Diagnosticos da America SA

BOVESPA:DASA3

Earnings Call Transcript 2022-Q4

[Operator]

Good morning, and thank you for standing by. Welcome to Dasa's Fourth Quarter and Full Year of 2022 Earnings Video Conference. We would like to inform you that this event is being recorded. [Operator Instructions].

The link to access the webcast transmission with audio and slides is available on Dasa's Investor Relations website at www.dasa3.com.br. The presentation is also available for download on the website.

We point out that the information contained in this presentation and any statements that may be made during the video conference regarding business prospects, projections, operating and financial goals of Dasa constitute the beliefs and assumptions of the company management as well as information currently available.

Forward-looking statements are no guarantee of performance. They involve risks, uncertainties and assumptions or may refer to future events and depend on circumstances that may or may not occur. Investors should understand that general economic conditions, market conditions and other operating factors may affect Dasa's future performance.

Now I will turn the conference over to Mr. Glauco Desiderio, who will start the presentation.

[Glauco Desiderio, executive]

Good afternoon. Thank you for attending this call. We will start the presentation with the remarks of Pedro Bueno, Dasa's CEO; followed by Felipe Guimaraes, CFO. Also here with us are Andrea Dolabella, General Manager of Products, Marketing and Experience; Emerson Gasparetto, General Director of Hospitals and Oncology; Rafael Lucchesi, General Director of Diagnostics; and Nelcina Tropardi, Chief Legal Officer. Everyone will be available in the question-and-answer session.

I turn the call over to Mr. Pedro Bueno for his delivery.

[Pedro de Godoy Bueno, executive]

Hello, everyone. Good morning. Welcome to our earnings conference call. We presented a short presentation for you. We are going to start providing context for the year 2022 -- we'll go a bit deeper into our results for the year, and then I'm going to [ have ] some closing remarks for our perspectives of 2023.

2022 was a year where our strategic investments, our strategy started to pay off. We grew 26% in our gross revenue with a company, which is already 50% on oncology and diagnostics. We made a very important advance in our digital business, on ocology, as you can see, strong growth in revenue, but also a growth of gross margin year-on-year.

We ended the year of 2022 -- if we compare the fourth quarter of 2022 with fourth quarter 2021, almost 15 percentage points of growth of gross margin on hospitals and oncology. So we are very enthusiastic with the integrations that we have been doing with M&As and hospitals. And as to oncology, it's our [ thesis ] to use diagnostics in hospitals to feed the growth of all the [ patients of ] oncology with a growth of over 40%.

I will not follow the order of the slides, you can just skip some points and go straight to Nav. As to Nav, we have nearly 6.5 million registered users across the country. So we made headway expanding our user base.

Now focusing on engagement and generation of revenue. This worked well. This was a year of transformation of people and culture, which is very important to the company, especially for oncology and hospitals led by Emerson. We have just made -- formed a group of our hospital team, and the results were very successful. We were very successful [indiscernible], and we had big advances in the commercial area. And we can see the payoff, what we've done last year, among other adjustments that we made and these other new ones.

Even so, this was a challenging year, a year where some things happened in a different way than we expected. Now going to diagnosis and care coordination. In the first months of the year, we had revenue -- growth of revenue lower than we expected. And we responded quickly and we implemented important adjustments, focused on four levers: contracts with operators, the management of offers and tests in our units. So we can see the revenue according to the square meter in our units. So this drove the growth of this business.

Our focus on digital experience and check in and also on [indiscernible] check in and digital consultation, especially that is going to bring about efficiency, but also growth in our revenues, considering that you have a lot of loyalty with our clients. And also all the businesses in diagnostics, which is related to Alta brand and our home collections.

The good news is that in the fourth quarter, we can observe a growth of diagnostics, ex-COVID. [indiscernible] in the first 9 months of the year. In the fourth quarter, we were -- the company of diagnostics that grew the fastest in the period.

And as you are going to see at the end of the presentation, the first quarter is very [ deserted ] also in relation to diagnostics. I'm going to share some information related to this at the end of my presentation.

