Computer Programs and Systems, Inc. (CPSI) Q1 2021 Earnings Call Transcript

Image source: The Motley Fool.

Computer Programs and Systems, Inc. (CPSI -1.82%)
Q1 2021 Earnings Call
May 11, 2021, 9:00 a.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Greetings, and welcome to the CPSI First Quarter 2021 Earnings Conference Call. [Operator Instructions] As a reminder, this conference is being recorded.

I would now like to turn the conference over to your host, Drew Anderson.

Drew Anderson -- Investor Relations Contact

Good morning, and welcome to the CPSI first quarter 2021 earnings conference Call. During this call, we may make statements regarding future operating plans, expectations and performance that constitute forward-looking statements made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. We caution you that any such forward-looking statements only reflect management expectations and predictions based upon currently available information, and are not guarantees of future results or performance. Actual results might differ materially from those expressed or implied by such forward-looking statements, as a result of known and unknown risks, uncertainties and other factors, including those described in our public releases and reports filed with the Securities and Exchange Commission, including but not limited to, our most recent annual report on Form 10-K. We also caution investors that the forward-looking information provided in this call represents our outlook only as of this date, and we undertake no obligation to update or revise any forward-looking statements to reflect events or developments after the date of this call.

At this time, I will now turn the call over to Mr. Boyd Douglas, President and Chief Executive Officer. Please go ahead, sir.

Boyd Douglas -- President and Chief Executive Officer

Thank you, Drew. Good morning, everyone, and thank you for joining us to that. After my comments, I will hand the call over to Matt Chambless, our Chief Financial Officer, who will provide additional color regarding our first quarter results. At the conclusion of our prepared comments, the two of us, along with David Dye, our Chief Growth Officer; and Chris Fowler, our Chief Operating Officer, will be available to take your questions.

I'd like to begin by sharing how much I am looking forward to the day when the COVID pandemic and many ramifications it has created are behind us. Until then, I feel compelled to continue offering our appreciation for the tireless efforts of the healthcare providers in the communities we serve. Community hospitals serve as the epicenter of healthcare for their families, friends and neighbors from miles around, especially throughout the pandemic. With rural communities disproportionately at risk to COVID due to their increased vulnerability, the January surge of COVID cases hit many of our customers especially hard.

Shortly following in March, efforts were focused on the initial rollout of the vaccination. All told, the first quarter of 2021 left our community customers immeasurably affected as a result of this ongoing fight against the COVID pandemic. Our respect is stronger than ever and the pride we have in our partnerships across the country is unwavering.

The end of the first quarter of 2021 marks a strong start to the transformation under way at CPSI, as we began our journey executing on an aggressive yet obtainable plan to increase shareholder return over the next three years. As a reminder, there are three components to our plan, core growth, margin optimization, and tangible upside growth through digital innovation. Matt will provide more detail around our solid financial results in the first quarter. However, I would like to highlight a couple of key drivers that are directly related to core growth and margin optimization.

With a notable improvement in patient volumes across our TruBridge client base, TruBridge achieved record quarterly revenue of $31.6 million and more importantly, increased revenue visibility and predictability with 90% of CPSI total revenue now being recurring in nature. Following the organizational realignment last quarter, we are leveraging 2021 to build the foundation necessary to realize meaningful cost savings. Those building blocks are currently in flight and include automation of our revenue cycle services, outsourcing through expanded partnerships that will help absorb work related to medical coding and accounts receivable management services, and finally diving deeply into our operations in order to eliminate waste and drive efficiencies.

For example, our Transformation Management Office has begun rolling out the lean process methodology to help our employees to be more efficient in their job through training tools and ongoing evaluation. Following extensive training from the Virginia Mason Institute, a well-respected organization across the world and a leader in applying process improvement methodologies to the healthcare setting, we began powering some of these methodologies within our private pay and accounts receivable management services teams in the first quarter. The results so far are promising as employees become empowered to improve how we do things, always having the customer in mind, whether that customer is internal or external.

