Fleury SA

BOVESPA:FLRY3

Earnings Call Transcript 2021-Q2

[Operator]

Good morning, and thank you for waiting. Welcome to Grupo Fleury Second Quarter 2021 Earnings Conference Call. Joining us today are Mrs. Jeane Tsutsui, CEO; and Mr. Fernando Leao, CFO and IR Director. This event is being recorded. [Operator Instructions]

This event is also being transmitted simultaneously through the Internet via webcast and can be accessed at www.fleury.com.br/ri, where the slide deck is also available. Participants [indiscernible]. Replay will be available shortly after the event is concluded. Those following the presentation via the website may post their questions on our website.

For proceeding, let me mention that forward-looking statements may be made during this conference about the future prospects of Grupo Fleury are based on beliefs and assumptions of the company's management and on information currently available to the company.

These forward-looking statements are no guarantee of performance, and they involve risks and uncertainties because they relate to future events, and therefore, depend on circumstances that may or may not occur. Investors and analysts should understand that general economic conditions, industry conditions and other operating factors may affect the future results of Grupo Fleury and may lead to results that differ materially from those expressed in these forward-looking statements.

Now I'd like to turn the floor over to Mrs. Jeane Tsutsui, who will start the presentation. You have the floor.

[Jeane Tsutsui, executive]

Good morning, everyone. Welcome to the Second Quarter 2021 Earnings Conference Call of Grupo Fleury. In recent months, we have repeated that we have entered a new cycle of growth, reflecting our strategic positioning of being integrated, preventive and hybrid health ecosystem with physical and digital strategy. And this is not only something we say, Grupo Fleury has reached an all-time record of avenue for the period, achieving BRL 1.5 billion, 104% up year-over-year.

As you can see in the highlights on Slides #3 and #4, the numbers are starting to reflect the expansion to other links in the chain, which in the second quarter of 2021 accounted for 4.1% of the group's revenue, including the revenue from the acquisition of Clinica de Olhos Moacir Cunha and Centro de Infusão Pacaembu. Although we faced the second wave of the pandemic in Brazil, the share of COVID tests and total revenue has achieved the lowest level since last year, 8.3%. At the same time, we see an increase in the volume of routine screening tests. The share of revenue from mobile services has gone up, achieving 8.1% of the total revenue of the group.

Strengthening our platform strategy, the number of lives coming from Saúde iD is still growing. Since its opening at the beginning of pandemic, almost 600,000 medical televisits have been made, positioning healthtech, Saúde iD as well as the leaders in this segment in the country. We have also started to offer surgeries in an addressable market of 1.45 -- or BRL 1.9 billion, thus making its asset-light platform model a reality. And even without our own hospitals, we can offer beds in partner institutions.

On Slide 5, you can see that these movements make our company the best integrated health model available, providing care throughout the whole patient journey with prevention, diagnostics, primary care, secondary and tertiary care, offering all services available and increasing lifetime value. We offer checkup services, telemedicine visits or in-person visits in our patient service units and diagnostic tests and therapy of different specialties, ophthalmology, orthopedics, infusion of immunobiologics, for example, and now surgeries. Thus, the group has become a concrete and powerful as well as capable health ecosystem, something that all health care industry needs, but that, in practice, patients couldn't yet find.

So we had like little parts of a puzzle, and now these parts are coming together in the value generated for clients, physicians, partner hospitals, HMOs and shareholders, and the whole health ecosystems is clear. Throughout the years, we have built a relationship of trust with our clients and physicians, with brands that are strong and acknowledged. And now we have digital and physical platforms to offer health care in a hybrid way.

Our purpose is to promote health in a preventive way and to be there for patients when they need specific care, meeting their needs in an integrated way. Grupo Fleury is, increasingly, a complete health care company, a multichannel one that is always finding new pathways for growth.

In September 2020, when it was founded, Saúde iD had a customer base 7 million potential clients coming from HMOs that purchase the products and benefited from the marketplace. The total of 1.1 million lives served this quarter, 14.5% of them came from Saúde iD, 27.9% up quarter-on-quarter.

Looking at televisits only, there was an increase of 21.9% compared to the first quarter of '21, totaling 228,000 visits. The B2B2C strategy was the embryo of a more ambitious strategy that will start to be implemented now with sales of services to consumers. Saúde iD has professionals that know the platform and focus on consumer experience, thus we can expand the portfolio's products and the patient partners. We created this to reinvent our access to health care in Brazil. We have also started to offer subscription service involving telemedicine visits, in-person visits and test packages straight to consumers.

More recently, we have implemented an all-inclusive surgery service accessible to people who don't have health care plans. The list of surgeries includes procedures with low complexity, high predictability of cost and a care cycle of up to 30 days. We have an outcome-based compensation model that means that all costs are included. With this business model, we created an offer of beds without having a hospital asset. And more than that, we're offering patients the possibility of having surgery without having to wait for months or even years, and this potential -- this is a potential market of BRL 1.9 million.

