Fleury SA

BOVESPA:FLRY3

Earnings Call Transcript 2024-Q1

[Operator]

Good morning, ladies and gentlemen and welcome to Grupo Fleury's Earnings Call for the First Quarter of 2024. We have with us Ms. Jeane Tsutsui; and Jose de Almeida Filippo, Financial Investor Director; as well as Renato Braun, Investor Relations Officer. This event is being recorded, and we're also being simultaneously translating into English. First, we will present the company's results, and then we will have a questions-and-answer session. At the end, Ms. Jeane will provide her closing remarks.

All of the numbers presented here are compared to the first quarter of 2023, and they have been rounded up. Before we continue, we would like to state that this presentation may contain information about future events. This information is not just historical facts but reflect the wishes and expectations of the company's management.

The words believe, expect, plan, anticipate, estimate, project, aim and the like are intended to identify statements that necessarily involve known and unknown risks. Known risks include uncertainties which are not limited to the impact of price and service competitiveness, market acceptance of services in the market, company and competitor service transactions, regulatory approval, currency fluctuation, changes in the mix of services offered and other risks are described in the company's reports.

We will now pass it over to Ms. Jeane Tsutsui.

[Jeane Tsutsui, executive]

Good morning, ladies and gentlemen, and thank you for listening in to our earnings call for the Fleury Group in the first quarter of 2024. We will begin with an overview of the group, and we will continue with some of our innovation initiatives. And finally, we will see the financial highlights for the first quarter of 2024. As you know, this is our strategic positioning in Fleury Group. We remain focused on our diagnostic medicine core with our diagnosis centers that provides imaging and clinical analysis. And this goes to reinforce the strategy.

In April 2024, we started in a B2C strategy in the state of Santa Catarina where we already worked as a B2B service provider. We are close to the 1-year anniversary of our combination with Pardini, and the integration is continuing as planned. Cultural integration, synergy capture and integration of processes and systems is currently ongoing. We have 60 work fronts mapped. This is being followed up with governance and controls.

We continue to grow across diagnostic B2B and B2C platforms and systems.

So Slide 6 shows the growth avenues and highlights how our strategy has been carried out, ensuring the diversification of services for the patient's journey. The first avenue is Diagnostic Medicine B2C and it grew in scale and revenue with a greater presence in the access market. It represents 67% of our revenues for the first quarter of 2024, of which 7% comes from mobile services. Diagnostic Medicine, B2B represents 24% of our pro forma revenues, and this is due to a good execution of our lab-to-lab services and hospitals.

By strengthening core activities through increased integration of the patient's journey, New Links grew significantly, especially in ophthalmology and in [indiscernible]. (4:26) It corresponded to 8% of our revenues in the first quarter. And the fourth avenue is Health Platforms, which is exploring new growth paths with digital solutions and represents 1% of the group's total revenue.

Slide 7 shows the group's innovation initiatives. This is one of our competitive advantages, keeping the company at the forefront of medicine. Through innovation, we've implemented new technologies that increase productivity and allow us to have more precise diagnosis, strengthening our relationship with clients and with the medical community. We're working on 4 innovation fronts, as I'll show you on the next slide.

As you can see on Slide 8, our innovation initiatives are split into Research and Development, or R&D, Startups, Artificial Intelligence and New Businesses. In R&D, we have an extensive relationship with academic and scientific institutions, allowing us to develop advances in health care. As a result, we have 5 patents like genic micro -- genic expression microarrays that can sequence human genes to diagnose acute leukemia.

In 2023, we carried out 73 research projects and published 66 papers in scientific journals. These efforts add value to our portfolio and allow us to stand out from the rest of the market, generating new products and strengthening our reputation in medicine.

We know how important it is to adapt to change and to evolve in our services. And that goes to boost the company's growth. So in start-ups, 5 years ago, we started working with [ open innovation ]. We've evaluated over 800 startups and implemented 57 solutions in 27 of our areas. For example, with startup Vuupt, we were able to reduce 1.4 million kilometers in transportation and mobile services in 2023, which saved in logistical costs and helped us with impressions related to these services. We also have new projects such as the [ Amplia ] platform, which was launched last year. That is our official platform for innovation. In the artificial intelligence front, we have a number of initiatives that help us to become a player with more productivity, that is more precise in diagnosis and that is better integrated to the patient's health care journey.