In terms of automation, we have been investing in development resources dedicated to equipping our revenue cycle workforce with modern tools and processes to reduce labor intensive work. Finally, in partnership with key outsource labor partners, we are making good progress in our effort to apply outsourced resources related to medical coding and accounts receivable management services for the emergency department. with these transformational changes under way within our operations, We expect to realize $1 million to $2 million in cost savings as we exit 2021, with significant momentum building throughout 2022 for anticipated $7 million to $9 million in run rate savings.

With continued acceleration through 2023, we expect to drive a total run rate cost savings of $11 million to $15 million as we enter 2024. Along with the return of a healthier revenue stream, these efforts contributed to an improved profitability this quarter with an adjusted EBITDA of $11.8 million and non-GAAP earnings per share of $0.64. Finally, an important initiative of our core growth plan is maintaining a healthy retention rate across our EHR base and the pursuit of conservative growth of new EHR client as they are critical to driving cross sales of our TruBridge services.

While our client retention rate for the first quarter remained within our set goal of 95%, we are disappointed in our bookings performance that came in just under $9 million this quarter. As I mentioned earlier, the first quarter of 2021 brought an intensified pressure on our market as healthcare providers and decision makers address the more immediate needs of their communities due to COVID. Understandably, the unique environment created at first quarter of mostly stalled decisions. However, we continue to be encouraged by the healthy pipeline and a historical win rate that certainly trends in our favor. While we can't predict the exact timing of when this pause in sales activity will fade, we are laser-focused on making up this ground and achieving our annual bookings goals.

Shifting to our progress related to upside growth through digital innovation, the first quarter proved successful in our efforts to accelerate a culture of innovation necessary to thrive in the dynamic markets we serve. With a flatter organization, we have turned our attention toward improving employee engagement, recruiting and creating an environment that sparks faster decision-making. As stated in our earlier releases, we have added two key senior leadership positions, including a Chief People Officer and a Chief Innovation Officer. We are energized by the contribution that Amaris McComa and Wes Cronkite will make on our path to growth through digital innovation. To that end, it is also worth mentioning that our company roots remain in Mobile, Alabama. However, we have moved our corporate headquarters to downtown Mobile to foster a new mindset for innovation among our employees with fresh surroundings that encompasses a modern and open environment that is common in today's technology workplace.

We expect a significant portion of our employee base to continue to work remote or in a hybrid model post pandemic. Therefore, our real estate strategy is twofold. While decreasing our real estate front footprint, we will look to renovate key regional offices over the coming months and years to generate an innovative spirit companywide. With employee engagement at the heart of these initiatives, we will take a thoughtful approach to creating workplace environments where ideas can be shared and bounced around, while we also continue to introduce and implement tools, systems, and resources that support our goal of operating smarter and helping our customer tackle obstacles.

With that, I would like to turn the call over to Matt for a deeper dive into the financial results.

Matt Chambless -- Chief Financial Officer

Thanks, Boyd, and good afternoon, everyone. On today's call, I'll provide a high level overview of the quarter, including some additional detail on bookings performance and a brief walk through our first quarter financial results. As you heard from Boyd's opening remarks, the weak decision environment led to bookings results that shouldn't distract from an overall successful quarter for CPSI. Continued execution on our strategy of increasing sources of recurring revenues combined with improving patient volumes and efficiency gains led to a quarter that surpassed internal expectations on the top and bottom lines. As we look to the rest of 2021, we see these two developments, namely bookings below expectations and TruBridge patient volumes continuing to exceed expectations as effectively offsetting each other. As a result, there is no update to the guidance we gave back in February as those ranges still reflect our internal expectations.

Moving onto bookings. Total bookings for the first quarter of $8.8 million were clearly disappointing as the pandemic attacked bookings, creating a stingy decision environment, the likes of which we can't recall seeing before. The early part of the quarter saw a severe uptick in COVID cases, while the latter portion of the quarter saw our clients facilities rightfully preoccupied with vaccine distribution efforts. Many rural communities are effectively healthcare deserts with our hospital customers serving as the lone Oasis, making them critical to vaccination efforts in these communities. As a result, we ended up with quarterly bookings that don't reflect the markets want and excitement for our products and services.