An example of this scalability of Saúde iD is the recent partnership with Smiles, a Go loyalty program management company. Now the 18 million clients of Smiles can start exchanging their miles for services from our marketplace. Thus, the potential customer base of Saúde iD more than tripled, achieving 25 million lives. As new products are incorporated to the platform, they will also be available to those clients.

As a 95-year-old company acknowledged for its quality and excellence in diagnostic medicine, we have many opportunities for growth in new locations where we still don't operate. So this quarter, we made the acquisition of 2 traditional medicine -- diagnostic medicine brands in Espírito Santo, the Bioclínico and Pretti laboratories. In addition to marking the entry of Fleury in that state, we reinforce our national footprint, adding to our offer in the Southeast region of the country. But we have changes in the way health is consumed today and we don't want to focus only on organic or inorganic expansion in our service units.

Today, expansion is not only based on square footage, but also on remote services. And Saúde iD is an example of that transformation.

Another one is the growth of our mobile services. In the second quarter of 2021 in accounted for 8.1% of the group gross revenue, a 40.4% increase compared to the same period last year. Another impressive information is that, today, the revenue generated by mobile services is similar to that of 25 service units. In order to continue with that growth, we also focus on another differential we have, which is medical knowledge. Thus, we are a reference in innovation in health care. We have 192 new products that were implemented this year with a highlight for genomic tests that had a 100% growth in the second quarter of 2021. And as a company that works in health care from prevention to therapy, we have been increasing our integrated offer in different specialties.

On Slide #8, you can see that the revenue coming from the different links in the chain, going beyond diagnostic medicine has had an increase of 443% this quarter compared to the previous year, now accounting for 4.1% of the total revenue of the group.

In ophthalmology, Clínica de Olhos Moacir Cunha offers visits, diagnostic tests, therapy, surgery and other procedures. The addressable market for that specialty can get up to BRL 2 billion per year.

As we can see on Slide #9, we have also just acquired an interest of 66% of Clinica Vita, a premium asset that shows how present we are in the orthopedics market with an advanced diagnostic assessment of the locomotor system and at this clinic for ortho procedures.

So you understand what this can offer. The also addressable market alone is estimated at BRL 10 billion per year. We have also enhanced our services of infusion of immunobiologic drugs with the acquisition of Clinica de Infusões Pacaembu. This market is of around BRL 7 billion per year. So this shows that the growth potential of these new links are exponential, and it will position us a unique way in the health care market. We are creating an integrated approach that will recommend what patients need when they need it, and our goal is to take care of people's health so that they can have a better quality of life.

And one of the greatest challenges of companies with an ESG ambition is to include environmental, social and governance actions into their business strategy. This has been a concern of ours for over 20 years. And although we still have a long way to go, we believe that we took a very important step in July when we did our first issuance of ESG link debentures. In addition to raising BRL 1 million, a volume that will help us boost growth, we were pioneers in the issuance of this type of debt in the health care industry is the first company in Brazil to establish social indicators among the commitments made in the issuance of sustainability-linked bonds. If the targets are not met, the company will pay a premium to investors.

And the most innovative goal is related to democratization of health, where we'll impact a million customers from classes C, D and E with the Saúde iD platform by 2026. This ambition is closely related to the goal of expanding our business result and also to our purpose of offering quality health care to a higher number of resilience from all social classes. It's worth mentioning that, to date, only 25% of the Brazilian population have access to health care.

Now the second target is environmental in nature. We want to reduce biologic waste by 14% by 2023 and by 20.5% by 2025. We have also expanded the initiatives that aimed to hurt the impact of the COVID-19 pandemic. We are part of the vaccination campaign that aims to make it feasible for all Brazilians to get vaccinated by September this year, and we will contribute with technical and scientific knowledge and disseminating content and training. Also, we are part of the Corona no Paredão, Fome Não campaign managed by NGO Gerando Falcões, which aims to collect and distribute food baskets to families in the favelas of Grupo.

As it comes to governance, Fernando Leao will end his cycle as CFO and Investor Relations Director after contributing to our company in a very relevant way. He was key to strengthening our finance area, and he was also part of projects that leverage the growth of our company through organic growth and acquisitions to help us raise financial proceeds that made it possible for us to expand and grow. So I take this opportunity to thank Leao for his leadership and significant contribution since he joined Grupo Fleury.