They include Air ReconDL, a reconstruction algorithm that reduces the time to capture images in MRIs, and contribute to quality gains. Oncofoco, which assesses changes in 421 genes and contributes to caring for cancer patients on the metastatic stage who do not respond to standard treatments. And Huna, an artificial intelligence model to predict for the risk of breast cancer through blood tests and other routine exams.

We can also discuss innovations in our way of creating new businesses, for example, through joint ventures and genomic in a partnership with the Albert Einstein Hospital and oncology with BP and Atlantica Hospitais. This has allowed us to provide a more comprehensive portfolio for our patients. Before I show the financial highlights for the quarter, we'd like to say that aside from accounting standards, we are offering same-base comparisons.

On Slide 10, we see that the accounting result is capturing the Fleury and Pardini Group and comparing them to Fleury in 2023. The pro forma nonaudited result is for simple comparison, and it includes the 3 months of Fleury and Pardini as if both operations were combined in the same period of 2023 and 2024.

On Slide 11, we see the accounting highlights for the first quarter of 2024. We see that the business combination has elevated the company to a new revenue level. Gross accounting revenue was BRL 2.1 billion, a growth of 54.5% versus the same quarter of 2023. There was 2.3% growth in the Fleury brand, 45.1% in other brands in Sao Paulo, 23.2% growth in Mobile Services, representing 7.4% of our revenue and 26.7% in New Links, 21.8% of which was organic growth.

Our EBITDA was BRL 517.1 million, a growth of 49.6% and margins were 27.2%. Net income was a total of BRL 168 million, a growth of 79% versus the first quarter of 2023 with an 8.8% margin. This regarding Pardini net income was BRL 179.4 million, a 9.4% margin.

Slide 12 shows our pro forma nonaudited results for a simple comparison. It shows how consistent we are in delivering results. Gross revenue for the second -- for the first quarter of 2024 was BRL 2.1 billion, a growth of 7% versus the same time last year. Organic growth was 6.6%. The Fleury brand grew 2.3%, Mobile Services reached 12.5% and New Links, 26.7%.

We would like to highlight the growth of our other brands in Sao Paulo with a growth of 11%. EBITDA grew BRL 517 million, a growth of 11% and margins of 27.2%. Although there were changes in the mix of brands and products and the impact of seasonal factors, our EBITDA and margin expansions are reflecting our cost control and the synergies we have captured. I'll now pass it over to Jose Filippo, the Financial Executive Officer and Financial -- excuse me, Investor Relations Officer, who will talk about our financial highlights.

[Jose de Almeida Filippo, executive]

Thank you. Good morning, everyone. We will now go into details about our financial highlights. On Slide 13, we can see that the accounting gross revenue was went to BRL 2 billion, up 54.5% versus the first quarter of 2023. Mobile Services grew 23.2%, representing 7.4% of our revenue. New Links grew 26.7%. The next slide, Slide 14, shows our pro forma gross revenue, which was BRL 2.1 billion in the first quarter of 2024, up 7% versus the first quarter of 2023; 6.6% of this growth was organic. The Mobile Service channel grew 12.5% in this pro forma comparison, and it represents 7.4% of the quarter's gross revenue. New Links went up 26.7%, of which 21.8% was organic.

On Slide 15, we see that gross revenue across all brands reached BRL 1.4 billion, a growth of 29.7% and versus the first quarter of 2023. 16.3% of it was in Rio de Janeiro, 15.3% in Minas Gerais, 22.6% in regional brands, and 2.3% in the Fleury brand.