System sales and support bookings were down 45% sequentially and 38% from the first quarter of 2020, as the stingy net new decision environment simply didn't yield many decisions either for us or against us. This same dynamic made its presence felt in our TruBridge bookings as well, which were down 73% sequentially and 72% from the first quarter of 2020, with the decline in bookings from outside our EHR base outpacing declines from cross-sell opportunities, including add-on sales. Subscription arrangements made up 31% of the first quarter's total EHR bookings as we continue our efforts toward driving recurring revenue growth through greater emphasis on our SaaS offerings throughout the sales process. By steering more of our new business toward SaaS offerings, we're increasing the prevalence of recurring revenues within our topline mix, leading to enhanced predictability for revenues and cash flows.

Turning to the financial results for the period. The combined effects of shifting license mix dynamics in our EHR business and the continuing improvement in patient volumes for TruBridge customers resulted in recurring revenues increasing 4% sequentially and 7% over the first quarter of 2020. Recurring revenues for each of our acute care EHR, post-acute EHR, and TruBridge segments saw their third consecutive quarter of sequential gains, ending the quarter at an all time high of 90% of total revenues compared to 88% in the fourth quarter of 2020% and 82% in the first quarter of 2020.

This momentum in recurring revenues was enough to drive a modest sequential increase in total revenues, while the renewed emphasis on our SaaS solutions created significant headwinds when compared to the first quarter of 2020, with declines in nonrecurring revenues outpacing recurring revenue gains for a slight decrease in the year-over-year total revenue line. On the profitability front, the seasonal cost dynamics outpaced the sequential revenue increase, resulting in a $0.5 million or 4% sequential decrease in adjusted EBITDA, while non-GAAP net income increased $1.3 million or 17% as our effective tax rate normalized after an unusually high rate in the fourth quarter of 2020. Compared to the first quarter of 2020, efficiency gains led to margin improvement, such that adjusted EBITDA was effectively flat despite the 2.5% decrease in total revenue with EBITDA margins improving nearly 40 basis points from 17% to 17.4%. Non-GAAP net income increased $6,000 or 7% compared to the first quarter of last year, mostly due to improved interest expense resulting from a more favorable rate environment and a decrease in debt of over $30 million due to aggressive de-levering over the trailing 12 months.

Looking deeper at our segments, TruBridge revenues increased 5% sequentially on continued improvement in patient volumes at our client hospitals with the related margins pulling in slightly to 50% compared to the fourth quarter's record 51%. Compared to the first quarter of 2020, which was largely unaffected by the pandemic, revenues increased $3.1 million or nearly 11%, driven by increased demand for our accounts receivable management, medical coding, and TruBridge RCM offerings. This solid execution on the topline was met with continuing efficiency gains across the spectrum of TruBridge service offerings, propelling TruBridge's gross margin to 280 basis point increase from the first quarter of 2020s 47% margin.

Next, system sales and support revenues saw a slight sequential decrease as the $600,000 or 11% decrease in non-recurring revenues was partially offset by a $300,000 or 1% increase in recurring revenues. Compared to the first quarter of 2020, overall system sales and support revenues are down $4.8 million or 12% as our continued emphasis on our SaaS offerings in new customer decisions creates a challenging environment for nonrecurring revenues, which decreased $5.7 million or nearly 54%. This decrease in year-over-year non-recurring revenues should not distract from the gains we've made in two areas that are key to our long-term growth strategy.

First, acute care SaaS revenues increased 20% sequentially and 51% from the first quarter of 2020, a testament to our focus on prioritizing our SaaS offerings in new customer conversations and successful attempt to convert existing customers to SaaS. Second, our post-acute segment posted another modest 2.6% sequential increase in recurring revenues, its third consecutive quarter of recurring revenue growth following a period in which 11 of the previous 12 quarters posted sequential declines. We view this as evidence that our efforts to revitalize our post-acute offerings are being recognized and appreciated by the post-acute market.