As part of a new cycle, José Antonio de Almeida Filippo will join Grupo Fleury as CFO and Investors Relations starting on August 1. He has experience from Brazilian companies with international business. He was at Natura & Co since 2018. Before that, he held positions as CFO at Embraer, Grupo Pão de Açúcar, CPFL and other companies rate performance in their segments. He conducted relevant financial and capital market operations in all of those companies, and he will help us in our growth strategy, strengthening our integrated, preventive and hybrid health ecosystem.

Finally, at the end of June, Grupo Fleury has had a cyber incident that caused system instability. For a few days, we had to operate in a contingency scheme, and we were able to overcome that, thanks to the dedication and commitment of over 12,000 employees and 3,000 physicians. To this restless team, who put our patients first at all times, I'd like to thank them. I would also like to thank our clients, hospitals and HMOs who understand that companies and governments all around the world can be victims of attacks like this. And the relationship of trust that we have built throughout that case, with all of our stakeholders, were tested during this episode that this relationship is firm and is the foundation for the group to continue pursuing its goal of offering high-quality health care in different channels to an increasingly greater number of resilience.

Now I turn the floor over to Fernando Leao, who will give you further details about our results. Thank you very much.

[Fernando Leão, executive]

Thank you, Jeane. Good morning. Now I'm going to talk about the second quarter 2021 financial results. On Slide 10, you can see our consolidated gross revenue. We have achieved a new all-time record and consolidated gross revenue totaling BRL 1 billion, a 104.2% growth vis-à-vis the second quarter of 2020 and a decrease of 4.2% vis-à-vis the first quarter of 2021.

On Slide 11, you can see the share of COVID-19 tests in our results. About 550,000 tests were performed in the quarter. Compared to the total revenue the RT-PCR and Serology tests share in revenue decreased compared to the previous quarter, now accounting for 8.3% of total gross revenue compared to 9.7% in the first quarter of 2021 and 11.1% in the fourth quarter of 2020. This is the lowest level registered since the beginning of the pandemic. The tests accounted for 7% of the revenue of patient service units and 15.9% of B2B revenue. This shows the strong growth of the group's consolidated revenue as the share of COVID tests decreases gradually.

Now on Slide 12, you can see further details about the performance of our brand portfolio. Gross revenue of patient service units grew by 114.4% compared to the second quarter of 2020 and by 1.5% compared to the first quarter of 2021, achieving BRL 793.7 million. Once again, all of the company's brands have had relevant growth, which reflects the continued demand recovery. This reinforces the continuity of the expansion of our mobile services up 40.4% compared to the second quarter of 2020. This reflects how much refocusing and making the most of opportunities expanding our logistics routes and expanding the service to all of the brands of our company.

On Slide #13, you can see the evolution of costs and operating expenses. It's important to mention that there is a reduced basis of comparison to the second quarter of 2020 when we had significant savings and cost avoidance measures implemented due to the beginning of the pandemic. On the chart on the left-hand side, you can see a 49% increase in the costs in the quarter. This was boosted mainly by personal medical services and direct materials. Both reflect a significant increase in the volume of tests in the period as the demand goes back to previous levels, including also the strong expansion of our mono services infrastructure. It's worth mentioning that the lower cost with personnel registered in the second quarter of 2020 were due to the company adhering to MP 936 reduce in salaries and working hours of employees. In direct materials, there was an increase due to COVID test and an addition of pharma products for infusion services in that line.

On the right-hand side of the slide, we can see our operating expenses. This quarter, we had an 88.4% increase. And excluding nonrecurring effects of BRL 29.4 million of expenses related to the cyber incident, acquisition of companies and organization restructuring of the company, the increase in operating expenses was this 45.6%. The main impacts are due to the reduced basis of comparison to the second quarter of 2020 when salaries and working hours were reduced and the expansion of the org structure of our Saúde iD platform.

Now on Slide 14, you can see that our EBITDA achieved BRL 219.7 million in the quarter. an increase of over 11x compared to the second quarter of 2020 with margins of 23.6%. Excluding nonrecurrent effects, EBITDA achieved BRL 249.1 million in the second quarter of '21 with recurring margins of 26.7%.

In the chart on the right-hand side, you can see the accumulated comparison of EBITDA, which totaled BRL 505.3 million, a 134.4% increase year-over-year. Excluding nonrecurring effects, EBITDA totaled BRL 534.7 million, a 148% increase and recurring margins was 29.3%.

On Slide #15, you can see our net income, which achieved BRL 65.5 million in the quarter compared to a loss of BRL 73.3 million in the second quarter of 2020 and net margins of 7%. Excluding nonrecurring effects, net income totaled BRL 86.6 million with recurring margins of 9.3%.

On the chart on the right-hand side, you can see an accumulated comparison of net income in 2021, which totaled BRL 184.1 million and net margins of 10.1%. Excluding nonrecurring effects, net income totaled BRL 205.2 billion in the first half of 2021 with recurring margins of 11.2%.

