% on the first anniversary of the vesting commencement date with the remaining 75% of such award vesting in equal quarterly installments thereafter over the next three years, as well as a performance stock unit award with respect to a maximum number of 83,000 shares that are eligible to be earned based on the achievement of specified revenue targets.

Peter Anevski, who served as President and Chief Operating Officer, succeeded Mr. Schlanger as Chief Executive Officer, effective as of January 1, 2022. In connection with this transition, the Company entered into an amended and restated employment agreement with Mr. Anevski, effective as of January 1, 2022. Pursuant to this agreement, Mr. Anevski received an equity award for fiscal year 2022 comprised of 1,000,000 non-qualified stock options and 250,000 restricted stock units, in each case vesting as to 25% on the first anniversary of the vesting commencement date with the remaining 75% of such award vesting in equal quarterly installments thereafter over the next three years, as well as a performance stock unit award with respect to a maximum number of 250,000 shares that are eligible to be earned based on the achievement of specified revenue targets.

Employee Stock Purchase Plan

In October 2019, the Board of Directors and stockholders also adopted and approved the 2019 Employee Stock Purchase Plan (the “ESPP”). Following the IPO, the ESPP authorized the issuance of 1,700,000 shares of common stock to purchase rights granted to the Company’s employees or to employees of the Company’s designated affiliates. As of

December 31, 2021, 1,560,693 shares of common stock remained available to be issued under the ESPP. The following table summarizes the purchases that were made for each purchase period of the ESPP through December 31, 2021 (in thousands, except for share amounts):


Purchase Period	Proceeds used for purchase		Shares purchased
October 25, 2019 to July 31, 2020	$	1,146	103,677
August 1, 2020 to January 31, 2021		481	21,125
February 1, 2021 to July 31, 2021		595	14,505

The next purchase period commenced on August 1, 2021 and ended on January 31, 2022.

Stock-Based Compensation Expense

The following table summarizes stock-based compensation expense for employees, which was included in the statements of operations and comprehensive loss as follows (in thousands):


	Year Ended
	December 31
	2021		2020		2019
Cost of services	$	8,969	$	3,056	$	537
Sales and marketing		5,462		2,066		900
General and administrative		19,275		7,699		3,624
Total stock-based compensation expense	$	33,706	$	12,821	$	5,061

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

+ References

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+ Details

Net Income (Loss) Per Share

12 Months Ended

Dec. 31, 2021

Earnings Per Share [Abstract]

Net Income (Loss) Per Share

11. Net Income (Loss) Per Share

A reconciliation of net income (loss) and the number of shares in the calculation of basic and diluted net income (loss) per share is as follows (in thousands, except share and per share amounts):


	Year Ended
	December 31,
	2021		2020		2019

Basic net income (loss) per common share:
Numerator:
Net income (loss)	$	65,769	$	46,459	$	(8,569)

Denominator:
Weighted-average shares used in computing basic net income (loss) per share		89,105,562		85,722,670		20,735,202
Basic net income (loss) per share	$	0.74	$	0.54	$	(0.41)

Diluted net income (loss) per common share:
Numerator:
Net income (loss)	$	65,769	$	46,459	$	(8,569)

Denominator:
Weighted-average shares used in computing basic net income (loss) per share		89,105,562		85,722,670		20,735,202
Effect of dilutive securities		11,252,485		13,332,856		—
Weighted-average shares used in computing diluted net income (loss) per share		100,358,047		99,055,526		20,735,202
Diluted net income (loss) per share	$	0.66	$	0.47	$	(0.41)

The following weighted-average outstanding shares of potentially dilutive securities were excluded from the computation of diluted net income (loss) per share for the periods presented because including them would have been antidilutive:


	Year Ended
	December 31,
	2021	2020	2019
Options to purchase common stock	1,562,029	699,233	13,610,441
Shares issuable under ESPP	—	70,184	—
Warrants to purchase common stock	—	—	122,882
Restricted stock units	186,547	—	—
Total potential dilutive shares	1,748,576	769,417	13,733,323

401(k) Plan

12 Months Ended

Dec. 31, 2021

Retirement Benefits [Abstract]

401(k) Plan

12. 401(k) Plan

The Company sponsors a 401(k) defined contribution plan covering all employees and began employer contributions in 2018. The Company incurred expenses of $0.9 million, $0.5 million, and $0.4 million for the years ended December 31, 2021, 2020, and 2019 respectively.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

13. Income Taxes

A tax benefit of $33.3 million and $37.8 million was recorded for the years ended December 31, 2021 and 2020. A tax provision of $12,000 was recorded for the year ended December 31, 2019.

The provision/(benefit) from income taxes is composed of the following (in thousands):


	December 31,
	2021		2020		2019
Current
Federal	$	—	$	—	$	—
State		(31)		191		12
Total Current		(31)		191		12
Deferred:
Federal		(25,154)		(28,852)		—
State		(8,149)		(9,119)		—
Total Deferred		(33,303)		(37,971)		—
Total provision/(benefit) from income taxes	$	(33,334)	$	(37,780)	$	12

A reconciliation of the U.S. federal statutory income tax rate to the Company’s effective tax rate is as follows:


	December 31,
	2021		2020		2019
Income tax provision at statutory rate	21	%	21	%	21	%
State income taxes, net of federal benefit	(25)		(38)		6
Stock-based compensation	(99)		(100)		56
Warrant valuation	—		—		(45)
Change in valuation allowance	—		(317)		(35)
Other	—		(2)		(3)
Effective tax rate	(103)	%	(436)	%	—	%

The Company’s effective tax rate for the years ended December 31, 2021, 2020, and 2019 was (103%), (436%), and 0%, respectively. For the year ended December 31, 2021, the effective tax rate differs from the U.S. federal statutory

rate primarily due to permanent tax adjustments, including windfalls upon the exercise of stock options and vesting of RSUs. For the year ended December 31, 2020, the effective tax rate differs from the U.S. federal statutory rate primarily due to the release of the valuation allowance in this period, in addition to permanent tax adjustments, including windfalls upon the exercise of options and vesting of RSUs. For the year ended December 31, 2019, the effective tax rate differs from the U.S. federal statutory rate due to the increase in valuation allowance.

Deferred Tax Balances

The components of the Company’s net deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2021		2020
Deferred tax assets:
Net operating loss carryforwards	$	55,180	$	29,291
Capitalized start‑up costs		8		11
Research and development credits		1,039		1,039
Stock-based compensation		9,133		3,241
Accruals and reserves		5,916		4,116
Operating lease liabilities		2,297		2,475
Property and equipment		164		154
Intangibles		414		195
Indirect tax		—		313
Total deferred tax assets		74,151		40,835
Valuation allowance		(224)		(225)
Deferred tax assets after valuation allowance	$	73,927	$	40,610
Deferred tax liabilities:
Goodwill		(581)		(392)
Operating lease right-of-use assets		(2,072)		(2,247)
Total deferred tax liabilities		(2,653)		(2,639)
Net deferred tax assets	$	71,274	$	37,971

Assessing the realizability of deferred tax assets requires the determination of whether it is more-likely-than-not that some portion or all the deferred tax assets will not be realized. In assessing the need for a valuation allowance, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, loss carryback and tax-planning strategies. Generally, more weight is given to objectively verifiable evidence, such as the cumulative loss in recent years, as a significant piece of negative evidence to overcome. As of December 31, 2020, the Company achieved three years of cumulative income, along with projections of profitability, for which management determined that there is sufficient positive evidence to conclude that it is more likely than not that substantially all of the deferred tax assets will be realized. As such, $28.5 million of the valuation allowance had been released. Management continues to maintain this position as of December 31, 2021. During the year ended December 31, 2021, the net change in the valuation allowance was not significant.

As of December 31, 2021, the Company has net operating loss carryforwards for federal and state income tax purposes of approximately $86.2 million and $167.8 million, respectively, which expire beginning in the year 2027. In addition to the above federal net operating losses, the Company has net operating losses of $112.7 million with an indefinite carryforward period. There are certain state net operating losses that follow the federal carryforward period and are indefinite in nature. The federal and California research and development tax credits are approximately $0.7 million and $0.8 million, respectively. The federal research credits will begin to expire in 2030 and the California research and development credits have no expiration date. Utilization of the net operating loss carryforwards and credits may be subject to a substantial annual limitation due to ownership changes that may occur, as provided by Section 382 of the Internal Revenue Code of 1986, as well as similar state provisions. Such annual limitation could result in the expiration of net operating losses and credits before their utilization.