Slide 16 considers the pro forma growth. And we can see that -- excluding the pro forma effect, it would be minus 1% for regional and 3.8% for PSCs. This reflects the important advances of the main brands in Sao Paulo and Minas Gerais. Both had a growth of 11%. There was a slight reduction of 0.7% in Rio de Janeiro. The Fleury brand grew 3.1% in the first quarter, which reflects the holidays that affected us in this quarter and allowed us to maintain our market share. We saw a 5% contraction in regionals with the B2B reclassification. Without this effect, it would be 1%.

Continuing with Slide 17, we see accounting results for New Links and HC platforms, a growth of 28.5% in gross revenue to BRL 171.2 million in New Links. For health care platforms, our gross revenue was BRL 17.5 million. Slide 18 shows that the pro forma gross revenue for New Links and HC platforms went up 27.5% this quarter to BRL 188.7 million. New Links reached BRL 171 million during this quarter, a growth of 26.7% of which 21.8% is organic. And it represents 8.3% of the consolidated net revenue. In health care platforms, gross revenue was BRL 17.5 million.

Slide 19 shows accounting gross profits. In the first quarter of 2024, it was BRL 565 million, up 58.5% versus the first quarter of 2023. The next slide, Slide 20 shows pro forma gross profit, BRL 565 million, a growth of 11.4% versus the first quarter of 2023 with a margin of 29.7%.

The next slide, Slide 21, shows accounting operational expenses reaching BRL 238 million on the first quarter, 12% of net revenue. Slide 22 shows pro forma operational expenses, which had a growth of 10% versus the same time last year. Operational expenses represented 12.5% of our net revenue in the first quarter of 2024 versus 12.1% in the first quarter of 2023.

Slide 23 shows that accounting EBITDA in the first quarter of 2024 reached BRL 517.1 million, a growth of 49.6% versus the first quarter of 2023. And a 27.2% margin. Slide 24 shows our pro forma EBITDA; versus the first quarter of 2023, it grew 11.1%. The EBITDA margin was 27.2%, up from the 26% we had the first quarter of 2023. Slide 25 shows that net income disregarding the effects of the business merge. So excluding the IHP surplus value reached 179.4 million, up 91.2% versus the first quarter of 2023 with a net margin of 9.4%. Without excluding the merge, net income was BRL 168 million.

Slide 26 shows our capital investments or CapEx which came to a total of BRL 67.3 million in the first quarter of '24, down 4.9% versus the first quarter of 2023. We saw a growth of 20.4% in new PSCs offer expansion in units and technical areas and a growth of 42.7% in diagnostic equipment renewal and maintenance. Slide 27 shows operating -- excuse me, accounting operating cash flow, which reached BRL 220 million, a growth of 3.7% versus the previous year. Cash conversion was 42.5% of the EBITDA, which is compatible to the typical profile in the first quarter of the year.

Slide 28 shows our leverage which was at 1.2x net debt to EBITDA at the end of the quarter, flat in comparison to the fourth quarter of 2023 and the first quarter of 2023. This has been below the 3x limit of our financial covenants. Slide 29 shows the debt amortization schedule for the Fleury Group. It shows our robust cash position, which is in line with our obligations. The average term is 3.2 years with no concentration of terms.

Before we go to the Q&A session, I would like to ask Jeane to conclude the presentation.

[Jeane Tsutsui, executive]

Thank you, Filippo. The results show that we are concluding the first quarter of 2024 with a solid business space with financial stability and it highlights our robust capital structure. We will continue to strengthen our position as a partner for operators and other agents in the health care industry. Our work in preventive and outpatient medicine is contributing towards the sustainability of the health care system through products and services that engage with patients and help them keep track of chronic diseases.

We are assessing our capital allocation and our leverage was at 1.2 net debt-to-EBITDA, which is far below our covenants. This reflects the company's financial discipline in a scenario in which interest rates are still high. The acquisition of Sao Lucas shows that the Fleury Group is still using a positive market agenda, looking at the opportunities that contribute towards our growth and that are aligned to our financial parameters.

Our competitive advantages are medical excellence, science, technology, innovation, a national footprint, operational efficiency and ESG practices, and they contribute to developing the entire health care ecosystem with the engagement of our over 27 employees and physicians who are providing health care to our patients, we are well positioned to deliver consistent results for one more year, adding value to all of our stakeholders.