From a margin standpoint, the first quarter of 2021 gross margin of 52% was effectively flat sequentially, but marked a 270 basis point decrease from the first quarter of 2020 as the sharp decline in nonrecurring revenues has a severe impact on margins. We currently anticipate five new client facilities going live with our Thrive solution in the second quarter of 2021, with all expected to go live in a cloud or SaaS environment.

Moving on to operating expenses. Product development cost increased 2% or less than $200,000 both sequentially and year-over-year due mostly to expanded resources and slight changes in project mix impacting capitalization opportunities.

Sales and marketing costs were down $400,000 or 6% sequentially, as recent business transformation initiatives have led to a flattening of our sales organization lowering overall expenditures. Compared to the first quarter of 2020, the aforementioned decrease in year-over-year nonrecurring revenues resulted in decreased commission costs that worked in tandem with the flattening of our sales organization and the continued impact of COVID-19 on sales travel, resulting in a cost reduction of $1.7 million or 24%, while revenues were down only 2.5%. General and administrative cost increased $1.3 million or 11% both sequentially and year-over-year due mostly to $2.1 million dollars of severance costs associated with the reduction in force that we announced in our 8-K filing on February 9th of this year.

Closing out the income statement, our effective tax rate during the quarter was 19% compared to 23% during the first quarter of 2020, with most of the decrease coming from more favorable tax consequences related to restricted stock vestings. We continue to expect an effective tax rate of 18% to 19% for the remainder of the year normalized for discrete items.

From a cash flow standpoint, operating cash flows of $13.7 million marked an 80% improvement over the first quarter of 2020, driving trailing 12-month operating cash flows to a record $55 million, a 28% increase over trailing 12-month operating cash flows from a year ago that has allowed CPSI to reduce bank debt by over $30 million in the past year, while increasing balance sheet cash by nearly $14 million. A little over three years ago, we set of capital allocation priority of right-sizing our leverage profile, setting a target leverage ratio of 2.5 times debt to EBITDA that was achieved during 2019 and since surpassed. With the improved health of our balance sheet coupled with robust cash generating capabilities, CPSI is poised to confidently deploy capital in opportunistic ways that enhance shareholder value and support our growth strategy.

In late 2020, our Board authorized the first share repurchase program in company history, allowing for a maximum of $30 million of share repurchases to be executed over a few year timeframe. At the same time, our Board suspended our long-standing quarterly dividend indefinitely, all with the goal of optimizing flexibility as we pursue a multifaceted capital allocation strategy. This strategy includes using value-based stock repurchases, while maintaining abundant capital to continue to invest in our business and pursue attractive acquisitions that strengthen and broaden our market position using a disciplined approach to M&A that will be additive to the organic growth plan that we unveiled in February.

During the first quarter, we repurchased approximately 12,000 shares for approximately $350,000 on the open market, while another 21,000 shares were purchased upon required tax withholdings related to restricted stock vestings. Our primary rationale is to capture value from undervalued shares using the program as a flexible tool to enhance shareholder value and return capital when prudent. The cadence and volume of our repurchases will be influenced by a number of factors with valuation being achieved, but also considering capital needs and availability, potential M&A, cost of replacement capital and other capital allocation alternatives. Capital allocation alternatives and priorities may evolve over time, so a lack of repurchase activity in a given quarter may not reflect our views on the intrinsic value of our stock.

To wrap up our prepared remarks, we clearly have some ground to make up in bookings. But we'd like what we're seeing in the sales pipeline and don't see the relatively drive first in 90 days of 2021 as indicative of a prolonged sales drought. Our bookings are comprised of a relatively low volume of high value deals and that kind of composition is naturally more prone to severe shocks when decisions are artificially suppressed. When the pace of decisions recovers from this COVID induced shock, we fully expect renewed bookings success to amplify our growth trajectory as we continue on our path toward $80 million of EBITDA by 2024.

And with that, we'd like to open up the line for questions.