Another front that we could have done better last year was the corporate expense that I mentioned. We reached the peak in the second quarter of nearly 15% of our net income, which was consumed by administrative expenses. And we end -- we reached the end of the year with 20% less, but -- so the dilution is happening, but we could have been faster.

In October we opened a project, and we looked at the effect of centralizing the activities. We went deeper into our administrative structure, and we had very positive results from this project. And we have already implemented [indiscernible] on the project in February of this year. So we understand that this corporate dilution will accelerate this year. As I mentioned in the fourth quarter, we stood at 14%. This is an informal guidance, but we are going to go after this efficiency in relation to the net income for 2023.

Another front that we could have -- differently last year was related to our focus on leveraging. And this is a priority topic of the company now. We have different fronts. We need to go over them so that we can improve our future structure, prioritize our cash generation, and this came from the lessons we learned [ embedded ] under the company last year related to cultural transformation.

Fortunately, I have a good mentor. Localiza is my mentor, and we have been implementing different changes, incentives, KPIs. So we have been implementing many efforts in 2023, focused on cash generation and deleveraging.

I turn the call to Felipe, [indiscernible] into the results of 2022, and then I'll come back to talk about the prospects for 2023.

[Felipe da Silva Guimaraes, executive]

Thank you, Pedro Starting on Slide 6, gross revenue. We posted a significant growth of 21% this quarter, pointing out the progress in the maturity of Dasa Ecosystems. The revenue from the business on hospitals and oncology presented a growth of 49%, reaching BRL 1.8 billion in the quarter, with significant growth in the two segments that make up such a business.

Looking specifically at the segment of hospitals, the 50% increase year-over-year is explained by the increase in the number of beds in the period, mostly due to recent acquisitions and the average ticket due to greater complexity and contractual readjustments in the last 12 months.

The same for oncology. The 40% growth also comes from an increase in volumes and in the average tickets. So we performed approximately 127,000 procedures, including infusion, radiotherapy and consultation.

Moving on to the business of diagnostics and coordination. Revenue for the quarter totaled BRL 1.7 billion, an increase of 2% year-on-year and 6% ex-COVID.

In the segment of diagnostics, we can see a 7% growth in gross revenue compared to the same period of last year, 13% ex-COVID. This shows a resumption of growth in the segment and the gain in [ number of organic ] shares from the fourth quarter onwards when compared to our major peers.

Even with the additional impact brought about by the same seasonality of the World Cup, we managed to deliver a good result, coming from larger tests and larger average tickets.

Second, in the segment of care coordination, we draw your attention to the one-off effect brought about by the recognition of the lower-than-expected gain related to profit-sharing contracts. I will provide more details on this topic on the BU2 gross margin slide.

Moving on to Slide 7. BU1 gross margin continues to show strong progress, supported by management efficiency and synergy gains, ending the fourth quarter of 2022 at 28.2%, an increase of 13 percentage points compared to the fourth quarter of 2021 and showing a clear upward trend. When we compare the first half of 2022 and the second half of '21, growing by 10%. [indiscernible].

It's been one year since we assumed the assets, and we can confirm the integrations [indiscernible]. In these 12 months of consolidation of the growth, strategy and [ average ] margin gains. We remain confident in the continuity of the margin improvement process.

Moving on to Slide 8, we present the gross margin of diagnostics and care coordination, 28.2% In the fourth quarter of 2022, a reduction of 7% in comparison to the fourth quarter of '21 and 3 percentage points when adjusted by the profit-sharing contracts. And therefore, it's important to segregate segments that make up this BU for a better understanding of the results. Starting with diagnostics, which recorded a drop of 3% -- 3 percentage points due to the following effects: the reduction of the share of COVID tests, which can be seen more clearly in the graph of the lower side corner of this slide; and the FX effect in international operation, which reflects a reduction of 1.2 percentage points.

Going to care coordination, we see the one-off impact. In a summarized way, in 2021, we had two integrated care contracts in the segment, and if we share the gains by reducing the claims in a certain portfolio along 2 years. And these operations had positive results in the period, however, lower than the first year. And that's why we made this adjustment this quarter.