Unrecognized Tax Benefits

A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (in thousands):


	December 31,
	2021		2020		2019
Balance at the beginning of the year	$	390	$	390	$	397
Reductions based upon tax positions related to the current year		—		—		(7)
Balance at the end of the year	$	390	$	390	$	390

In order for these unrecognized tax benefits to be realized, the net operating loss carryforwards must be utilized first. The Company does not anticipate any material change in its unrecognized tax benefits over the next twelve months.

The Company files U.S. federal and state income tax returns with varying statutes of limitations. All tax years since inception remain open to examination due to the carryover of unused net operating losses and tax credits.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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+ Details

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

14. Commitments and Contingencies

Arbitration/Litigation

On January 14, 2019, a vendor filed a Demand for Arbitration and Statement of Claim against the Company (“Demand”) for alleged breach of the November 10, 2017 Preferred Specialty Pharmacy Agreement (“Agreement”) between the Company and the vendor. On March 13, 2019, the Company terminated the Agreement for material breach with the vendor. On April 3, 2019, the vendor filed a Second Amended Demand for Arbitration (“SAD”) for breach of the Agreement. The vendor was seeking $25.0 million in damages, fees, interest and cost. Pursuant to a schedule set forth by the Arbitration Panel, on May 3, 2019, the Company filed a Motion to Dismiss the SAD. That Motion was fully briefed on June 14, 2019 and was decided on July 31, 2019. The Arbitration Panel dismissed two of the vendor’s four claims. The Arbitration Panel held additional hearings for the two remaining claims between August 17, 2020 and August 26, 2020. Final arguments were held on October 20, 2020. Based on a willingness to expeditiously resolve the matter, the parties proposed settlement to the panel on November 16, 2020. In December 2020, the Company finalized and settled the arbitration for $5.75 million without admission of liability to avoid further legal costs.

The Company believes there is no other litigation pending that could have, individually or in the aggregate, a material adverse effect on the Company’s financial position, results of operations, or cash flows.

Indemnifications

The Company indemnifies each of its officers and directors for certain events or occurrences, subject to certain limits, while the officer or director is or was serving at the Company’s request in such capacity, as permitted under Delaware law and in accordance with its certificate of incorporation and bylaws. The term of the indemnification period lasts as long as an officer or a director may be subject to any proceeding arising out of acts or omissions of such officer or director in such capacity. The maximum amount of potential future indemnification is unlimited; however, the Company currently holds director and officer liability insurance. This insurance allows the transfer of risk associated with the Company’s exposure and may enable it to recover a portion of any future amounts paid. The Company believes that the fair value of these indemnification obligations is minimal. Accordingly, it has not recognized any liabilities relating to these obligations for any period presented.

Unaudited Quarterly Results of Operations Data

12 Months Ended

Dec. 31, 2021

Quarterly Financial Information Disclosure [Abstract]

Unaudited Quarterly Results of Operations Data

15. Unaudited Quarterly Results of Operations Data

The following table sets forth the unaudited quarterly consolidated results of operations for each of the eight quarterly periods in the period ended December 31, 2021. The unaudited quarterly results of operations have been prepared on the same basis as the audited consolidated financial statements, and we believe they reflect all normal recurring adjustments necessary for the fair statement of the Company’s results of operations for these periods. This

information should be read in conjunction with the consolidated financial statements and related notes included elsewhere in this Annual Report. The Company’s historical operating data may not be indicative of the Company’s future performance.


	Three Months Ended
	Mar. 31,		Jun. 30,		Sep. 30,		Dec. 31,		Mar. 31,		Jun. 30,		Sep. 30,		Dec. 31,
	2020 ⁽¹⁾		2020 ⁽¹⁾		2020 ⁽¹⁾		2020		2021		2021		2021		2021

	(in thousands)
Revenue	$	81,024	$	64,605	$	98,928	$	100,301	$	122,133	$	128,651	$	122,284	$	127,553
Cost of services		64,422		52,650		78,092		79,635		93,226		99,030		93,792		102,438
Gross profit		16,602		11,955		20,836		20,666		28,907		29,621		28,492		25,115
Operating expenses:
Sales and marketing		3,267		3,608		3,355		4,776		4,014		4,028		4,441		7,696
General and administrative		9,904		9,419		12,653		14,729		13,086		13,937		14,986		17,607
Total operating expenses		13,171		13,027		16,008		19,505		17,100		17,965		19,427		25,303
Income (loss) from operations		3,431		(1,072)		4,828		1,161		11,807		11,656		9,065		(188)
Other income (expense), net		164		3		11		32		7		12		(92)		(293)
Interest income (expense), net		150		5		(17)		(17)		(18)		252		144		83
Total other income (expense), net		314		8		(6)		15		(11)		264		52		(210)
Income (loss) before income taxes		3,745		(1,064)		4,822		1,176		11,796		11,920		9,117		(398)
Benefit (provision) for income taxes		(116)		—		—		37,896		3,370		6,807		7,679		15,478
Net income (loss)	$	3,629	$	(1,064)	$	4,822	$	39,072	$	15,166	$	18,727	$	16,796	$	15,080
Net income (loss) per share:
Basic	$	0.04	$	(0.01)	$	0.06	$	0.45	$	0.17	$	0.21	$	0.19	$	0.17
Diluted	$	0.04	$	(0.01)	$	0.05	$	0.39	$	0.15	$	0.19	$	0.17	$	0.15
Weighted-average shares used in computing net income (loss) per share:
Basic		84,537,538		85,281,151		86,265,297		86,514,619		87,404,287		88,165,158		89,571,226		90,537,077
Diluted		99,665,158		85,281,151		98,969,588		99,021,233		100,106,497		99,808,085		100,370,331		100,321,297

(1)

In the fourth quarter of 2020, the Company adopted ASU 2016-13, “Financial Instruments – Credit Losses (Topic 326)” with an adoption date of January 1, 2020. As such, quarterly financial information for the interim periods of 2020 has been recast with resulting impacts to the previously disclosed general and administrative expense of $0.4 million, $(0.7) million, and $0.5 million for the three-month periods ended March 31, 2020, June 30, 2020, and September 30, 2020, respectively.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Basis of Presentation

Segment Information

Use of Estimates

Cash and Cash Equivalents

Marketable Securities

Marketable securities, primarily consisting of U.S. Government and agency securities with original maturities greater than three months but less than one year when purchased, are classified as available-for-sale, and are stated at fair value. Unrealized gains and losses on marketable securities are excluded from earnings and reported as a component of other comprehensive income (loss).

Revenue Recognition

The Company applies the following five-step model to recognize revenue from contracts with clients:

●

Identification of the contract, or contracts, with a client

●

Identification of the performance obligations in the contract

●

Determination of the transaction price

●

Allocation of the transaction price to the performance obligations in the contract

●

Recognition of revenue when, or as, a performance obligation is satisfied

Fertility Benefits Solution Revenue

Pharmacy Benefits Solution Revenue

Accrued Receivables and Accrued Claims Payable

Accrued Receivable and Accrued Claims Payable

Accounts Receivable and Allowance for Doubtful Accounts

Accounts Receivable and Allowance for Doubtful Accounts


	Years Ended December 31, 2021, 2020 and 2019

December 31, 2021	Balance at Beginning of Period		ASU 2016-13 Adoption Adjustment		Charged to Costs and Expenses		Write-offs		Balance at End of Period
Allowance for doubtful accounts	$	9,502	$	—	$	9,783	$	(1,906)	$	17,379

December 31, 2020
Allowance for doubtful accounts	$	2,771	$	1,169	$	5,562	$	—	$	9,502

December 31, 2019
Allowance for doubtful accounts	$	1,175	$	—	$	1,606	$	(10)	$	2,771

Cost of Services

Fertility Benefit Services

Pharmacy Benefit Services

Vendor rebates

Concentration of Credit Risk and Off-Balance-Sheet Risk

Concentration of Credit Risk and Off-Balance-Sheet Risk

Financial instruments that potentially subject the Company to concentrations of credit risk consists primarily of cash and cash equivalents, marketable securities, and accounts receivable.