Now on Slide 16, you can see charts with our operating cash flow, which achieved BRL 286.5 million in the second quarter, an increase of 316.1% boosted by the strong EBITDA growth in the period. On the right-hand side, you can see our CapEx, which totaled BRL 85.9 million in the second quarter, up 113.7%.

Now on Slide #17, our ROIC. ROIC ex goodwill achieved 50.7% (sic) [ 58.7% ] in the second quarter of 2021. The right-hand side, you can see the evolution of our NPS, which achieved 76.1% as a result of our continuous efforts for continuous improvement of service at our units.

On Slide 18, you can see that the Board of Directors approved yesterday, the 29th, the distribution of interest on capital in the amount of BRL 42.4 million, BRL 0.13 per share. This will be paid based on the shareholding position of August 3. Payments to shareholders is to be made on August 16.

Finally, on Slide 19, you can see the events that the market already confirmed for the coming months.

Now we would like to open for questions. Thank you very much.

[Operator]

[Operator Instructions] First question by Ricardo Boiati from Banco Safra.

[Ricardo Boiati, analyst]

Okay. Talking about the Saúde iD platform and the health care platform as a whole with integrated business. I think it's amazing that you are now sharing important information more and more. So thank you for that.

Now about the tertiary care vertical, can you tell me a bit more about that initiative? What is the current status of that vertical? And what is your target audience? Are you thinking about a B2C business? Or are you talking to HMOs to try and offer that new service that include that in the contracts you have with HMOs? Who are your main partners there?

Now still talking about your verticals, there are many complementary businesses now. So which of the new verticals you think have the greatest growth potential? We have a great addressable market for infusions, for example, and you're already participating in that market with Centro de Infusões Pacaembu. But is there something that you would highlight for growth in the short term considering the speed in which things are happening?

And now finally, since the vision of the company now focuses more on this platform. Can you share some analysis with us? Does it make sense to accelerate investments in acquiring clients, acquiring users so that the platform can be expanded as quickly as possible? Do you think it's now time to accelerate investments in customer acquisition or not yet? That's all.

[Jeane Tsutsui, executive]

Thank you for your questions. I'm happy you asked them because, yes, we are focusing on building this integrated health ecosystem and to our strategy, and we see strong pathways for growth. Now the thing I'd like to emphasize is that this vision is based on the vision of a patient journey. And the patient journey is focused on health prevention. That's why we need to join physical and digital assets, that suit.

But you're right, in addition to prevented medicine, diagnostic medicine, yes, we see opportunities for growth, especially in the different specialties, as we were saying. This quarter, we have seen significant growth compared to last year when we were already starting to work on that. But this quarter, we included assets such as Clinica de Infusões Pacaembu, which can be expanded later on to the whole of Brazil, that same type of business, and also ophthalmology;.

And in June, we closed the acquisition of an interest in Vita. So we are also growing in orthopedics. Although we already had assets with and orthopedic day hospital for integrated care, but now we are adding visits and physical therapy. So we believe that focusing on these new wins is very promising. That's why we shared with you the size of the addressable market. It's hard to say which of these pathways will give us more growth, but it's more important to work on all of that at the same time to offer what patients need at the time they need from prevention to therapy.

Now for the tertiary care vertical, we started to define a few elements in order to complete the patient journey either with an offer of our own services or by establishing partnerships with other companies to supply offers for the whole journey. We want to be there from end to end and integrate data for a better health management. However, we already have a few elements that can be mentioned already.

First, we're working with day hospital model for lower complexity surgeries. We have day hospitals for orthopedics, but also at Clínica de Olhos Moacir Cunha. We also performed low complexity surgery. So we have this day hospital there at this clinic. And the fertility clinic that was opened in March this year also offers an OR for procedures. So we are offering lower complexity surgeries at different places within Fleury Group.

And at the Saúde iD platform, we have recently launched this model in which we do not have a hospital asset necessarily, but we established partnership with hospitals. For example, we have a partnership with BR Surgery, and we are discussing new opportunities for partnerships. And we use idle periods in those hospitals to offer our surgery services. So that's a possibility of product that is now being offered in the B2C arena for now.

We are still trying to define these businesses and products so that they can gain scale. But yes, we believe this has a great potential for growth. Now it's also important to mention that when we look at the different specialties, we're going to offer the whole journey end to end, from the first visit in primary health care to secondary health care to diagnostic, low complexity procedures, therapy and maybe at some point in time, connect and offer higher complexity procedures and surgeries as well.

Our strategy is to focus on the whole journey, and we see opportunity for growth there. Now about investing in the acquisition of customers, we have been sharing data about our own business. The diagnostic medicine, we know that our cost for customer acquisition is low. The strength of our brand is great. And with Saúde iD, we are still reformulating the management of Saúde iD and including professionals who are very experienced with this platform model to see how we can increase this network effect. So we are still shaping our products.