This reduction represents a little bit less than 10% of the revenue. And due to the high complexity of this kind of contract, this modality is no longer a focus for us. And that's why we are back to operating the PMPM mode. This impact explains the gap of approximately 4 percentage points in the comparison between the periods, as highlighted in the upper left graph.

Here on Slide 9, we highlight the dilution for the second consecutive quarter of our G&A, in line with the company's efficiency and productivity plan. Some important adjustments are being carried out and the annualized impact of the actions will be savings of approximately BRL 100 million, which will be largely seen along the year, given that most of them would be finalized by the end of the year, the first quarter of 2023, more specifically. And the result of this work front should lead to a significant dilution of G&A throughout the year, coming to levels lower than 2021 in terms of percentage of the revenue.

Now on Slide 10, we show the evolution of our adjusted EBITDA, which showed a 42% increase when compared to the fourth quarter of 2021, in addition to a 2-percentage-point growth in the margin for the period.

Now looking at the snapshot of the second half of 2022, we see an increase of 23% in comparison to the same period of last year. This snapshot is important, given the advances in conducting our business during the second half of 2022 and considering that there's a distortion caused by a high volume of assistance related to COVID-19 in the period.

Now moving on to Slide 11, we show the digital strategy and the Nav platform monetization funnel. Starting at the top, we can see that we have been very effective in increasing our user base, both patients and physicians. At the end of Q4 2022, we already had 6.4 million individual patients and 37,000 physicians registered on the platform, very expressive growth in comparison to the same period of the previous year.

Of the registered users, we noticed an increase in the recurring use of the platform, showing a greater engagement of the space. The number of monthly active patients grew 1.6x this quarter when compared to the same period a year ago, while the number of weekly active physicians increased 2.2x over the same period.

Finally, we can see there has been a robust advance in the reach of our services, measured by the number of [ unified ] access that grew 2.2x generating, even more opportunities for navigation.

Now on Slide 12, we are going to talk about leverage, where we closed for the purpose of covenants, 3.87x, the value of the debt owed -- the net debt over adjusted EBITDA. Our net debt ended the quarter at BRL 8.4 billion. It's important to point out that in line with our strategy of liability management, we continue working on the optimization of the future, demonstrating the schedule, where we had two important operations, as you can see on the lower part of the slide.

Having said that, I turn the call to you, Pedro.

[Pedro de Godoy Bueno, executive]

Can we go to the next slide? So let's talk about capital structure. Our absolute priority for the company is to generate cash and to improve our capital structure. We brought some opportunities that we have been prioritizing. The first one, obviously, is the strategic opportunity that we mentioned in the material fact that we released on Friday.

As you saw in the material fact, we have some -- been engaged in a potential public offering of shares that is being discussed at the company.

And the second point is CapEx. We have been making an important reduction in our CapEx. The CapEx of 2022 pointed at BRL 1.3 billion. And what we went for this year is not a formal guidance, but in 2023, we want to spend with millions not billions, focused on 5% of the net income. This is not a formal guidance, but this is what we're going to go after.

That means that we still have some room for important investments that we're going to have a positive prioritization for the company. We need to do some more strategic investments with the investment with return which are higher.

We have made many investments in the past 3 years. So we have a lot of contracted growth. So we want to realize the CapEx that we have already used. So we are going to be more conservative this year in terms of CapEx.

And third, we bring possibilities of sales back -- leaseback. And we have in Sao Domingos in Maranhao and Bahia Hospital in Salvador. These are two assets that came together with those M&As, and we are talking to potential investors. We do not want to provide a formal guidance, but we tend to invest up to BRL 600 million in the short term.

And fourth -- another is to reduce the working capital days. These are things that are in our hands at the moment and we see opportunities to improve this aspect along 2023.

And item 5 is that we continue to gain efficiencies, especially in G&A, that is going to bring us major profitabilities for 2023.