Substantially all of the Company’s cash is maintained with one financial institution with a high credit standing. From time to time, such deposits may exceed federally insured limits.

Impairment of Long-Lived Assets

Leases

Property and Equipment

Goodwill and Intangible Assets

Stock-Based Compensation

Common Stock Valuation

Common Stock Valuation

●

the Company’s financial performance

●

the rights, preferences and privileges of the convertible preferred stock relative to those of the common stock; and

●

general economic and financial conditions, and the trends specific to the markets in which the Company operates

Income Taxes

The amount of deferred tax provided is calculated using tax rates enacted at the balance sheet date. The impact of tax law changes is recognized in periods when the change is enacted.

Fair Value of Financial Instruments and Fair Value Measurements

Level 1—Quoted prices in active markets for identical assets and liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Net Income (Loss) per Share Attributable to Common Stockholders

Net Income (Loss) per Share

Basic net income (loss) per share is calculated by dividing the net income (loss) by the weighted-average number of shares of common stock outstanding for the period.

share is the same as basic net loss per share because dilutive common shares are not assumed to have been issued if their effect is anti-dilutive.

Recently Adopted Accounting Pronouncements and Accounting Pronouncements Issued but Not Yet Adopted

Recently Adopted Accounting Pronouncements

Accounting Pronouncements Issued but Not Yet Adopted

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Schedule of accounts receivable and allowance for doubtful accounts


	Years Ended December 31, 2021, 2020 and 2019

December 31, 2021	Balance at Beginning of Period		ASU 2016-13 Adoption Adjustment		Charged to Costs and Expenses		Write-offs		Balance at End of Period
Allowance for doubtful accounts	$	9,502	$	—	$	9,783	$	(1,906)	$	17,379

December 31, 2020
Allowance for doubtful accounts	$	2,771	$	1,169	$	5,562	$	—	$	9,502

December 31, 2019
Allowance for doubtful accounts	$	1,175	$	—	$	1,606	$	(10)	$	2,771

Revenue (Tables)

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Schedule of disaggregation of revenue


	Year Ended
	December 31,
	2021		2020		2019
Revenue
Fertility benefit services revenue	$	355,616	$	253,556	$	189,618
Pharmacy benefit services revenue		145,005		91,302		40,065
Total revenue	$	500,621	$	344,858	$	229,683

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Schedule of Property and equipment


	Estimated
	Useful Life	December 31,
	(in years)	2021		2020
Machinery and equipment	3-5	$	95	$	95
Computers and hardware	3		1,023		660
Leasehold improvements	lease term		3,110		3,074
Furniture and fixtures	7		453		452
Capitalized software	3		2,909		995
Property and equipment, gross			7,590		5,276
Less: accumulated depreciation			(2,563)		(1,876)
Total property and equipment, net		$	5,027	$	3,400

Intangible Assets, Net (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of intangible assets


	Estimated
	Useful Life	December 31,
	(in years)	2021		2020
Trademarks	8	$	4,000	$	4,000
Physician Network	6		3,500		3,500
Website	5		2,000		2,000
Intangible assets, gross			9,500		9,500
Less: accumulated amortization			(8,901)		(8,287)
Total intangible assets, net		$	599	$	1,213

Schedule of future amortization expense of other intangible assets


Year ending December 31:
2022	$	500
2023		99
Thereafter		—
Total	$	599

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Schedule of lease information


	Balance Sheet Location	December 31, 2021
Operating Leases
Right-of-use asset	Operating lease right-of-use assets	$	7,805
Short-term lease liabilities	Accrued expenses and other current liabilities	$	1,231
Long-term lease liabilities	Operating lease noncurrent liabilities	$	7,419

Other information
Weighted average remaining lease term, operating lease			7.4 years
Weighted average discount rate, operating lease			4.29%

Schedule of future minimum facility lease payments


	Balance at December 31, 2021
Year Ending December 31:
2022	$	1,286
2023		1,286
2024		1,326
2025		1,407
2026		1,407
Thereafter		3,400
Total undiscounted lease payments	$	10,112
Less: imputed interest		1,462
Present value of lease liabilities	$	8,650
Less: current portion of operating lease liabilities		1,231
Operating lease noncurrent liabilities	$	7,419

Accrued Expenses and Other Current Liabilities (Tables)

12 Months Ended

Dec. 31, 2021

Accrued Liabilities and Other Liabilities [Abstract]

Schedule of accrued expenses and other current liabilities


	December 31,
	2021		2020
Accrued claims payable	$	19,998	$	22,799
Accrued compensation		10,089		5,087
Accrued commission		3,092		1,334
Operating lease current liabilities		1,231		1,231
Professional fees		843		1,216
Other		2,172		2,605
Total accrued expenses and other current liabilities	$	37,425	$	34,272

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Summary of stock option activity


				Weighted
		Weighted		Average
		Average		Remaining	Aggregate
	Number of	Grant Date		Contractual	Intrinsic
	Shares	Fair Value		Life (Years)	Value
					(In thousands)
Outstanding at December 31, 2020	13,384,301	$	5.03	7.7	$	500,053
Granted	5,290,216		30.60
Exercised	(3,440,937)		2.93
Forfeited	(303,639)		13.56
Cancelled	(5,928)		9.15
Outstanding at December 31, 2021	14,924,013	$	25.11	7.9	$	439,557

Exercisable at December 31, 2020	7,343,948	$	2.02	7.1	$	396,496

Exercisable at December 31, 2021	6,694,592	$	4.21	6.6	$	308,893

Schedule of assumptions used in the option-pricing model for options granted


	Year Ended December 31
	2021	2020	2019
Expected term (in years)	3.00 - 6.11	5.50 - 6.11	5.63 - 6.28
Risk-free interest rate	0.6% - 1.4%	0.3% - 1.7%	1.5% - 2.5%
Expected volatility	52.4% - 59.5%	49.2% - 54.7%	48.6% - 49.0%
Expected dividend rate	—	—	—

Summary of restricted stock unit activity


			Weighted
	Number		Average
	of		Grant Date
	Shares		Fair Value

Outstanding at December 31, 2020	489,067	$	25.47
Granted	1,517,075	$	58.13
Vested	(201,916)	$	26.48
Forfeited	(38,708)	$	32.75
Outstanding at December 31, 2021	1,765,518	$	53.25

Summary of purchases made for each purchase period, employee stock purchase plan


Purchase Period	Proceeds used for purchase		Shares purchased
October 25, 2019 to July 31, 2020	$	1,146	103,677
August 1, 2020 to January 31, 2021		481	21,125
February 1, 2021 to July 31, 2021		595	14,505

Summary of stock based compensation expense for employees


	Year Ended
	December 31
	2021		2020		2019
Cost of services	$	8,969	$	3,056	$	537
Sales and marketing		5,462		2,066		900
General and administrative		19,275		7,699		3,624
Total stock-based compensation expense	$	33,706	$	12,821	$	5,061

Net Income (Loss) Per Share (Tables)

12 Months Ended

Dec. 31, 2021

Earnings Per Share [Abstract]

Reconciliation of net income loss available to common stockholders


	Year Ended
	December 31,
	2021		2020		2019

Basic net income (loss) per common share:
Numerator:
Net income (loss)	$	65,769	$	46,459	$	(8,569)

Denominator:
Weighted-average shares used in computing basic net income (loss) per share		89,105,562		85,722,670		20,735,202
Basic net income (loss) per share	$	0.74	$	0.54	$	(0.41)

Diluted net income (loss) per common share:
Numerator:
Net income (loss)	$	65,769	$	46,459	$	(8,569)

Denominator:
Weighted-average shares used in computing basic net income (loss) per share		89,105,562		85,722,670		20,735,202
Effect of dilutive securities		11,252,485		13,332,856		—
Weighted-average shares used in computing diluted net income (loss) per share		100,358,047		99,055,526		20,735,202
Diluted net income (loss) per share	$	0.66	$	0.47	$	(0.41)