Once these products are fine-tuned and consider the whole patient experience, then we'll start to scale them up. And yes, we believe we'll need to make investments in order acquire customers, but we're already considering potential partnerships that will help us connect with the customers. For example, the partnership with Smile that we have just announced. And maybe in a short period of time, we'll be able to triple the number of customers that are in contact with the services offered within Saúde iD. I hope I have answered all of your questions, [indiscernible] for further questions that you have.

[Operator]

Our next question is by Leandro Bastos with Citi.

[Leandro Bastos, analyst]

I would like to talk a little bit about costs and expenses. We saw an acceleration here in costs and expenses this quarter. So I would like to get for the details. You're talking about the platform and your mobile services. So how can you focus on the costs and expenses area from now on?

[Jeane Tsutsui, executive]

Thank you, Leandro, for your question. I will start, and then maybe Leao can add to my answer. I'd like to take this opportunity to clarify what happened this quarter and also to give you some ideas about the future. This quarter specifically, we had a major nonrecurring effect. We were reorganizing our structure, and we also had costs involved with the cyber incident. So 1/3 for the reorganization and about 2/3 to deal with that cyber incident. Now when it comes to the cyber incident, Leandro, it's important to mention that we have an insurance policy, and we will probably recover part of the expenses incurred with the cyber incident from our insurance.

Now when it comes to the recurring part, I'd like to highlight 2 points. First, yes, this quarter, we had a recomposition of our headcount. This is because routine cleaning tasks have been resuming, going back to normal levels. And in previous quarters, we had an increase in productivity, but a reduction in NPS. So we made a decision to recompose our headcount. And we see our NPS going up, and our organization is now getting ready to meet the growing demand. We emphasize imaging tests are coming back and COVID tests share is going down gradually. So we believe that once the vaccination picks up speed in the second half of the year, we have an opportunity to continue growing in a sound manner in our business, and we need to adjust our operating levels. And when we compare our costs with personnel compared to the pre-pandemic period, we have approximately the same level in percentage numbers.

Now in the second quarter, in the first half of April and the last days of June, yes, we saw an impact on a slight reduction of the revenue. This is because, in the beginning of the quarter, we went through a second wave of the pandemic and the lockdown was reestablished. But also, the last part of the quarter, we had that cyber incident. And with all the contingency plans, we were able to continue serving our clients. But yes, that had certain impact on our revenue. So we were prepared to have an even higher revenue this quarter.

Having said that, I would also like to take this opportunity to give you a medium-term vision considering our strategic thinking. We're now thinking about investing and leveraging our Saúde iD platform, which would definitely grow. We are confident about the potential of Saúde iD to attract new lives, and that will contribute to this health management model that we have to be there for patients throughout their whole journey. And we believe that health care is going to become hybrid, both physical and digital. So Saúde iD still has costs related to its initial phases of operation.

Now another important aspect is that we feel completely comfortable with the investments we've been making in the platform. Another point is that in the -- as in the medium and long term, the share of revenues coming from other lengths increase in addition to diagnostic medicine, will have a mix. Some of these links will bring greater margins, and others will bring lower margins. But our goal is that the company grow. We want to be the main players in this strategy looking at health care from an integrated perspective. So in our future vision, yes, we believe that we are going to bring other businesses that are also important to our company, but that might have lower margins. The most important thing is to continue firm with our growth strategy. Leao, would you like to add anything related to the cost and expenses of the quarter?

[Fernando Leão, executive]

Yes, Jeane. Thank you, Leandro, for your question. I think Jeane has given us a very broad and accurate view. There are indeed several factors, some of them related to the pandemic, but we also had the cyber incident. And we have a mix revenue that start to change now as we incorporate the acquisitions that were made and other acquisitions will be made in the future as well.

What I'd like to say is that we see all of these movements in the P&L of our company in a very natural way. The company has a clear strategy of diversification. We want to be a health care company and not only a diagnostic company. And being a health care company principles a broad combination of services. The level of productivity and efficiency that we have in diagnostic medicine will be kept. We can guarantee that.

What will more to happen is that as we incorporate the services, we will experience greatest growth in the company. So this growth principles a change in the mix of revenue. This change will impact the margins of our company, which will be taken to a new level. But that's part of the group's strategy. There is a relevant growth in all of these fronts. And as a consequence, the changes in the mix of revenue will have an impact on our margin. But as we continue to deliver productivity and efficiency in all different fronts, especially diagnostic front, we understand that we still deliver value to shareholders because we continue to grow and deliver results.

[Operator]

Our next question is by Fred Mendes from Bank of America.