The conclusion of all this, to give you an order of magnitude, we see the improvement opportunities in the capital structure, excluding the improvement of our EBITDA. We're talking about [ BRL 3 billion ] of new capital for the company in 2023. With this, we are going to improve significantly our capital structure.

And at other fronts, we're focusing is to reduce leverage, but we also want to generate more cash. As I said we are going to be more conservative with G&A and CapEx, and we're going to focus in reaching the breakeven of our cash generation. This is not a guidance, as I mentioned before. So we are going to focus on lowering our debt service as well.

So all those strategies that will improve our capital structure will operate to reduce the leverage of the company. And in 2024, we will have the operational evolution of the company. And we are happy to have a very positive cash generation, speeding up our deleveraging process. And in the medium term, we want to be at a comfortable position of 2x. And this is what we need to go after in the medium term.

Now talking about the outlook for 2023. We are very enthusiastic about 2023. One more slide, please. I've just mentioned the capital structure. This is our absolute priority. As I said, not in terms of leverage, but also in terms of cash generation, we are prioritizing this at the company this year.

And as for hospital and oncology, we are on track of all integrations that we started. And even considering all this, there's a long way to go yet. So we expect to continue evolving, expanding our organic growth, and we're also going to improve our targets for 2023.

We have been working on four growth levers for this business, which are: outpatient clinics, digital outpatient clinics, generating counts of patients and procedures, conversion of the surgical center oncology. As you saw, oncology is growing at a fast pace and the combination of all this.

And the last one, which is related to navigation of new patients. And this is an initiative that we have, where we create an algorithm that would create -- that would connect the image report and will identify whether or not the patient will require a hospital service and we're going to use this test -- the result of this exam in order to convert into a hospital patient. And what we've served in the first quarter is that we saw an organic double-digit growth when we compare it to the first quarter of the previous year.

For diagnostics, we have been working on the levers along the second half of last year, leading to the growth that we reported. And this is also helping the growth of the first quarter. I'm not going to repeat all the levers, as I have already mentioned them in the beginning.

And in the first quarter, of course, this is not a formal guidance, but we have observed an ex-COVID growth. If you observed in 2022 in the first quarter, we had important revenue. But when you look at the growth ex-COVID, comparing these periods, you understand that we have reached double digits. But it's not the final -- figure. These are robust double digits. We are on track to increase our share in the diagnostics business, and we are also focusing on digitalizing our businesses to improve the margin of this business unit.

Fourth, navigation. Navigation is a big upside for the company this year. So we are working, not only navigation using our platform, but also, we are considering other results of navigation that do not require all the Nav-related technology. So we can already start capturing results in the company. We have five important fronts. One is the oupatient clinics. The other is care coordination, and this is something that we can work with to use diagnosis -- digital diagnosis with Dasa; our broker, [ NLP ], which is the initiative that I mentioned; and other navigation tools that we have.

So we expect and we've been working on aggressive targets for the company so that we can move the total organic growth of the company in 2023. We're very enthusiastic about all those opportunities, many of them are not budget -- there's upsides considering the numbers that have been planned.

And lastly, the SG&A. As I mentioned, we are very confident with this dilution that I mentioned because we have already implemented the actions in February and March. And there are some other actions to be implemented in April, but we have already done the hard work. And this is going to bring out a lot of efficiency in the expenses of the company.

When we look at all this, we expect a year with [indiscernible] growth, organic growth, an improvement in profitability and very importantly, improvement in the capital structure. These are our focus for 2023.

And I think I can now open the Q&A session. Thank you.

[Operator]

[Operator Instructions] Our first question comes from Vinicius Figueiredo with Itau BBA.

[Vinicius Figueiredo, analyst]

The first point I would like to discuss with you as we bring all positive information in terms of operating improvement for 2023, the SG&A is something that has already been diluted along 2022. There was a sequential improvement in 2022 already.

I understand that you're not going to provide a formal guidance, but -- so we should agree this can reach as a percentage of the revenue, and I would also like to know some more, not only about the paying sources, but also the environment of those payment sources.

We can see that the [indiscernible] has been improving. And I would like to understand if you're being very conservative? And if you could provide some more light in relation to this, I would be grateful.