Antidilutive securities excluded from computation of earnings per share


	Year Ended
	December 31,
	2021	2020	2019
Options to purchase common stock	1,562,029	699,233	13,610,441
Shares issuable under ESPP	—	70,184	—
Warrants to purchase common stock	—	—	122,882
Restricted stock units	186,547	—	—
Total potential dilutive shares	1,748,576	769,417	13,733,323

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Composition of the income tax (benefit) provision


	December 31,
	2021		2020		2019
Current
Federal	$	—	$	—	$	—
State		(31)		191		12
Total Current		(31)		191		12
Deferred:
Federal		(25,154)		(28,852)		—
State		(8,149)		(9,119)		—
Total Deferred		(33,303)		(37,971)		—
Total provision/(benefit) from income taxes	$	(33,334)	$	(37,780)	$	12

Reconciliation of the statutory income tax rate to the effective tax rate


	December 31,
	2021		2020		2019
Income tax provision at statutory rate	21	%	21	%	21	%
State income taxes, net of federal benefit	(25)		(38)		6
Stock-based compensation	(99)		(100)		56
Warrant valuation	—		—		(45)
Change in valuation allowance	—		(317)		(35)
Other	—		(2)		(3)
Effective tax rate	(103)	%	(436)	%	—	%

Components of net deferred tax assets and liabilities


	December 31,
	2021		2020
Deferred tax assets:
Net operating loss carryforwards	$	55,180	$	29,291
Capitalized start‑up costs		8		11
Research and development credits		1,039		1,039
Stock-based compensation		9,133		3,241
Accruals and reserves		5,916		4,116
Operating lease liabilities		2,297		2,475
Property and equipment		164		154
Intangibles		414		195
Indirect tax		—		313
Total deferred tax assets		74,151		40,835
Valuation allowance		(224)		(225)
Deferred tax assets after valuation allowance	$	73,927	$	40,610
Deferred tax liabilities:
Goodwill		(581)		(392)
Operating lease right-of-use assets		(2,072)		(2,247)
Total deferred tax liabilities		(2,653)		(2,639)
Net deferred tax assets	$	71,274	$	37,971

Reconciliation of unrecognized tax benefits


	December 31,
	2021		2020		2019
Balance at the beginning of the year	$	390	$	390	$	397
Reductions based upon tax positions related to the current year		—		—		(7)
Balance at the end of the year	$	390	$	390	$	390

Unaudited Quarterly Results of Operations Data (Tables)

12 Months Ended

Dec. 31, 2021

Quarterly Financial Information Disclosure [Abstract]

Schedule of quarterly consolidated results of operations


	Three Months Ended
	Mar. 31,		Jun. 30,		Sep. 30,		Dec. 31,		Mar. 31,		Jun. 30,		Sep. 30,		Dec. 31,
	2020 ⁽¹⁾		2020 ⁽¹⁾		2020 ⁽¹⁾		2020		2021		2021		2021		2021

	(in thousands)
Revenue	$	81,024	$	64,605	$	98,928	$	100,301	$	122,133	$	128,651	$	122,284	$	127,553
Cost of services		64,422		52,650		78,092		79,635		93,226		99,030		93,792		102,438
Gross profit		16,602		11,955		20,836		20,666		28,907		29,621		28,492		25,115
Operating expenses:
Sales and marketing		3,267		3,608		3,355		4,776		4,014		4,028		4,441		7,696
General and administrative		9,904		9,419		12,653		14,729		13,086		13,937		14,986		17,607
Total operating expenses		13,171		13,027		16,008		19,505		17,100		17,965		19,427		25,303
Income (loss) from operations		3,431		(1,072)		4,828		1,161		11,807		11,656		9,065		(188)
Other income (expense), net		164		3		11		32		7		12		(92)		(293)
Interest income (expense), net		150		5		(17)		(17)		(18)		252		144		83
Total other income (expense), net		314		8		(6)		15		(11)		264		52		(210)
Income (loss) before income taxes		3,745		(1,064)		4,822		1,176		11,796		11,920		9,117		(398)
Benefit (provision) for income taxes		(116)		—		—		37,896		3,370		6,807		7,679		15,478
Net income (loss)	$	3,629	$	(1,064)	$	4,822	$	39,072	$	15,166	$	18,727	$	16,796	$	15,080
Net income (loss) per share:
Basic	$	0.04	$	(0.01)	$	0.06	$	0.45	$	0.17	$	0.21	$	0.19	$	0.17
Diluted	$	0.04	$	(0.01)	$	0.05	$	0.39	$	0.15	$	0.19	$	0.17	$	0.15
Weighted-average shares used in computing net income (loss) per share:
Basic		84,537,538		85,281,151		86,265,297		86,514,619		87,404,287		88,165,158		89,571,226		90,537,077
Diluted		99,665,158		85,281,151		98,969,588		99,021,233		100,106,497		99,808,085		100,370,331		100,321,297

(1)

Business and Basis of Presentation - Description of Business (Details) - segment	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract]
Number of operating segments	1	1	1

Business and Basis of Presentation - Reverse Stock Split (Details)	Oct. 14, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Reverse stock split ratio	0.22000264

Business and Basis of Presentation - Initial Public Offering (Details) - USD ($) $ / shares in Units, $ in Thousands		12 Months Ended
	Oct. 29, 2019	Dec. 31, 2019
Subsidiary, Sale of Stock [Line Items]
Underwriters' discounts and commissions		$ 5,900
Offering costs		3,700
Reclassification of temporary equity to permanent equity		106,237
Additional Paid in Capital
Subsidiary, Sale of Stock [Line Items]
Reclassification of temporary equity to permanent equity		$ 106,230
Common Stock
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold (in shares)		6,700,000
Conversion of convertible preferred stock to common stock upon initial public offering (in shares)		65,428,088
Reclassification of temporary equity to permanent equity		$ 7
IPO
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold (in shares)	6,700,000
Share price (in dollars per share)	$ 13.00
Net proceeds after deducting underwriters' discounts, commissions, and offering costs	$ 77,600
Underwriters' discounts and commissions	5,900
Offering costs	$ 3,600
Conversion of convertible preferred stock to common stock upon initial public offering (in shares)	65,428,088
Conversion basis (in shares)	1
IPO \| Additional Paid in Capital
Subsidiary, Sale of Stock [Line Items]
Reclassification of temporary equity to permanent equity	$ 106,200
IPO \| Common Stock
Subsidiary, Sale of Stock [Line Items]
Reclassification of temporary equity to permanent equity	$ 7
Selling Shareholders, Including Over-Allotment Option
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold (in shares)	4,800,000
Over-Allotment Option
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold (in shares)	1,500,000

Business and Basis of Presentation - Segment Information (Details) - segment	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract]
Number of operating segments	1	1	1

Summary of Significant Accounting Policies - Revenue Recognition (Details)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Contract term	3 years
Contract termination, notice period, low end of range	30 days
Contract termination, notice period, high end of range	90 days

Summary of Significant Accounting Policies - Accrued Receivable and Accrued Claims Payable (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Accrued receivables	$ 30,200	$ 28,200
Accrued claims payable	19,998	22,799
Unbilled receivables	$ 23,700	$ 16,400

Summary of Significant Accounting Policies - ASU 2016-03 (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Accumulated deficit	$ (2,424)	$ (68,193)
Accounting Standards Update 2016-13 \| Cumulative Effect, Period of Adoption, Adjustment [Member]
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Accumulated deficit			$ (1,200)

- Definition

The cumulative amount of the reporting entity's undistributed earnings or deficit.