[Frederico Mendes, analyst]

I have 2 questions, and that's aligned with the previous questions that were asked, but I'd like to understand a bit more about the margins and also about medical relationship, the relationship you have with physicians. I believe you have a fee for life, and you -- based on that, you pay for physicians.

You don't have enough slides included in the platform, but you already have this medical cost. Is that Why the margin has been impacted? I just want to understand how this happens and how scaling that up will improve the margin.

Now Saúde iD is a healthtech for start-up, so I think it makes perfect sense to make investments that you have been making now to get the returns later on. It's natural to take some time for you to monetize and bear the fruit. So I just want to understand, most of the costs have already been incurred? Or since this is a start-up, the costs will remain high until you're able to monetize on that asset?

[Jeane Tsutsui, executive]

Thank you, Fred, for your question. Actually, Saúde iD has different contracts or operating model, Fleury Medicine more specifically, yes. Today, we have us paid online, and we pay for physicians. And you need to strike a balance because if you have essential bits of demand, then you need to hire more physicians in order to serve that demand. Of course, now during the pandemic we're going through, there is great fluctuation in demand when we see more patients with symptoms, and that interferes in the economic rationale of the model. But generally speaking, we feel very reassured that Saúde iD as a healthtech is going through this growth phase, and the lives that are added bring a lot of value because through all times, we'll be able to capture this whole life cycle and offer new services.

One thing we did mention is that we already have estimated the revenue for diagnostic medicine interactions happening within Saúde iD. So this was not mentioned specifically in the line of revenues or Saúde iD. That's important. In our strategy, we have this connection between individuals of what they need throughout their lives and other health care services [indiscernible] healthtech. And as a healthtech, it will go through a growth period. And this platform model in the retail segment, you can see several different platform models. That's a very successful model. You connect needs, you can acquire the seller and you have many ways to monetize either through tax rate throughout time. You may also need the network effect and add the total value of customers who were active to the platform.

So right now, we [indiscernible] our Saúde iD platform, it's already a significant platform in terms of its size and the number of lives served as well as in the number of potential lives be added, and it will continue growing from now on. But the valuing of the healthtech is different [indiscernible] traditional model that we have company. And [indiscernible] traditional diagnostic medicine company. In the healthtech segment, you usually have valuing based on revenue and not necessarily on margin, and it has to go through that growth period. So we firmly believe in this model, we are very confident, and we'll make all investments needed so that Saúde iD can gain momentum and become a very successful health care platform in Brazil. As I said, health care will become both physical and digital from now on, more hybrid.

[Operator]

[Operator Instructions] Our next question is by Vinicius Ribeiro with UBS.

[Vinicius Ribeiro, analyst]

I actually have 2 questions. First, can you give us further details about your organizational restructuring. Does that mean that the company will be structured in business units based on different packages or specialties like platforms and so on? I think it makes perfect sense to go through that restructuring, but I just want to understand how this is going to work, not from the reporting perspective, but from the structure perspective itself.

Now about the second quarter, there, you've had a few impacts. What about the recomposition of recurring volume of elective tasks and also the ramp-up of the other initiatives that you've been implemented? Can you give us your take on that?

[Jeane Tsutsui, executive]

Sure. Thank you, Vinicius. We're looking at this organizational restructuring with the rationale of more autonomous business units that are focused on growth. Of course, our diagnostic medicine business is doing really well. We continue to grow organically and inorganically. This quarter, we also announced the acquisition of Pretti labs and Bioclínico lab. But thinking about new links, we are getting organized in order to have a more specific management of this new front, ophthalmology, orthopedics, infusions.

And we have also strengthened our team with professionals who are experienced in both businesses and that are committed and focused for us to continue growing. Our M&A team has also been strengthened so that we can consider all the opportunities of inorganic growth. And with autonomy and agility of organization, we'll be able to gain speed of growth, which is what we want.

Now about the second half of the year, we already see some recovery of the diagnostic medicine business, especially with routine screening test. Now for imaging tests, we also saw significant growth compared to last year. But as we said, the basis of comparison is not that valid because we were hardly hit by the pandemic. But compared to the first quarter this year, in imaging test, we grew by 9.7%. Now we also see reports of medical society saying that many patients with chronic diseases have not had their assessment tests, preventive and diagnostic tests as they should during the pandemic. So we see an opportunity there to provide these assessments.

Now another aspect that we take into account is that patients who have had COVID-19, I mean we have increasing evidence that these patients can have [indiscernible] in the cardiovascular, neurologic system and pulmonary systems. So we are now considering new services in order to better serve patients who need post-COVID care. And the number of users in the health care system is also important. Even though the unemployment levels went up, we keep track of the number of users in the health care system, and we saw the numbers going up.