[Felipe da Silva Guimaraes, executive]

Vinicius, thank you for the question. To answer the first point, yes, we expect an acceleration in the dilution of the G&A. You see a soft curve, in the previous quarters, we dropped by 1 point, but we want to drop more than this. We want a stronger reduction. So we'd like to expect levels much lower than we had in 2021 that we showed in the presentation.

In relation to your second question, in terms of receivables, we do not expect an improvement of receivables for this year from the operators. For a better cash generation, we want to improve internal processes so that we can cause a positive impact on the negative scenario. And this can be related to inventory levels and the payment terms. And we understand there is a lot to do yet.

And second, our receivables process is even more robust internally. And we can see this in the percentages that -- receivables that we saw, and we have been reducing our processes year-on-year, and this is a result of our internal processes that is going to be reflected on the results and can offset any negative scenario from negative receivables from other operators.

[Operator]

Our next question comes from Yan Cesquim, BTG Pactual.

[Yan Cesquim, analyst]

I would like to ask two questions. First one is related to BU2. It was very clear that you had a positive message to give us in terms of growth of revenues ex-COVID for the beginning of the year, but I would like to understand a little bit better the mix considering COVID. We saw this in the first quarter of 2022 -- we still see this impact and that brought a positive impact to the margin.

So where can we see this turning point? When is it going to happen? When the organic growth and the operating leverage is going to offset this COVID coming out of the scene? Are we to see this in the second half of 2023? Is it fair to say that?

And the second question is to measure your perception on -- we've seen the level of this fall in the market, happens at a macro level in the chain, considering how you observed this, especially at the beginning of 2023. Do you see any improvement?

[Rafael Lucchesi, executive]

Thank you for the question. Okay. Here we go. It's an excellent question. We are going to feel this effect that you mentioned in a very strong way in the second quarter of 2023.

For the first quarter, we still have an impact of Omicron of last year. So COVID still impacts the revenue. As Pedro mentioned, we have been accelerating the revenue operations to offset this drop. But for the second quarter, COVID impact is going to be much lower. So we have the positive effect of organic growth impacting the operating leverage. And then we will go back to have a margin growth down the road as we expect.

Answering your question, as of the second quarter, this effect is going to be much clearer, especially for the second half. If you observe the levels of impact of COVID, there is a decreasing level. So for the second quarter, is as if the baseline is already 100% corrected.

[Yan Cesquim, analyst]

What about disallowance?

[Unknown Executive]

As I mentioned, in terms of disallowance, we -- our performance has been very positive. We have been able to reduce disallowance year after year. And in both businesses, both for diagnostics and the hospitals. And we are working hard on the disallowances, which are initial that can impact the terms of receivables. Because disallowance, at first, had some discrepancies.

And then, in the future, you're going to see if it's going to be accepted or not. And the discussion can take long because of this -- because of this discussion. So the focus is to guarantee that the process is very robust. So that the [ PMR ] can be well reflected.

We have lots of opportunities to look at along the year, so that those effects will not offset any negative scenarios coming from outside.

[Operator]

Our next question comes from Gustavo Tiseo with Bank of America.

[Gustavo Tiseo, analyst]

I have two questions on my side. Out of curiosity, I would like to understand what this tells of more that your hospitals considering the navigation that you have and the beneficiaries are the focus.

[indiscernible] your hospital, those occupancy rate is very relevant. Can you bring higher efficiencies to those mature hospitals? Or are those efficiencies more clear in the new hospitals when you talk about navigation?

And the second question is related to care coordination. There were two agreements that you mentioned. I would like to understand how far can we see those avenues impacting diagnostics in a negative way? We want to understand the impact. Even though you are changing the types of contract, I would like to understand it. These are my two questions.

[Unknown Executive]

As for hospital and navigation, which is a very important lever for us, for the company -- for the strategy of the company as a whole, it brings in revenues and profitability to our assets. But in addition to that, it would mitigate some gaps and this improves the efficiency. We do not have -- we have integrated hospitals and also other hospitals. In all of them, we see opportunities to increase our revenue using this lever. The occupancy rate is about 75%. So this shows that we still have a good opportunity to occupy our assets, leading to 80% or 82%.