+ References + Details

Summary of Significant Accounting Policies - Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 9,502	$ 2,771	$ 1,175
Costs charged to expenses	9,783	5,562	1,606
Write-offs	(1,906)		(10)
Balance at end of period	$ 17,379	9,502	2,771
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period		$ 1,169
Balance at end of period			$ 1,169

Summary of Significant Accounting Policies - Cost of Services (Details)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Contract Term, Clinics, Low End of Range	1 year
Contract Term, Clinics, High End of Range	2 years

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - Institution	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Concentration Risk [Line Items]
Number of financial institutions where substantially all of the cash is maintained	1
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2021
Concentration Risk [Line Items]
Concentration risk (as a percent)	35.00%
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2021, Entity 1
Concentration Risk [Line Items]
Concentration risk (as a percent)	17.00%
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2021, Entity 2
Concentration Risk [Line Items]
Concentration risk (as a percent)	11.00%
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2020
Concentration Risk [Line Items]
Concentration risk (as a percent)		28.00%
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2020, Entity 1
Concentration Risk [Line Items]
Concentration risk (as a percent)		14.00%
Accounts Receivable \| Credit Concentration Risk \| Two Entities, 2020, Entity 2
Concentration Risk [Line Items]
Concentration risk (as a percent)		14.00%

Summary of Significant Accounting Policies - Goodwill and Other Intangibles (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Asset Impairment [Abstract]
Impairment of goodwill or intangible assets	$ 0	$ 0	$ 0

Summary of Significant Accounting Policies - Impairment of Long-Lived Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Impairment or Disposal of Tangible Assets Disclosure [Abstract]
Impairments	$ 0	$ 0

Summary of Significant Accounting Policies - Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Jan. 01, 2020
Accounting Policies [Abstract]
Lease, Practical Expedients, Package	true
Lease, Practical Expedient, Use of Hindsight	true
Assets and Liabilities, Lessee [Abstract]
Operating lease right-of-use assets	$ 7,805	$ 8,668	$ 9,500
Operating Lease, Liability [Abstract]
Operating lease, liability	$ 8,650		$ 9,900

Summary of Significant Accounting Policies - Stock-Based Compensation (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected dividend rate (as a percent)	0.00%	0.00%	0.00%

Summary of Significant Accounting Policies - Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Unrecognized Tax Benefits, Income Tax Penalties and Interest Expense [Abstract]
Income tax penalties and interest expense	$ 0	$ 0	$ 0

Summary of Significant Accounting Policies - Accounting Pronouncements (Details)	12 Months Ended
	Dec. 31, 2021
Accounting Standards Update 2019-12
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2021
Accounting Standards Update 2016-02
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2020
Change in Accounting Principle, Accounting Standards Update, Transition Option Elected	us-gaap:AccountingStandardsUpdate201602CumulativeEffectPeriodOfAdoptionMember
Accounting Standards Update 2016-13
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2020
Accounting Standards Update 2021-04
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Change in Accounting Principle, Accounting Standards Update, Adopted	false

- Definition

Indicates (true false) whether accounting standards update was adopted.

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- Definition

Date accounting standards update was adopted, in YYYY-MM-DD format.

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Indicates transition method applied for adoption of amendment to accounting standards.

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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 30: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
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-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Publisher FASB
-Subparagraph (a)(1)

+ Details

Revenue - Disaggregated Revenue (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Revenues [Abstract]
Revenue	$ 127,553	$ 122,284	$ 128,651	$ 122,133	$ 100,301	$ 98,928	$ 64,605	$ 81,024	$ 500,621	$ 344,858	$ 229,683
Fertility benefit services revenue
Revenues [Abstract]
Revenue									355,616	253,556	189,618
Pharmacy benefit services revenue
Revenues [Abstract]
Revenue									$ 145,005	$ 91,302	$ 40,065

- Definition

Amount, including tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value-added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (b)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 30
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
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-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Revenue - Concentration of Major Clients (Details) - Sales Revenue, Net - Customer Concentration Risk	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Three Clients, 2019
Concentration Risk [Line Items]
Concentration risk (as a percent)			41.00%
Three Clients, 2019, Client 1
Concentration Risk [Line Items]
Concentration risk (as a percent)			16.00%
Three Clients, 2019, Client 2
Concentration Risk [Line Items]
Concentration risk (as a percent)			15.00%
Three Clients, 2019, Client 3
Concentration Risk [Line Items]
Concentration risk (as a percent)			10.00%
Two Clients, 2020
Concentration Risk [Line Items]
Concentration risk (as a percent)		35.00%
Two Clients, 2020, Client 1
Concentration Risk [Line Items]
Concentration risk (as a percent)		18.00%
Two Clients, 2020, Client 2
Concentration Risk [Line Items]
Concentration risk (as a percent)		17.00%
Two Clients, 2021
Concentration Risk [Line Items]
Concentration risk (as a percent)	34.00%
Two Clients, 2021, Client 1
Concentration Risk [Line Items]
Concentration risk (as a percent)	19.00%
Two Clients, 2021, Client 2
Concentration Risk [Line Items]
Concentration risk (as a percent)	15.00%

Fair Value of Financial Instruments - Assets (Details) - Recurring - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Level 1
Investments, Fair Value Disclosure [Abstract]
Debt Securities, Available-for-sale	$ 28,000	$ 39,000
Level 1 \| Money Market Funds
Assets, Fair Value Disclosure [Abstract]
Cash and Cash Equivalents, Fair Value Disclosure	93,700	66,300
Level 2
Assets, Fair Value Disclosure [Abstract]
Assets, Fair Value Disclosure	0	0
Level 3
Assets, Fair Value Disclosure [Abstract]
Assets, Fair Value Disclosure	$ 0	$ 0

Fair Value of Financial Instruments - Liabilities (Details) - Recurring - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Level 2
Liabilities, Fair Value Disclosure [Abstract]
Financial and Nonfinancial Liabilities, Fair Value Disclosure	$ 0	$ 0
Level 3
Liabilities, Fair Value Disclosure [Abstract]
Financial and Nonfinancial Liabilities, Fair Value Disclosure	$ 0	$ 0

Fair Value of Financial Instruments - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Debt Securities, Available-for-sale, Realized Gain (Loss) [Abstract]
Gross realized loss	$ 0.4
OCI, Debt Securities, Available-for-Sale, Gain (Loss), after Adjustment and Tax [Abstract]
Net unrealized holding gains (losses) out of other comprehensive loss and into earnings	$ (0.4)

Property and Equipment, Net - Useful Lives (Details)	12 Months Ended
Property and Equipment, Net - Useful Lives (Details)	Dec. 31, 2021
Machinery and equipment \| Minimum
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	3 years
Machinery and equipment \| Maximum
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	5 years
Computers and hardware
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	3 years
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	lease term
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	7 years
Capitalized Software
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful life	3 years

Property and Equipment, Net - Tabular Disclosure (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	$ 7,590	$ 5,276
Less: accumulated depreciation	(2,563)	(1,876)
Total property and equipment, net	5,027	3,400
Machinery and equipment
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	95	95
Computers and hardware
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	1,023	660
Leasehold improvements
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	3,110	3,074
Furniture and fixtures
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	453	452
Capitalized Software
Property, Plant and Equipment, Net, by Type [Abstract]
Property and equipment, gross	$ 2,909	$ 995

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Depreciation, Depletion and Amortization [Abstract]
Depreciation expense	$ 0.7	$ 0.7	$ 0.7

Property and Equipment, Net - Stock-based Compensation Expense Capitalized (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Capitalized Software
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share-based Payment Arrangement, Amount Capitalized	$ 0.1

Intangible Assets, Net - Useful Lives (Details)	12 Months Ended
Intangible Assets, Net - Useful Lives (Details)	Dec. 31, 2021
Trademarks
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, estimated useful life	8 years
Physician network
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, estimated useful life	6 years
Website
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, estimated useful life	5 years

Intangible Assets, Net - Tabular Disclosure (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Net [Abstract]
Intangible assets, gross	$ 9,500	$ 9,500
Less: accumulated amortization	(8,901)	(8,287)
Total intangible assets, net	599	1,213
Trademarks
Finite-Lived Intangible Assets, Net [Abstract]
Intangible assets, gross	4,000	4,000
Physician network
Finite-Lived Intangible Assets, Net [Abstract]
Intangible assets, gross	3,500	3,500
Website
Finite-Lived Intangible Assets, Net [Abstract]
Intangible assets, gross	$ 2,000	$ 2,000

Intangible Assets, Net - Amortization Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 0.6	$ 1.2	$ 1.5