Thank you very much. And we are now available for questions.

[Operator]

[Operator Instructions] We will now pass it over to Mr. Renato Braun. Go ahead, sir.

[Renato Braun, executive]

So let's Jeane start us off.

[Jeane Tsutsui, executive]

In recent days, we've been keeping track of what has happened in the state of Rio Grande do Sul, a very difficult situation. We have a multi-disciplinary team from the Fleury Group supporting the work of people there. We are supporting life, helping with rescuing and locating people who work in our company and who were in a risk situation. Fortunately, all of them have been rescued and are now safe. Since then, we've been supporting them by providing food, water, medication and supporting clinical and mental health.

Moreover, physicians and employees from the company have been making efforts to help everyone in the area, including our hospitals and diagnostic operations. And we've been very successful in doing so. Our service units will gradually resume their activities in HC for environment as the state recovers. Our expectation is that very soon our personnel and the population of the state will have the possibility of resuming their normal lives. We can now continue with the Q&A.

[Operator]

The first question was received from Ricardo Boiati from Safra Bank.

[Ricardo Boiati, analyst]

Congratulations for the initiatives you've been having to help. Rio Grande do Sul. My first question is about the Fleury brand specifically. You mentioned a seasonal effect this quarter. I think this is relevant for Fleury and helps explain why there was this deceleration this quarter. So my question is now that April has passed, I don't know how much information you can provide, but are we seeing different sales performance in the first 4 months of the year to try to mitigate seasonal effects, especially for Fleury brand, which is being more affected. So that's my first question. I'm just trying to understand your recurring run rate at the top line for the Fleury brand.

My second question is about [ glosas ]. The company's level is quite low, but we did see it increase this quarter. I'd just like to understand if that's a one-off or we understand that there is a calendar effect that might have affected you, but we'd just like to understand if this is more in diagnosis or New Links?

[Jeane Tsutsui, executive]

So for the Fleury brand, we did suffer that effect of the Holy Week being in the last days of March. And in April, of course, we can't provide guidance, but there was a recovery. So we do see that the Fleury brand as you know, has a high market share. It has been maintained and that the seasonal effect has been neutralized when we talk about working days. So the Fleury brand is standing out due to our medical relationships with innovation, and that involves the entire Fleury group, but specifically, the Fleury brand is benefiting from this innovation, artificial intelligence, our products and services. And we believe that it will perform within expectations this year. It's a mature brand.

And here in Sao Paulo, we have other brands, specifically My Sao Paulo, which is still performing very well. And this change in mix, brands and services in the Fleury Group has been taking place, but we have been expanding our margins due to the cost discipline and the synergies we mentioned before. So we're aware that we're a company that has a good portfolio of brands and services.

Regarding cancellations, they are at a very low level, and we have a close relationship with the operators. So this slight change that you're seeing for the quarter is one-off. And it is due to the seasonal effect as well. As a reminder, March is very strong in services and consultations overall. And we had a holiday at the end of it. So it affects us specifically in receivables due to this calendar effect. Overall, our discipline has been maintained in our process in our cycle and cancellations have been at a low level in general.

[Operator]

The next question will be asked by Vinicius Figueiredo from Itau BBA.

[Vinicius Figueiredo, analyst]

I'm trying to understand something. I think you surprised us with your margin expansion in this first quarter. Even despite this mix that is not so obvious, the Fleury brand has faced some deceleration. So I'd just like to understand if you still see space for more margin gains, whether they are in B2B or in the different service units. Is there still space for more gains. Of course, synergies with Pardini influenced this a lot. But if you can tell us what opportunities you see with and without synergies, and this relates to what you mentioned in the call. I'm trying to understand the addressable market for the Fleury brand. This premium segment. In this scenario, does it start reaching the addressable market? Do you see trade down and plans or replacement in those premium segment, maybe service unit that is a bit cheaper? I'd just like to understand that.