So health care is being valued by the population and the number of users in the system is a good indication of the opportunity to grow. And as Grupo Fleury, we focus very much on these pathways. We want to continue growing in diagnostic medicine, both organically and inorganically and focus on the new link in order to capture more revenue, more customers and most of all, what makes perfect sense, which is to take care of people's health from end to end.

[Operator]

Our next question is by Mauricio Cepeda from Crédit Suisse.

[Mauricio Cepeda, analyst]

I have a few questions related to your future strategy. You talked about the consolidation and the inorganic growth. Now can you tell us a bit about your ambitions. Are you planning to be more aggressive there? Or are you taking your time there for the expansion?

Now you also issued the bankers and raise some proceeds. So are you changing your profile of inorganic growth? And you're offering outpatient services now, right? Do you plan to become a consolidator in any of those verticals or you're just using this cross-reference between users and services?

Now another question, which is not related to strategy, but it seems to me, based on the results, that the average ticket has dropped. So can you tell me about the relationship with HMOs? What's your take on that?

[Jeane Tsutsui, executive]

Thank you very much, Cepeda. I will start, and then Leao can add to my answer. Yes, we see the opportunity for growth in the new links, both inorganically and organically. So inorganically, we have the possibility of bringing capabilities to add to what we already have in-house. We acquired 66% interest on Vita, and we kept all of the physicians who are references in the orthopedics field. And that brings additional knowledge so that we can grow on this pathway throughout time, both inorganically and organically.

Maybe our strategy is a bit different from that of market players who are fairly consolidators or more financial investors profile. For all time, we want to capture synergies from different businesses. For example, we already have diagnostic medicines. But once you add other businesses from other links, therapy or focusing on the whole patient cycle, you also leverage the businesses of the diagnostic medicine unit. So we capture the synergies from the business itself, and we also capture synergies.

From our diagnostic medicine business, another example is human reproduction, which was a greenfield project we had. No acquisitions. But that was part of the cycle, this women health journey that we focused mainly on diagnostics previously. But now we also focus on facility, and we can provide fetal care and children services so that we can complete that journey view. But answering your question, yes, we intend to grow inorganically as well so that we can speed up our growth and, at the same time, seek synergy opportunities with our businesses.

Now I'd like to turn the floor over to Leao, so that he can talk about ESG.

But now about the average ticket that you mentioned. There is not a specific price issue, but we have a mixed composition. So if you have a smaller share of diagnostics or imaging test in this composition, then you increased the clinical analysis, thus you reduce the average ticket. We can tell that we will not reduce prices, mainly a matter of ticket combination.

[Fernando Leão, executive]

This is Leao speaking. Thank you for your questions, Cepeda. Well, Jeane said that you mentioned that also the [indiscernible] that we did with [indiscernible] BRL 1 million reflects our ambition and the speed that we want to achieve when it comes to the company's organic growth. This year, we have made a few moves to that. Our pipeline continues to be variable for us. We have companies at different [indiscernible] of different phases of maturity, and there will be new announcements by the end of the year.

And [indiscernible] shows that we are financially prepared with that organic growth. The results of the company continue very robust. Cash continues to be robust. [indiscernible] we have space and financial flexibility to be very [indiscernible]. The inner [indiscernible] growth strategy that we consider very important to prevent our platform strategy grow quickly, and we provide all the diversification and all of the new revenue flows for the company.

[Operator]

Our next question is Yan Cesquim from BTG Pactual.

[Yan Cesquim, analyst]

Well, most of my questions have already been answered by my colleagues, but I'd like to take this opportunity to ask 2 very straightforward questions. First about Saúde iD. Have you defined any target for growth? I know that you have achieved over 150,000 lives or 14% of the total number of lives served by the group, but do you have medium-term growth targets for Saúde iD?

Now about M&A I would like to know what your views are on leverage targets considering that you have now a stronger appetite for M&A?

[Jeane Tsutsui, executive]

Thank you for your question, Yan. With Saúde iD, yes, we have a great ambition especially because we have an amazing potential with that business model and, of course, we have internal targets. But we are now going through this organizational space of the products offered by Saúde iD. And after that, we'll start a scalability phase, which is really important for this business model.

So today, if we look at the number of customers we were planning to have at Saúde iD, I'd say we are very optimistic. We launched Saúde iD in September with 7 million lives. In the second quarter, we will triple the number of eligible lives in the platform. We have also established another target, which is 1 million. This is related to our ESG-linked debentures. So we want to have 1 million customers served in the Saúde iD platform in classes -- social classes C, D and E by 2026, and that's only part of the population that we aim to serve.

But just so you have an idea of the size and the ambition we have for Saúde iD, our mission is great, the perspectives are great, and we're looking at Saúde iD with Hans as CEO and a very qualified team that has all the autonomy they need in order to leverage Saúde iD.