Intangible Assets, Net - Future Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2022	$ 500
2023	99
Total intangible assets, net	$ 599	$ 1,213

Leases - Corporate Offices (Details) $ in Millions	Feb. 28, 2022 USD ($) ft²	Sep. 30, 2019 USD ($) ft²
Corporate Headquarters Lease, New York, New York, September 2019
Lessee, Operating Lease, Description [Abstract]
Leased area (in square feet) \| ft²		25,212
Operating lease, base rent per annum, through year five		$ 1.3
Operating lease, base rent per annum, after year five		$ 1.4
Corporate Headquarters Lease, New York, New York, September 2019 \| Subsequent Event
Lessee, Operating Lease, Description [Abstract]
Operating lease, base rent per annum, after year ten	$ 1.6
Corporate Offices Lease One, New York, New York, February 2022 \| Subsequent Event
Lessee, Operating Lease, Description [Abstract]
Leased area (in square feet) \| ft²	24,099
Operating lease, base rent per annum, through year five	$ 1.4
Operating lease, base rent per annum, after year five	$ 1.5
Corporate Offices Lease Two, New York, New York, February 2022 \| Subsequent Event
Lessee, Operating Lease, Description [Abstract]
Leased area (in square feet) \| ft²	21,262
Operating lease, base rent per annum, through year five	$ 1.3
Operating lease, base rent per annum, after year five	$ 1.4

Leases - Lease Expense (Details) - USD ($) $ in Millions	12 Months Ended
Leases - Lease Expense (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020
Income and Expenses, Lessee [Abstract]
Lease expense	$ 1.3	$ 1.3

Leases - Cash Outflows (Details) - USD ($) $ in Millions	12 Months Ended
Leases - Cash Outflows (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020
Cash Flow, Operating Activities, Lessee [Abstract]
Cash outflows from operating activities attributable to operating leases	$ 1.3	$ 0.8

Leases - Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Jan. 01, 2020
Assets and Liabilities, Lessee [Abstract]
Right-of-use assets	$ 7,805	$ 8,668	$ 9,500
Operating Lease, Liability [Abstract]
Operating lease current liabilities	$ 1,231	$ 1,231
Operating Lease, Liability, Current, Statement of Financial Position	Accrued expenses and other current liabilities	Accrued expenses and other current liabilities
Long-term lease liabilities	$ 7,419	$ 8,318

Leases - Other Information (Details)	Dec. 31, 2021
Lessee Disclosure [Abstract]
Weighted average remaining lease term, operating lease	7 years 4 months 24 days
Weighted average discount rate, operating lease	4.29%

Leases - Future Minimum Lease Payments (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2022	$ 1,286
2023	1,286
2024	1,326
2025	1,407
2026	1,407
Thereafter	3,400
Total undiscounted lease payments	$ 10,112

Leases - Gross Difference (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Jan. 01, 2020
Operating Lease Liabilities, Gross Difference, Amount [Abstract]
Total undiscounted lease payments	$ 10,112
Less: imputed interest	1,462
Present value of lease liabilities	8,650		$ 9,900
Less: current portion of operating lease liabilities	1,231	$ 1,231
Operating lease noncurrent liabilities	$ 7,419	$ 8,318

Leases - Rent Expense (Details) $ in Millions	12 Months Ended
Leases - Rent Expense (Details) $ in Millions	Dec. 31, 2019 USD ($)
ASU 2016-02 Transition [Abstract]
Rent expense	$ 1.2

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accrued Liabilities, Current [Abstract]
Accrued claims payable	$ 19,998	$ 22,799
Accrued compensation	10,089	5,087
Accrued commission	3,092	1,334
Operating lease current liabilities	1,231	1,231
Professional fees	843	1,216
Other	2,172	2,605
Total accrued expenses and other current liabilities	$ 37,425	$ 34,272

Debt (Details) - Line of Credit - Silicon Valley Bank Revolving Line of Credit $ in Thousands	1 Months Ended	12 Months Ended
	Jun. 30, 2018 USD ($) installment	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Short-term Debt [Line Items]
Maximum borrowing capacity	$ 15,000
Advance rate upon which the borrowing capacity is based (as a percent)	80.00%
Threshold period of accounts receivable aging	90 days
Unrestricted cash balance to determine threshold for interest rate	$ 5,000
Short term debt		$ 0	$ 0
Interest expense		$ 38	$ 75	$ 213
Commitment fee	$ 225
Frequency of commitment fee	annual
Commitment fee, number of installments \| installment	3
Commitment fee, installment amount	$ 75,000
Commitment fee, amount paid	$ 75,000
Unrestricted cash balance greater than 5 million, interest accrues
Short-term Debt [Line Items]
Interest rate (as a percent)	4.75%
Unrestricted cash balance less than 5 million, interest accrues
Short-term Debt [Line Items]
Interest rate (as a percent)	4.75%
Prime Rate \| Unrestricted cash balance greater than 5 million, interest accrues
Short-term Debt [Line Items]
Variable rate spread (as a percent)	0.00%
Prime Rate \| Unrestricted cash balance less than 5 million, interest accrues
Short-term Debt [Line Items]
Variable rate spread (as a percent)	0.50%

Stockholders' Equity - Common Stock (Details)	12 Months Ended
Stockholders' Equity - Common Stock (Details)	Dec. 31, 2021 Vote
Common Stock, Number of Shares, Par Value and Other Disclosures [Abstract]
Common Stock, Voting Rights	The holders of common stock are entitled to one vote for each share held of record on all matters submitted to a vote of the stockholders.
Common Stock, Voting Rights, Votes Per Share	1

Stockholders' Equity - Treasury Stock (Details) - $ / shares	1 Months Ended
	Aug. 31, 2019	Dec. 31, 2021	Dec. 31, 2020
Equity [Abstract]
Shares repurchased (in shares)	26,659
Purchase price (in dollars per share)	$ 6.91
Treasury stock (in shares)		615,980	615,980

Stockholders' Equity - Common Stock Warrants (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Stock-based compensation expense	$ 33,706	$ 12,821	$ 5,061
Warrants to purchase common stock
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 1.73
Warrants outstanding (in shares)	565,351	1,419,415
Warrants exercised (in shares)	854,065	188,449
Warrants exercised, shares issued (in shares)	824,991	177,854
Stock-based compensation expense	$ 0	$ 0	$ 0
Warrants to purchase common stock \| Weighted Average
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)		$ 1.73

Stockholders' Equity - Stock Incentive Plan - 2019 Equity Incentive Plan (Details) - 2019 Equity Incentive Plan	Oct. 31, 2019 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum number of shares (in shares)	19,198,875
Maximum number of shares, new shares (in shares)	2,640,031
Maximum number of shares, additional shares (in shares)	16,558,844

Stockholders' Equity - Stock Incentive Plan - General Information (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Additional General Disclosures [Abstract]
Incentive stock options and non-statutory stock options, exercise price to fair value of common stock, maximum (as a percent)	100.00%	100.00%	100.00%
Shareholder stock options, exercise price to fair value of common stock, maximum (as a percent)	110.00%	110.00%	110.00%
Unvested shares subject to repurchase (in shares)	0	0
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award, Additional General Disclosures [Abstract]
Vesting period	4 years	4 years	4 years
Term of award	10 years	10 years	10 years

Stockholders' Equity - Stock Incentive Plan - Shares Available for Future Grant (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Additional General Disclosures [Abstract]
Shares available for grants under stock incentive plan (in shares)	4,160,618	5,287,341
Annual increase period	10 years
Annual increase percentage (as a percent)	4.00%

Stockholders' Equity - Stock Options - General Information (Details) - Stock Options	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Additional General Disclosures [Abstract]
Vesting period	4 years	4 years	4 years
Term of award	10 years	10 years	10 years