And on the operational viewpoint, this is very relevant to those hospitals. We have the capacity to support this growth coming from our strategy. And as mentioned, not only navigation, using the image and parts, but also for patients who need some services, which are not emergency services. But they need follow-up of their outpatient service and navigating to hospitals when necessary. So ensuring that the gaps are going to be looked at with cost-effective ratio and everything.

Answering your second question, related to coordination of care. This is a business that we see a lot of potential. We have been able to generate lots of savings to the operators. This specific contract -- well, first, I would like to say that we just had two performance contracts in this business, and these are contracts that have no downside risk. In other words, we can capture the savings.

But if there is -- if anything gets worse, nothing negative will happen. So in this contract, we can give back the gain that we had. In 2021, we had a positive -- gains were very positive. And in 2022, we returned part of the gains. We had a gain of [ 50 ] in '21 and returned [ 30 ] of those [ 50 ] in 2022.

When we see that long -- the lifelong period of those contracts, it was very positive for Dasa. So you say, when are you going to discontinue this? Why? Because there's a lot of discussion with the operator. We understood that PMPM is simpler and the commercial results grew to be more accelerated as we have seen in the first quarter of 2023. We are not going to sell new contracts of performance. And we just have this one, the only one, which was left, and we do not expect any relevant negative impact in 2023. So you can disregard this aspect in your projection.

[Operator]

The next question comes from Mauricio Cepeda with Credit Suisse.

[Mauricio Cepeda, analyst]

I'm going to concentrate on diagnostics. In general, what have you been doing to increase the registrations? What has been the proposition of value? And how is this process going out? What have you been doing in order to bring in more traffic? The tools you have been using? Since you have this natural advantage of having different brands, so how have you been linked to other services, B2C? And what are the prospects in this area?

[Unknown Executive]

Okay. Here we go. What do we have in terms of tools for registrations. New registrations is a continued work. So we have been able to register our units and services, which were not registered. Thinking about the products offered by the operators because sometimes, we have a group of products, which are already registered and the other ones which are potential products.

So we have the potential of managing the portfolio in order to have new registrations. So how do we go about it? We have a competitive advantage, which is the segmentation of the margins. So we can operate using the segmentation, using different products and with the capillarity in different segmentation. Sometimes, we can provide the complete services for the operator.

So with this, we can offer a complete package. We can segment by means of prices and services, and this has been a very good proposal to the operators. And this is why we have made new important commercial contracts. We have increased the volumes and this has been happening since the fourth quarter, and this has been playing out since now.

And what have we done in order to capture this volume? Oftentimes, we need to expand the service offer. As Pedro mentioned, we have invested a lot in the past few years. So we have the capacity to expand the services of the units.

And this is what we have done, with a double positive effect, which is bringing in revenue. And since we have fixed costs already established, so we can have an additional profitability because we dilute the fixed costs. We grew in volume and diluted expenses. So we have a possibility to make more profit.

And this all [ adhere ] to the digitalization being scaled, reduction of tests. All this brings in a positive sum, and we are very confident that we are on the right track for 2023. Thank you very much for the question.

[Operator]

[Operator Instructions] Our next question comes from Renan Prata with Citibank.

[Renan Prata, analyst]

I have a question on my side. You have already addressed very well the main points during the presentation. In BU1, on oncology, what are the opportunities a little bit before Nav? Is there any opportunity in the gross margin in terms of gaining some efficiency, especially the newly acquired hospitals? So I would like to know if there is any room for increasing the gross margin? Yes, all those topics a little bit before Nav in the [ presentation. ]

[Unknown Executive]

I don't know if I'm still connected. But just a moment, we are having a look. We're checking this out.

Yes, we have opportunity to increase the gross margin in hospitals. We have a lot to capture in revenues. As to navigation, and navigation is not limited to Nav. Navigation means that we are going to meet all the gaps. Oncology, as we mentioned before, has been growing quite a lot. And we have a thesis that early diagnosis is very relevant. And we are going to provide a better outcome considering the early diagnosis. So we can see a big evolution in third-party services and personnel.

