YNHHSYale New Haven Health System
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-The hybrid embedded care coordinator approach YNHHS has adopted in its PCMH primary care practices;
-The key features of YNHHS' home-based care model for homebound seniors that pairs a geriatrician with a care coordinator in a team-based model of care;
-How YNHHS addresses key challenges of embedded care coordination in a value-based reimbursement system, including 'coordinating' the care coordinators, building trusting relationships between care coordinators and patients, demonstrating program value and assuring the integrity of patient data to provide true patient-centered care;
However, the majority of the decline in operating gain in 2017 was due to an accounting change in how the mission support to the YNHHS is recorded.
The 'AA-' long-term rating also reflects YNHHS's consistent operations, solid liquidity growth, and improving financial profile.
YNHHS's revenue defensibility is midrange with a leading 60% market share in their primary service area (PSA).
Operating risk is strong given YNHHS's historical ability to achieve and sustain solid operating EBITDA and EBITDA margins, with five-year averages of 10% and 10.3%, respectively.
Financial Profile: 'aa'; YNHHS Demonstrates Steadiness Through The Cycle
YNHHS has a strong financial profile that is consistent with Fitch's 'aa' financial profile category.
LOW DEBT BURDEN: YNHHS's maximum annual debt service (MADS) of $62 million represented a very low 1.7% of total revenues in fiscal 2015 and compared favorably against Fitch's 'AA' category median of 2.4%.
SIZEABLE CAPITAL SPENDING: YNHHS intends to spend approximately $1.5 billion on capital over the next five years, with approximately $400 million from debt, to fund various projects, half of which will be directed to strategic growth.
31, 2015 (three-months unaudited), YNHHS had approximately $1.73 billion in unrestricted cash and investments, which translated into 186.2 days cash on hand (DCOH) and cash and unrestricted investments equal to 165% of debt, all slightly lighter than Fitch's 'AA' medians, but adequate for the rating level, particularly in light of the very modest debt burden.