Stockholders' Equity - Stock Options - Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Balance at beginning of period (in shares)	13,384,301
Granted (in shares)	5,290,216
Exercised (in shares)	(3,440,937)
Forfeited (in shares)	(303,639)
Cancelled (in shares)	(5,928)
Balance at end of period (in shares)	14,924,013	13,384,301
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Abstract]
Balance at beginning of period (in dollars per share)	$ 5.03
Options granted (in dollars per share)	30.60	$ 26.56	$ 2.68
Options exercised (in dollars per share)	2.93
Options forfeited (in dollars per share)	$ 13.56
Options cancelled (in dollars per share)	9.15
Balance at end of period (in dollars per share)	$ 25.11	$ 5.03
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Weighted average remaining contractual life (years)	7 years 10 months 24 days	7 years 8 months 12 days
Aggregate intrinsic value	$ 439,557	$ 500,053
Options exercisable, number of shares (in shares)	6,694,592	7,343,948
Options exercisable, weighted average exercise price (in dollars per share)	$ 4.21	$ 2.02
Options exercisable, weighted average remaining contractual life (years)	6 years 7 months 6 days	7 years 1 month 6 days
Options exercisable, aggregate intrinsic value	$ 308,893	$ 396,496

Stockholders' Equity - Stock Options - Intrinsic Value of Options Exercised (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Total intrinsic value of options exercised	$ 175.0	$ 79.6	$ 50.8

Stockholders' Equity - Stock Options - Weighted-average Grant Date Fair Value (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Abstract]
Options granted (in dollars per share)	$ 30.60	$ 26.56	$ 2.68

Stockholders' Equity - Stock Options - Grant Date Fair Value of Options Vested (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Fair value of options to purchase common stock vested	$ 16.0	$ 9.3	$ 2.8

Stockholders' Equity - Stock Options - Fair Value Assumptions (Details) - Stock Options	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Risk-free interest rate, low end of range (as a percent)	0.60%	0.30%	1.50%
Risk-free interest rate, high end of range (as a percent)	1.40%	1.70%	2.50%
Expected volatility, low end of range (as a percent)	52.40%	49.20%	48.60%
Expected volatility, high end of range (as a percent)	59.50%	54.70%	49.00%
Expected dividend rate (as a percent)	0.00%	0.00%	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	3 years	5 years 6 months	5 years 7 months 17 days
Maximum
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	6 years 1 month 9 days	6 years 1 month 9 days	6 years 3 months 10 days

Stockholders' Equity - Restricted Stock Units - General Information (Details)	12 Months Ended
	Dec. 31, 2021
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award, Additional General Disclosures [Abstract]
Vesting period	4 years

Stockholders' Equity - Restricted Stock Units - Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Balance at beginning of period (in shares)	489,067
Granted (in shares)	1,517,075
Vested (in shares)	(201,916)
Forfeited (in shares)	(38,708)
Balance at end of period (in shares)	1,765,518	489,067
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Balance at beginning of period (in dollars per share)	$ 25.47
Granted (in dollars per share)	58.13
Vested (in dollars per share)	26.48
Forfeited (in dollars per share)	32.75
Balance at end of period (in dollars per share)	53.25	$ 25.47
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Granted (in dollars per share)	$ 58.13	$ 25.46

Stockholders' Equity - Restricted Stock Units - Intrinsic Value (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value [Abstract]
Intrinsic value of restricted stock units vested	$ 11.1	$ 1.4

Stockholders' Equity - Restricted Stock Units - Weighted-average Grant Date Fair Value (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	$ 58.13
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	$ 58.13	$ 25.46

Stockholders' Equity - Restricted Stock Units - Fair Value of Restricted Stock Units Vested (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Additional Disclosures [Abstract]
Fair value of restricted stock units vested	$ 0.2

Stockholders' Equity - Unrecognized Compensation (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized [Abstract]
Compensation cost not yet recognized, options	$ 164.2
Stock Options
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized [Abstract]
Weighted-average remaining recognition period	3 years 7 months 6 days
Restricted Stock Units
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized [Abstract]
Compensation cost not yet recognized, other than options	$ 86.5
Weighted-average remaining recognition period	3 years 7 months 6 days

Stockholders' Equity - Executive Equity Grants (Details) - shares		12 Months Ended
	Jan. 01, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement, Tranche One \| Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage (as a percent)	25.00%
Vesting period	1 year
Share-based Payment Arrangement, Tranche One \| Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage (as a percent)	25.00%
Vesting period	1 year
Share-based Payment Arrangement, Tranche Two \| Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage (as a percent)	75.00%
Vesting period	3 years
Share-based Payment Arrangement, Tranche Two \| Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage (as a percent)	75.00%
Vesting period	3 years
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period		4 years	4 years	4 years
Stock Options \| Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	333,000
Stock Options \| Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	1,000,000
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period		4 years
Restricted Stock Units \| Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	84,000
Restricted Stock Units \| Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	250,000
Performance Shares \| Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	83,000
Performance Shares \| Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity award eligible to receive (in shares)	250,000

Stockholders' Equity - Employee Stock Purchase Plan - General Information (Details) - shares	Dec. 31, 2021	Oct. 29, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock shares reserved for issuance (in shares)	1,560,693
Employee stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock shares reserved for issuance (in shares)		1,700,000

Stockholders' Equity - Employee Stock Purchase Plan - Tabular Disclosure (Details) - USD ($) $ in Thousands	6 Months Ended		9 Months Ended
	Jul. 31, 2021	Jan. 31, 2021	Jul. 31, 2020
Equity [Abstract]
Proceeds used for purchase	$ 595	$ 481	$ 1,146
Shares purchased (in shares)	14,505	21,125	103,677

Stockholders' Equity - Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement, Additional Disclosure [Abstract]
Stock-based compensation expense	$ 33,706	$ 12,821	$ 5,061
Cost of services
Share-based Payment Arrangement, Additional Disclosure [Abstract]
Stock-based compensation expense	8,969	3,056	537
Selling and marketing
Share-based Payment Arrangement, Additional Disclosure [Abstract]
Stock-based compensation expense	5,462	2,066	900
General and administrative
Share-based Payment Arrangement, Additional Disclosure [Abstract]
Stock-based compensation expense	$ 19,275	$ 7,699	$ 3,624

Net Income (Loss) Per Share - Reconciliation (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Net Income (Loss) Available to Common Stockholders, Basic [Abstract]
Net income (loss)	$ 15,080	$ 16,796	$ 18,727	$ 15,166	$ 39,072	$ 4,822	$ (1,064)	$ 3,629	$ 65,769	$ 46,459	$ (8,569)
Weighted Average Number of Shares Outstanding, Basic [Abstract]
Weighted-average shares used in computing basic net income (loss) per share (in shares)	90,537,077	89,571,226	88,165,158	87,404,287	86,514,619	86,265,297	85,281,151	84,537,538	89,105,562	85,722,670	20,735,202
Earnings Per Share, Basic [Abstract]
Basic net income (loss) per share attributable to common stockholders (in dollars per share)									$ 0.74	$ 0.54	$ (0.41)
Basic net income (loss) per share (in dollars per share)	$ 0.17	$ 0.19	$ 0.21	$ 0.17	$ 0.45	$ 0.06	$ (0.01)	$ 0.04	$ 0.74	$ 0.54	$ (0.41)
Net Income (Loss) Available to Common Stockholders, Diluted [Abstract]
Net income (loss) - basic									$ 65,769	$ 46,459	$ (8,569)
Diluted net income (loss)									$ 65,769	$ 46,459	$ (8,569)
Weighted Average Number of Shares Outstanding, Diluted [Abstract]
Weighted-average shares used in computing basic net income (loss) per share (in shares)	90,537,077	89,571,226	88,165,158	87,404,287	86,514,619	86,265,297	85,281,151	84,537,538	89,105,562	85,722,670	20,735,202
Effect of dilutive securities (in shares)									11,252,485	13,332,856
Weighted-average shares used in computing diluted net income (loss) per share (in shares)	100,321,297	100,370,331	99,808,085	100,106,497	99,021,233	98,969,588	85,281,151	99,665,158	100,358,047	99,055,526	20,735,202
Earnings Per Share, Diluted [Abstract]
Diluted net income (loss) per share (in dollars per share)	$ 0.15	$ 0.17	$ 0.19	$ 0.15	$ 0.39	$ 0.05	$ (0.01)	$ 0.04	$ 0.66	$ 0.47	$ (0.41)