[Jeane Tsutsui, executive]

Thank you for that question, Vinicius. So you mentioned an important point. The Fleury brand represents about 20% or 25% of the group's total revenue. And over time, we've been posting growth. We've been showing changes to the services mix and margins have continued to expand. We've been having a recurring profitability forums, of course, volumes allow us to dilute costs. And we have a view of all brands in B2C. Little by little, margins have -- excuse me, margin percentages have gone up across all brands. And we've been capturing synergies. We always say that they are due to the integration process. And we've had a lot of discipline in our integration process with Pardini looking at cultural issues.

We are over 27,000 employees and physicians, and we need to continue growing across all of our businesses. We also need to integrate processes and systems. And these synergies are in line with what we mentioned before in our guidance to capture BRL 200 million to BRL 220 million incremental EBITDA in 3 years. The addressable market for the premium segment is more limited.

So with low growth across the entire country, it will tend to remain a bit flat. So we're looking at the market share closely, and we have been able to maintain it. What's interesting is seeing our strategic position from the path by positioning other brands in new segments. So we see expressive growth for the My Sao Paulo brand, which has a lower market share but has been growing a little by little. And brands in the basic segment are also becoming more expressive in our results. Of course, all of them have their own challenges, so that they can continue growing with profitability. But we have to adapt our service level and our investments to these segments so that we have a healthy balance in the end. So this is what I wanted to share with you, Vinicius, and thank you for your question.

[Operator]

The next question is going to be asked by Gustavo Miele from Goldman Sachs.

[Gustavo Miele, analyst]

I have a couple of questions. The first is a little bit more objective. If you can share with us the impact of dengue fever in the company's growth. We had a stronger dengue fever epidemic than usual. So if you can tell us a little bit about the impact of that in this quarter. That would be my question.

And also referring to what Vinicius said, I'd like to understand the moment for the industry. So prices are still very restrictive with procedure approval, cancellations. So do you think you can benefit from that in relative terms? As you mentioned, cancellation is under control. So I'd just like to see if you're seeing any share gain opportunities due to having your solid brands, and if you will suffer less than others and benefiting from this in relative terms.

[Jeane Tsutsui, executive]

So concerning dengue fever, unfortunately, this is very bad for the health care industry overall. And as a group, we're offering diagnostic tests, not only for dengue, but we also see influenza and other flu-like syndrome. So we're offering a quick dengue testing. And specifically in Minas Gerais, we did see a higher number of dengue tests being performed. We know that Belo Horizonte had a significant epidemic. And that led to an increase of 11% in that region. But that's not all. There are other initiatives; portfolio expansion agendas, and over time, we've also been growing in Minas in other exams aside from dengue fever. We don't really go into these figures, Miele, just like we didn't do in the COVID pandemic, because it doesn't affect the company's total revenue to a significant extent.

So we don't want to give that impression. But in Minas Gerais, it did increase our revenue. The Fleury brand's addressable market brings up an interesting point. In comparison with other players, when we look at diagnostic medicine, we have a couple of tests or some kinds of tests that need to be scheduled and preauthorized. I'll give you an example. An MRI, you always need to get an authorization. Since it's elective and scheduled, you can have a preauthorization before the client takes that exam. So you have more control on what will be done in diagnostic medicine.

Another point is that we have a very clear vision that as the health care group, we need to contribute to the system sustainability. So our position is to discuss cases to give contraindications to some exams that are not necessary and indicate the ones that are necessary. We have a number of algorithms that help physicians in their investigations, their diagnostic investigation, and we try to look at the results as a part of the chain. So we want results to reach physicians to be used for their decision and how they will care for the patient.

So this is a -- this is something that we do through reports, through algorithms, through guidance. And of course, we try to be partners with operators and appropriately using resources. So overall, we tried to have a very clear position and this has been reflected in our results. Thank you, Miele, for that question.

[Operator]

The next question will be asked by Leandro Bastos from Citibank.

[Leandro Bastos, analyst]

Okay. So on receivables. Can you tell us about the seasonal effect you suffered in the first quarter? If you look at Pardini, we see that it was affected by several factors. So I'm not sure if you can tell them apart and what we should consider for the future. The second question is about your strategy in Rio. I know that there was a specific calendar issue. But what strategies and opportunities do you see to accelerate your growth in -- across regions.