Questions and Answers:

Operator

[Operator Instructions] Our first question is with Donald Hooker from KeyBanc Capital Markets. Please proceed with your question.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Great. Good morning. Good morning, everyone. A quick question. Your reference remind me your referenced bookings targets for the year and you referenced to healthy pipeline. I think we can all understand that the bookings in the quarter were challenged due to sort of macro conditions with COVID. But can you maybe elaborate on your reference to bookings target for the year and sort of the healthy pipeline? Is there a way to put numbers to that?

David Dye -- Chief Growth Officer

Yeah, hey Donald, David Dye here. Approximately were are about $10 million behind as of the end of the quarter where we want to be. And as Matt and Boyd stated in their prepared remarks, our goal right now is to -- we've been saying internally is to get back to even par by the end of the year. The three-month pipeline as we exited the first quarter was a good number, it's actually the best number that we've seen since September of 2019. And the last quarter of that year the following quarter was a really good quarter from an execution standpoint, so we certainly hope to repeat that. We've gotten off to a fair start, but we still got room to go in the second quarter. But the market is definitely picking up. We're getting on-site meetings, the engagement is -- the vaccine rollout has slowed. Obviously, the surge is behind us hopefully for good. We certainly all hope that and the engagement levels have increased dramatically just over the course of the last couple of weeks. So we're hopeful that we're going to have a good quarter this quarter and get back some of that, with the goal of getting it all back by the end of the year.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Super. Great. And then in terms of -- can you help us think about, I guess you referenced a real estate strategy and it sounds like you're going to make some investments in capex in the coming quarters. Can you kind of update us on your view on free cash flow and capex? Does that do anything to our models in terms of expectations there?

Matt Chambless -- Chief Financial Officer

Yeah, so Don, I wouldn't expect anything material to come through on the capex line. Boyd mentioned that we recently moved our corporate headquarters from our Wall Street campus in Mobile to downtown Mobile. And fortunately for us, the location we moved into is relatively turnkey. So there may be some remodeling cost, painting the walls, things like that, but nothing material, and that's kind of what we expect for the rest of our locations as well. So if I had to put a number on it, I'd say it's probably for the year is going to be somewhere around $250,000 or so. So clearly not material compared to overall free cash flow.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Got you. And then maybe a last question from me I guess was sort of. I guess some people are concerned about inflation broadly in the U.S. economy. I'm just wondering if you have seen any sort of wage or cost pressure and can you kind of give us some thoughts on CPSIs pricing power across various products and services?

Boyd Douglas -- President and Chief Executive Officer

Speaking to pricing pressure at least for the resources that we consume, which is mainly our people, as the TruBridge line is very service intensive. We really haven't seen any demand or any pressure on those wage levels just yet, but it's definitely something that we keep an eye on to see what's happening in the macro trends as to a certain extent the geographies that we're in do tend to kind of lag behind the kind of macro economy in total.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Okay, thank you.

Operator

Our next question is with George Hill from Deutsche Bank. Please proceed with your question.

Maxine -- Deutsche Bank -- Analyst

Hi, Its Maxine [Phonetic] on for George. Thanks for taking the question. So last year you guys talked about you need to solve what's the additional value for hospital to switch to a subscription-based model. Could you give us some update on the progress on speeding up the transition?

Boyd Douglas -- President and Chief Executive Officer

Sorry, can you repeat the question.

Maxine -- Deutsche Bank -- Analyst

Yeah, last year you guys talked about you need to solve what's the additional value for hospitals to switch to a subscription-based model. I was just wondering if you could give us some update on the progress on speeding up that transition?

Boyd Douglas -- President and Chief Executive Officer

Yeah, I think a good question, and Matt touched on it in his commentary and I don't remember the exact numbers, but I think it was the SaaS EHR revenue was up, I believe 50% year-over-year from the prior period, which speaks of that progress. Some of that is -- some of the new sales and installations that occurred in 2020 and going into 2021, the higher percentage of those have continued to be SaaS as opposed to the license model. But in addition to that, I believe we sold 18 nTrust subscriptions into our current customer base in 2020 as well. So you're starting to see the fruits of that flowing into the income statement as well.