Net Income (Loss) Per Share - Potentially Dilutive Securities (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Total (in shares)	1,748,576	769,417	13,733,323
Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Total (in shares)	1,562,029	699,233	13,610,441
Employee stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Total (in shares)		70,184
Warrants to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Total (in shares)			122,882
Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Total (in shares)	186,547

401(k) Plan (Details) - USD ($) $ in Millions	12 Months Ended
401(k) Plan (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Defined contribution plan expenses	$ 0.9	$ 0.5	$ 0.4

Income Taxes - Provision (Benefit) (Details) - USD ($) $ in Thousands	3 Months Ended						12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Expense (Benefit), Continuing Operations [Abstract]
(Benefit) provision for income taxes	$ (15,478)	$ (7,679)	$ (6,807)	$ (3,370)	$ (37,896)	$ 116	$ (33,334)	$ (37,780)	$ 12

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Composition of Income Tax (Benefit) Provision (Details) - USD ($) $ in Thousands	3 Months Ended						12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current Federal, State and Local, Tax Expense (Benefit) [Abstract]
State							$ (31)	$ 191	$ 12
Total Current							(31)	191	12
Deferred Federal, State and Local, Tax Expense (Benefit) [Abstract]
Federal							(25,154)	(28,852)
State							(8,149)	(9,119)
Total Deferred							(33,303)	(37,971)
Total provision/(benefit) from Income taxes	$ (15,478)	$ (7,679)	$ (6,807)	$ (3,370)	$ (37,896)	$ 116	$ (33,334)	$ (37,780)	$ 12

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Reconciliation of Statutory Income Tax Rate (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Effective Income Tax Rate Reconciliation, Percent [Abstract]
Income tax provision at statutory rate (as a percent)	21.00%	21.00%	21.00%
State income taxes, net of federal benefit (as a percent)	(25.00%)	(38.00%)	6.00%
Stock-based compensation (as a percent)	(99.00%)	(100.00%)	56.00%
Warrant valuation (as a percent)			(45.00%)
Change in valuation allowance (as a percent)		(317.00%)	(35.00%)
Other (as a percent)		(2.00%)	(3.00%)
Effective tax rate (as a percent)	(103.00%)	(436.00%)	0.00%

Income Taxes - Net Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred Tax Assets, Gross [Abstract]
Net operating loss carryforwards	$ 55,180	$ 29,291
Capitalized startup costs	8	11
Stock-based compensation	9,133	3,241
Research and development credits	1,039	1,039
Accruals and reserves	5,916	4,116
Operating lease liabilities	2,297	2,475
Property and equipment	164	154
Intangibles	414	195
Indirect tax		313
Total deferred tax assets	74,151	40,835
Valuation allowance	(224)	(225)
Deferred tax assets after valuation allowance	73,927	40,610
Deferred Tax Liabilities, Gross [Abstract]
Goodwill	(581)	(392)
Operating lease right-of-use assets	(2,072)	(2,247)
Total deferred tax liabilities	(2,653)	(2,639)
Net deferred tax assets	$ 71,274	$ 37,971

Income Taxes - Valuation Allowance (Details) $ in Millions	12 Months Ended
Income Taxes - Valuation Allowance (Details) $ in Millions	Dec. 31, 2020 USD ($)
Valuation Allowance [Abstract]
Increase (decrease) in valuation allowance	$ (28.5)

Income Taxes - Net Operating Loss Carryforwards (Details) $ in Millions	Dec. 31, 2021 USD ($)
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards, begin to expire in the year 2030	$ 86.2
Operating loss carryforwards, indefinte carryforward period	112.7
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	$ 167.8

Income Taxes - Tax Credit Carryforwards (Details) $ in Millions	Dec. 31, 2021 USD ($)
Domestic Tax Authority
Tax Credit Carryforward [Line Items]
Tax credit carryforwards	$ 0.7
State and Local Jurisdiction
Tax Credit Carryforward [Line Items]
Tax credit carryforwards	$ 0.8

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at the beginning of the year	$ 390	$ 390	$ 397
Reductions based upon tax positions related to the current year	0	0	(7)
Balance at the end of the year	$ 390	$ 390	$ 390

Commitments and Contingencies - Arbitration and Litigation (Details) - Second Amended Demand for Arbitration, Vendor $ in Thousands			1 Months Ended
	Jul. 31, 2019 claim	Apr. 03, 2019 USD ($) claim	Dec. 31, 2020 USD ($) claim
Loss Contingency, Information about Litigation Matters [Abstract]
Damages sought \| $		$ 25,000
Loss Contingency, Quantities [Abstract]
Loss contingency, new claims filed, number		4
Loss contingency, claims dismissed, number	2
Loss contingency, pending claims, number	2
Loss contingency, claims settled, number			2
Litigation Settlement [Abstract]
Arbitration settlement amount \| $			$ 5,750

Commitments and Contingencies - Indemnifications (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Indemnification Agreement
Guarantor Obligations [Line Items]
Guarantor obligations, current carrying value	$ 0	$ 0

Unaudited Quarterly Results of Operations Data - Tabular Disclosure (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Selected Quarterly Financial Information [Abstract]
Revenue	$ 127,553	$ 122,284	$ 128,651	$ 122,133	$ 100,301	$ 98,928	$ 64,605	$ 81,024	$ 500,621	$ 344,858	$ 229,683
Cost of services	102,438	93,792	99,030	93,226	79,635	78,092	52,650	64,422	388,486	274,799	184,178
Gross profit	25,115	28,492	29,621	28,907	20,666	20,836	11,955	16,602	112,135	70,059	45,505
Operating expenses:
Sales and marketing	7,696	4,441	4,028	4,014	4,776	3,355	3,608	3,267	20,179	15,006	11,901
General and administrative	17,607	14,986	13,937	13,086	14,729	12,653	9,419	9,904	59,616	46,705	23,927
Total operating expenses	25,303	19,427	17,965	17,100	19,505	16,008	13,027	13,171	79,795	61,711	35,828
Income (loss) from operations	(188)	9,065	11,656	11,807	1,161	4,828	(1,072)	3,431	32,340	8,348	9,677
Other income (expense), net	(293)	(92)	12	7	32	11	3	164	(366)	210
Interest income (expense), net	83	144	252	(18)	(17)	(17)	5	150	461	121	(58)
Total other income (expense), net	(210)	52	264	(11)	15	(6)	8	314	95	331	(18,234)
Income (loss) before income taxes	(398)	9,117	11,920	11,796	1,176	4,822	(1,064)	3,745	32,435	8,679	(8,557)
Benefit (provision) for income taxes	15,478	7,679	6,807	3,370	37,896			(116)	33,334	37,780	(12)
Net income (loss)	$ 15,080	$ 16,796	$ 18,727	$ 15,166	$ 39,072	$ 4,822	$ (1,064)	$ 3,629	$ 65,769	$ 46,459	$ (8,569)
Net income (loss) per share:
Basic (in dollars per share)	$ 0.17	$ 0.19	$ 0.21	$ 0.17	$ 0.45	$ 0.06	$ (0.01)	$ 0.04	$ 0.74	$ 0.54	$ (0.41)
Diluted (in dollars per share)	$ 0.15	$ 0.17	$ 0.19	$ 0.15	$ 0.39	$ 0.05	$ (0.01)	$ 0.04	$ 0.66	$ 0.47	$ (0.41)
Weighted-average shares used in computing net income (loss) per share:
Basic (in shares)	90,537,077	89,571,226	88,165,158	87,404,287	86,514,619	86,265,297	85,281,151	84,537,538	89,105,562	85,722,670	20,735,202
Diluted (in shares)	100,321,297	100,370,331	99,808,085	100,106,497	99,021,233	98,969,588	85,281,151	99,665,158	100,358,047	99,055,526	20,735,202

Unaudited Quarterly Results of Operations Data - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
General and administrative	$ 17,607	$ 14,986	$ 13,937	$ 13,086	$ 14,729	$ 12,653	$ 9,419	$ 9,904	$ 59,616	$ 46,705	$ 23,927
Accounting Standards Update 2016-13 \| Cumulative Effect, Period of Adoption, Adjustment [Member]
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
General and administrative						$ 500	$ 700	$ 400