[Jose de Almeida Filippo, executive]

Leandro, let me ask your question about receivables. We cannot say, but basically, the main factors, the mix or the seasonal effects have a similar influence. In this quarter specifically, the seasonal effect was more significant. So for example, when you compare the accounting aspect, last year, we didn't have that business combination and now we do. And the mix is very clear when you have that comparison. It shows some activities, especially lab to lab and others that have different terms. When we look at pro forma, then the calendar effects start to appear.

The calendar effect that we're mentioning here is that at the end of the quarter in the last 3 days of March, we had a long holiday, which means that some of the terms will continue in the next month. That's a very technical thing. It's one-off. It's not a trend. And it should be adjusted when we look at the next quarter. We'll be able to tell you about that during the next call. So it's a little bit of both. But with diverse revenues and with business growth, these things will happen. Lab-to-Lab has been growing. And along with that growth, we are seeing different terms. So unfortunately, we can't give you too many details, but during the next releases, we'll try to provide you with more details. So it's a matter of how we diversified our channels and our revenues. I think at the end, this is a strength for the company.

About our strategy in Rio. We know that the number of beneficiaries there has reduced, and we had a very good performance in 2023. And we had additional contracts that brought in additional lives in our addressable market. We have that business combination with Pardini. So we have a medicine center that has additional units in Rio. But from now on, we know that in the first quarter of 2024, the same calendar effect has affected us. Again, it's not a guidance, but looking at what happened in April, looking at the number of working days, we see that it was normalized.

So these services didn't happen in March, but they did happen in April. And it's important to mention that we have over 100 service units. Looking at 2024, we have a very clear strategy to capture all demands from Rio. We're working specifically with medical agendas to provide more offers with more physicians. So we have a medical staff that's working actively to expand our offers where we have demand and to make use of all of the opportunities we have in Rio de Janeiro.

[Operator]

The next question will be asked by Mauricio Cepeda from Morgan Stanley.

[Mauricio Cepeda, analyst]

I have a couple of questions. First, specifically about PSC and the growth lever. We understand that price negotiations always lead to readjustments below inflation rates. So it's interesting because what I've seen is that there seems to be a slowdown in the volume growth, but an improvement in mix, which helps with the top line. So my question is, what can we expect? Should we expect improved mix and to what extent is that possible? And is that mix going to be more geared towards imaging, toxicology, genomics, will that be helpful? And how far can that push you? I also would like to ask about regional brands. I understand that you have -- you've been having trouble performing in other regions. Is this a structural issue in those regions? Or is that related to the brand?

[Jeane Tsutsui, executive]

Thank you for your questions, Cepeda. Regarding growth levers, again, volume will grow over time, we have this effect of working days. And specifically, I think you are referring to the fact that this quarter, we had a slight reduction in the number of exams per consultation and increased revenue per exam. There was a one-off effect this quarter due to the fact that we had a higher proportion of toxicology exams and dengue fever.

In toxicology, this is due to a regulatory factor requiring these tests from drivers. And in dengue fever, it will probably go down. In imaging, yes, we have expanded agendas. I give you the example of Rio, but here in Sao Paulo as well, we've expanded the supply of medical agendas. But overall, we look at 2024 as a year in which we will have a higher growth in volume than in price given the negotiations we had with operators.

But we're very confident that we'll be able to balance between PSC and lab-to-lab. And we've had good market share gains. So this is due to having more volume than price, but the mix will depend on the growth of these different avenues. Of course, in lab-to-lab, we have clinical analysis and in PSC, we have clinical analysis and imaging, but that's different from brand to brand.

Concerning regional brands. We've talked about Rio before. Again, I'd like to draw your attention to the fact that we had good growth here in Sao Paulo and other brands and in Minas Gerais and lower, more variable growth in regional brands. So we had some regions where we had great growth and others that had a negative impact. So it's a huge number of brands, but we are working on that with commercial agreements, with the occupation of our agendas in imaging, for example, as I mentioned, in Rio and strengthening our portfolio. Toxicology, an example of that, where we start offering in our units, some exams that were Pardini. So these are one-off events, but they are definitely focused so that we have better performance across all of our different brands.