David Dye -- Chief Growth Officer

And I think another thing to point out, Matt said it in his prepared comments that all five of the installs for for second quarter are stats as well.

Maxine -- Deutsche Bank -- Analyst

Thanks. That's very helpful, and maybe just a quick follow-up. Could you give us some color on what you're seeing in the process of TruBridge accounts receivable management services? I think last time you mentioned you had around 10% penetration within your existing EHR base.

Boyd Douglas -- President and Chief Executive Officer

Yeah, well, that obviously that did improve a whole heck of a lot in the first quarter given the bookings performance, but the pipeline is certainly there to continue to do so again going back to nTrust, that's a large part of our strategy there. I mean, clearly the way we view the revenue cycle management space both within our current customer base and outside of our EHR base is that it's extremely underpenetrated, it's similar to the where the EHR market was in 2010 prior to meaningful use, and we're positioned to capitalize on it and we hope to do so. And the pipeline supports that we just need to execute on that pipeline now.

Operator

Our next question is with Joy Zhang from SVB Leerink. Please proceed with your question.

Joy Zhang -- SVB Leerink -- Analyst

Hey guys, thank you for taking my question. I just wanted to follow-up on the bookings question that was asked earlier. Maybe can you provide more color on what new in assumptions are baked into your FY'21 guidance? For example, does the midpoint of guidance assume a similar booking levels as last year at that $20 million per quarter run rate or are there some questions on built in?

Matt Chambless -- Chief Financial Officer

Yeah. So the guidance we gave in February which we still feel kind of reflects our expectations for the year revenue wise. Yeah, I'd say that that's a fair assessment, the kind of $20 million-ish on bookings on a quarterly basis, perhaps just modest, very slight increase over 2020 levels.

Joy Zhang -- SVB Leerink -- Analyst

That's very helpful. And as a follow-up. I was wondering if you saw any uptick in small hospital M&A through the pandemic that would lead you to assume a higher attrition risk for FY'21? You mentioned the retention was 95% in 1Q. Does your guidance for FY'21 assume a similar level to that or would it be slightly lower?

Boyd Douglas -- President and Chief Executive Officer

Yeah, Joy, we did not see a pickup in M&A activity with the community healthcare market. I'm sure a lot of that had to do with government assistance that was provided as a result of the pandemic, we would say it's flat to down. And that's reflected in our retention rates.

Matt Chambless -- Chief Financial Officer

Yeah. And as far as the retention assumptions that went into our guidance, 2020 retention of 95%. We are expecting 2021 to follow pretty close to that. And we've been pretty encouraged by what we've seen so far into 2021 with the numbers actually trending just slightly ahead of that. But we do expect it to normalize back down to somewhere to the 2020 levels by the end of the year. So that 95% retention is kind of what we're pegging as our goal for 2021.

Joy Zhang -- SVB Leerink -- Analyst

That's super helpful. Thank you very much.

Operator

Our next question is with the Gene Mannheimer with Dougherty and Company. Please proceed with your question.

Gene Mannheimer -- Dougherty and Company -- Analyst

Thanks, gentlemen. Congrats on the good quarter. With respect to the TruBridge bookings in the quarter, when do you generally kind of see that convert to revenue? Is there generally a three-month to six-month lag between those bookings and revenue rec.

Matt Chambless -- Chief Financial Officer

Yeah, Gene. So you're hitting it nearly spot on in kind of a three-month to six-month lag between ink on paper for the contract and when we get the customer up and running on rev rec. So I know when we model it internally, it's generally either a one or two quarter lag, probably more consistently a two-quarter lag between when the bookings hit and when revenue begins.

Gene Mannheimer -- Dougherty and Company -- Analyst

Okay, perfect. And with respect to your longer-term goal for EBITDA of $80 million, I'm just trying to get a sense for how much of that will be driven by margin optimization as you call it versus organic growth and versus inorganic or acquired growth, is there a way we should think about that?