So '22 was sensational in this term. So we had significant evolutions in 2022, but there is still room to be captured as we mature any actions adopted in 2022, and also 2023, and also in the line of medical costs that we are working hard on. If we compare the two halves of the year, we see the run rates of the business. This is how we're going to work in 2023.

So as I mentioned, the levers in a summarized way that I described, are the ones that we're going to use for 2023.

[Operator]

Our next question comes from Marcio Osako with Bradesco.

[Marcio Osako, analyst]

I have two questions. The first is related to diagnostics. I would like to understand how much of this acceleration of the growth comes from new contracts? And considering this growth, how the public segment is going to peak and affects your business, it's also around your different segments.

As for hospitals, when the first negotiations have been with main paying source -- the main payers. If we consider the three main payers, when do negotiations happen? And do you see any sign of a tougher price negotiation when compared to last year, demanding reductions and discounts? These are the questions.

[Unknown Executive]

Marcio, thank you. I'm going to start answering your question about hospitals, and I'm going to turn to Lucchesi to talk about the other topic.

As for hospitals, the contract anniversaries are distributed along the year, so we do not have a quarter specifically that we would have a big concentration of negotiations.

Hospitals have the agreements that are negotiated in the second half of the year -- that are negotiated almost. And we are continuing with our strategy for hospitals, where we go for IPCA+. Why? Because many of the hospitals we acquired had the lower -- standards. So when we look at our peers, we see that there is like an umbrella of prices, where we can define the prices per hospitals and be more efficient. [indiscernible] our model, its 6 efficiencies. So you have to have to combine other price lists and the operating activities.

So we're going to use this strategy because we're comparing to our peers the way we're going after IPCA+.

I'm going to turn to Lucchesi so that he can answer the question about diagnostics.

[Rafael Lucchesi, executive]

About the growth in diagnostics, you can say the following: More than half of the growth comes from commercial leverage, considering volumes and prices; and half of the growth comes from levers of business operations, such as expansion of agendas, expansion of services, new service sales with high-growth levels, such as Alta brand, the premium brands that always pull our growth upwards.

The level of experience that we offer the users, we can see that there has been an increase in the recurrent use, the use of Nav, the use of check in, the uses of digital experience.

We have a very clear plan of growth, where the revenue growth would come, where the volumes would come from. And we can see this division have from commercial levers, increments of volume, price adjustments, and the other half comes from the actions in the business and in the operations.

[Marcio Osako, analyst]

[indiscernible] most efficient operating [indiscernible]? And then the average expense would be lower per patient? Is this it? Or are there opportunities to improve this average ticket in addition to the [ price ] list?

[Unknown Executive]

Yes, for sure because the average ticket is based on the price list, but it's also related to the complexity level. As Emerson mentioned, one of main growth levers to this BU is oncology. Oncology generates hospital events and surgeries of high complexity. So we are not dependent only on the price list, even though this is going to be very useful for the company in 2023.

But there's also the complexity aspect to be considered. And when I say operational model, I mean you have to see the conversion of those each services to hospitalization, to ICUs, and [ we generated ] the margins to those indicators. And we share those indicators with the operators showing the efficiency in our work as a -- and this is the opportunity we see.

[Operator]

The Q&A session ends. I would like to turn the call over to Mr. Pedro Bueno for his final remarks.

[Pedro de Godoy Bueno, executive]

Thank you very much for the call. As I mentioned, we have had important lessons learned in 2022 that we are going to apply in the beginning of 2023. We are seeing results and focus on cash generation, capital structure, and also monetizing all the investments that we made in the past few years that are going to contribute to a very healthy organic growth for 2023.

We'd like to thank you all, and see you in the next quarter.

[Operator]

Dasa's videoconference has come to an end. We would like to thank everyone's participation, and have a nice afternoon.

[Statements in English on this transcript were spoken by an interpreter present on the live call.]