[Operator]

The next question will be asked by Estela Strano from JPMorgan.

[Estela Strano, analyst]

It's about M&As. So you announced an acquisition of [indiscernible] Santa Catarina. And you've been working with Hermes Pardini for over 1 year. So what are you thinking for the new acquisitions for the rest of the year? And in market position and operational terms, what opportunities do you see?

[Jeane Tsutsui, executive]

Thank you, Estela. I think Filippo will discuss the M&A pipeline. But overall, we're confident about the integration of Hermes Pardini. In May, we are celebrating 1 year since we started integrating our business, and we're keeping a close eye on all initiatives with our schedule. And the process is going well. But this is also matched by the PSC in Santa Catarina, Sao Lucas, which show once again the strategic alignment, the cultural alignment and our discipline. That was an asset that we brought with very careful capital allocation. I think Filippo can tell us about the pipeline.

[Jose de Almeida Filippo, executive]

Thank you, Estela. As was said, we continue to be active in managing the pipeline. The M&A area has been working consistently. And with the recent acquisition in Santa Catarina, we had an opportunity, an alignment between the price to pay and we've been seeing a situation in the market, M&A operations have gone down. And the price of some assets did not go down. So that's why it's difficult to negotiate. We have been seeing some possibilities, the operation in Santa Catarina is reflecting that, and we're going to continue working on finding these opportunities. So there are economic and financial aspects. And there are cultural aspects as well.

Integration is just as important as acquisitions. So we're working in a model in which after an acquisition has been made, we need to integrate the company, allowing us to have synergy gains, controls from the acquisition. So this is very important. So with Hermes Pardini, we've been communicating our financial goals. There's a guidance associated to it. But this doesn't prevent us from having other acquisitions. Obviously, the company has the discipline and is aware of the need to use its resources in these integrations. So as we execute this plan, we're open to other acquisitions. This is how we see it. But of course, financial discipline is paramount.

[Operator]

So the next question will be asked by Yan Cesquim from BTG.

[Yan Cesquim, analyst]

We have a couple of questions on our side. The first is a follow-up on Estela's question on M&A. Even considering the San Lucas acquisition, leverage is still very low, close to 1.2x net debt to EBITDA. So how far do you think you can get in leverage considering a good pipeline? And what would those opportunities be? Would it be in your core business, New Links, B2B? And my next question is also a follow-up about Jeane's message on Rio Grande do Sul. Can you give us an update on the number of units. How representative that operation is and what part of it is interrupted. That's all.

[Jose de Almeida Filippo, executive]

Yan, so still on M&A. When it comes to leverage, it's important to mention that we have a strategy in which we built up some capital structure. And our intention is to have low leverage. This doesn't change. So it's important to remind you that when you have an acquisition, you have to understand that you'll have an EBITDA for that acquisition. So in some situations that won't change your leverage. So it should not affect us there. Of course, needing to have higher investments, capital allocation as an opportunity to build value can always appear, but we don't have a goal right now.

There was a time in which we were considering -- the entire market had higher interest rates and cost of capital was higher and our cap was 2x net debt to EBITDA. Then we increased it due to the environment or rather, we took it to 1.5x or 1.2x like we are right now. So we're not going to raise that leverage that much.

So we could use a bit more, but we're not going to advance much more than that. So of course, diagnostic medicine naturally is not as based on geography because we can integrate to our systems. So we have more opportunities, New Links normally would be more associated to regions where we are -- where we already have a footprint. So that might be more restrictive, but we're also looking at those assets. And the same goes for new businesses.

So due to the market fragmentation due to the assets that we see, diagnostics tend to provide more options, but we are looking at all other opportunities. And again, we have financial discipline, we're being strategic, and we have cultural aspects and integration. That's basically how we see it.