Matt Chambless -- Chief Financial Officer

Yeah, Gene. Boyd did a good job on the last call of laying out the details of how we expect to get to this $80 million in EBITDA by 2024. The first thing to point out is that the expectation is that will all be organic. Now any of our disciplined M&A contributions will be just additive to that $80 million number. But as far as the margin, that the cost on a margin optimization side of it, Boyd pointed out on the last call a $25 million cost reduction as far as the impact to the margin impact. And then the rest is just the incremental organic recurring revenue growth.

Gene Mannheimer -- Dougherty and Company -- Analyst

Great, thank you.

Operator

[Operator Instructions] Our next question is with Donald Hooker from KeyBanc Capital Markets. Please proceed with your question.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Okay, great. Just one -- a couple of follow-ups if you don't mind if we have time here. The gross margin at TruBridge was very strong and I'm trying to sort of understand kind of how to think about that going forward. My intuition is that aside from synergies and cost efficiencies that margin might trend down over time to the extent you have more revenue cycle outsourcing business, that's my hunch. But can you update sort of what the other direction over the past couple of quarters? Can you give us sort of an outlook on the TruBridge gross margins?

David Dye -- Chief Growth Officer

Yeah, Donald, a little of that comes from what the sales mix is. So depending on it, its accounts receivable management, the coding or the early out business, obviously that's a little bit more labor intensive. It's going to pull the margin down if that mix is heavier on the TruBridge RCM side, where we run at a higher margin more in line with your traditional software margins, we see a pickup there. Boyd also referenced in his opening comments, our efforts to improve efficiencies through automation and some offshoring initiatives throughout the coming years. So I would think that the margin that you're seeing right now is a good indicator of where we look to hold going forward as we see the bookings pick back up.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Okay, that's super helpful. And then I just -- I'd also love to hear with the balance sheet continuously improving, can you give us any kind of teasers in terms of what kind of acquisitions you might be looking at over time? Are there areas, I know this can be asked of you every quarter, but a common question. But I'd love to hear any kind of areas of interest that you guys might consider in the coming year or so on the M&A front?

David Dye -- Chief Growth Officer

Yeah, Donald. Boyd outlined this as well last quarter in his prepared remarks and the strategy remains unchanged and is really a key function of our next 36 initiative is that we just want to be thoughtful and specifically look at opportunities to drive TruBridge growth be across sales and new markets. That's where our focus is.

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Okay, super. I'll leave you guys alone. Thank you so much.

Boyd Douglas -- President and Chief Executive Officer

I'll just add on to that, I think again, and I said it last time, but I think it's worth repeating. The value of our customer base is something that we really feel there's a lot of untapped potential there both with the existing TruBridge services and then with future M&A. So that's really kind of the driver behind that, Just to kind of follow-up on that question as well. Operator, are there any more questions.

Operator

We have reached the end of the question-and-answer session. I would like to turn the call back over to Mr. Douglas for closing remarks.

Boyd Douglas -- President and Chief Executive Officer

Thank you for your time this morning. It was a pleasure sharing the solid start we have made in our transformation this first quarter. We believe wholeheartedly that our strategic plan while aggressive is achievable. We will continue to apply laser-focus on the three components of our plan, core growth, margin optimization and the tangible upside growth through digital innovation with the objective to increase shareholder return over the next three years. And while there is still plenty of work ahead of us, we believe the progress we covered today has already begun to have a positive impact on our effectiveness, efficiency, and value delivered to our shareholders, clients and employees. Thanks everyone for being on the call and have a great rest of your day.

Operator

[Operator Closing Remarks]

Duration: 38 minutes

Call participants:

Drew Anderson -- Investor Relations Contact

Boyd Douglas -- President and Chief Executive Officer

Matt Chambless -- Chief Financial Officer

David Dye -- Chief Growth Officer

Donald Hooker -- KeyBanc Capital Markets Inc. -- Analyst

Maxine -- Deutsche Bank -- Analyst

Joy Zhang -- SVB Leerink -- Analyst

Gene Mannheimer -- Dougherty and Company -- Analyst

More CPSI analysis

All earnings call transcripts