[Jeane Tsutsui, executive]

With Rio Grande do Sul, and thank you for your question, in the beginning, our concern was making sure that our employees were safe and also supporting the population there. We have 22 units in Rio Grande do Sul, which corresponds to 1% to 2% of the group's total revenue. Obviously, initially, we were focusing on maintaining the hospital operation there. And we have routes lab-to-lab to unaffected regions in the state.

We're also providing emergency services for severe cases such as cancer patients who need exams. We have a low number of units that were affected. So next week, we will probably resume especially focusing on supporting the population, which needs to take care of its health. So we're focusing on social impact as a healthcare company providing services for the population in need. So it will be a gradual resumption of work; hospital units continue and some service units will resume work probably next week if the conditions allow because we have units that are able to do so, that have the infrastructure to do so and they can service the population. So that is our plan. Thank you, Yan.

[Operator]

The next question will be asked by Fred Mendes from Bank of America.

[Frederico Mendes, analyst]

I have a couple of questions. I'll go straight to the point. In operational expenses, you had BRL 19 million as an impact this quarter. I'd just like to understand that because your margins could have been higher. That's the first question. And I'd just like to ask about [ Sao Judas ], if you can give us an update. So [ Sao Judas ] is recovering. And in theory, that synergy with Pardini would allow you to have higher margins. So if you could give us an update on [ Sao Judas ], that would be helpful.

[Jose de Almeida Filippo, executive]

Fred, on operational expenses, there are no trends that we can see. In this case, this is related to consultancy costs or something that was listed for this quarter. It's not representative of any trend. It's just a one-off for this quarter. And if you look at across the year, these impacts are diluted. Obviously, since it's the first quarter, it draws people's attention. But I don't think it's any sort of trend. We might investigate and tell you what it was, but I don't think that it's anything that is setting any trends.

[Jeane Tsutsui, executive]

Thank you. So with [ Sao Judas ], we have been launching new products and services on the platform as we had planned. As a reminder, you mentioned that despite there being a change in mix and services, our margins have been expanding. Even in integrated medicine, the category, which includes [ Sao Judas ] we have been seeing margins expanding overall. [ Sao Judas ] from the operational perspective since we're having a higher revenue due to that, we should balance revenue and costs from an operational perspective. We would have some additional costs related to the platform, but it will balance out over time. So that initial cash burn stage is being balanced in 2024 and we really expect an improvement on that. And we will probably have a change in 2025.

[Operator]

The next question was asked by Pedro [ Pimenta ] from [indiscernible]

[Unknown Analyst]

Going back to B2B, we see revenue going up due to higher volumes year-on-year. So you mentioned a couple of points in lab-to-lab, toxicology and the comparative base. So my question is, is there an impact in that B2B readjustment? I'm just trying to understand this balance to understand the change in price.

[Jeane Tsutsui, executive]

Thank you, Pedro. B2B has been showing robust growth this quarter, 11.9%. Of course, there's that comparative issue, but we also had a change in mix okay Pedro. So overall, when we see this change, for example, a higher growth in lab-to-lab, and lab-to-lab is when we say -- we say it as a were one thing only, but there's also a mix there that goes from routine exams to others. And we have toxicology. So in the first quarter, we had an increase in the number of exams. But overall, what we see is robust volume growth a change in mix, higher growth in lab-to-lab exams. And overall, we have been able to make adjustments. They are not the same across the board, but we have been able to readjust prices. But with this change in mix, we were able to maintain prices per exam. But we're very confident about this B2B perspective, which is now representing 24% of our revenue.

[Operator]

Thank you. Ladies and gentlemen, this concludes our question-and-answer session. We will now pass it over to Ms. Jeane Tsutsui for her closing remarks. Go ahead, ma'am.

[Jeane Tsutsui, executive]

Thank you, everyone, for listening in to our call. We once again posted consistent results, and we're confident in 2024. We're providing solutions that contribute to the sustainability of the entire health care industry. Thank you, and have a good afternoon.

[Operator]

This concludes our earnings call. Thank you for listening, and you may now disconnect.

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