Now about M&A, I'll turn the floor over to Leao.

[Fernando Leão, executive]

Okay. Now about the leverage, as I said previously, our P&L and our balance sheet despite down and flexible, and we can be very ambitious when it comes to growth through acquisitions. So we closed the quarter with a leverage of 1x our EBITDA, and we feel very comfortable to increase that leverage to around 2x or 2.5x our EBITDA in order to achieve the growth we want. So we think there is a lot of things there to bring new companies to our brand portfolio. This has already been executed here very carefully at our M&A area. And our M&A team has grown, and we have to focus. Actually, we have 1 team to focus on diagnostics. So there is a lot of opportunity to consolidate the diagnostics market.

And now considering the number of assets and the diversification in terms of the number of service verticals, we also have a team to focus on new links. So we have already started working on ophthalmology, orthopedic, infusion, and we have others that are being analyzed. The potential market for all of those verticals is great. So we have a huge ambition of growth, and we think that the share in revenue of these new links at the company can also be great. So yes, the company will focus on growth through M&A, and we think there is a lot of space for that.

[Operator]

Our next question is by Mr. Emerson Vieira with Itaú.

[Emerson Vieira, analyst]

I have 2 questions. First, I'd like to understand what share you think you might achieve in that area? Considering the medical relationship, what is the potential you see there in this segment?

Now you were talking about integrated patient care. Can we think about products and compensation models? Are you going to accelerate the offer of packages? And will that strengthen your relationship with current payers?

Now a follow-up question about the genomic test revenues. There has been a regulatory change, and I would like to understand your market time line when it comes to genomics.

[Jeane Tsutsui, executive]

Thank you for your questions, Emerson. We don't give guidance. So what we did was to establish the addressable market. And what we can say is that our ambition is great, but we don't know exactly what share we'll have on those new links. What we always say is that our ambition is great, but we don't give any special guidance on market share.

Now when it comes to integrated here, you're right. As we offer new services, we increasingly see the challenge of HMOs to find balance, sustainability and adequate use of resources. So it makes sense to start thinking about new models that considers a package of care throughout patient's journey. And we've been working with HMOs because we know there is a challenge related to system sustainability, and that's the differential we might have to help HMO to fight waste.

We always say that all of us who work in the health care industry need to think that the resources should be used appropriately and that we should fight waste. So once you focus on the whole journey, you can share information and use the resources appropriately.

Another point I'd like to emphasize is that early diagnosis and the right referral of the case in different clinical conditions make you reduce the total cost of care for that specific condition. So there are opportunities there, that's why our view of integrated care is important. And that focusing on preventive care is also something that can contribute to the sustainability of the system and to control HMO's medical loss ratio, and we're going to work closely with HMOs to do that.

Now about genomics, yes, there has been a significant increase year-over-year, maybe not quarter-on-quarter that much, but year-over-year, yes. And in genomics, we still have a challenge of managing new tests. And yes, the approval of some products to be included in ANL's list is important, like the EXAME test. But after it's been approved to be added to ANL's list, we go through a phase of negotiating with HMOs. That takes some time, but we've been working with all of them in order to make that happen, and we have a commercial team that is very much focused on that.

[Operator]

Our next question is by Eugenia Cavalheiro from JPMorgan.

[Eugenia Cavalheiro, analyst]

I have a question about the opening of new units. We see that the mobile service has been growing for the fifth quarter in a row. So what do you expect in terms of the opening of new units? Is that a focus of the company? Or are you focusing more on M&A?

Now about the new initiatives, can you give me a bit more detail about the margins compared to the level we currently have and what we can expect for the future?

[Jeane Tsutsui, executive]

Thank you, Eugenia, for your questions. Now about opening of new units. It's important to emphasize that in 2016, when we talked about opening [indiscernible], we were able to open 55 of them. [indiscernible] mobile services, the revenue that we [indiscernible] there was to about 25 of this unit from Grupo Fleury. So if we look at the average in terms of the number of brick-and-mortar units that were open and the mobile service that was actually larger, this is indeed the fifth year in a row that our mobile services revenue has grown, and there is still potential for growth.

Customer behavior is changing, especially customers who tried this type of service for the first time during the pandemic, and they come back because the NPS of the mobile services is very high, 84% compared to 76% of our general NPS. So we're focusing on expanding our mobile service throughout the whole country in the regions where we see opportunities for growth. And also, we're looking at new tests that can be added to that type of service.

So going back to the opening of units. When we look at the brick-and-mortar units that were opened and the mobile services, we'd say that we have achieved 80 openings, but we also added 72 service units in recent years through inorganic growth. So yes, there has been a significant growth, and we consider looking at the opportunities. Of course, they need to make sense within our strategy of balancing organic and inorganic growth. And of course, we want to make the most of the square footage we already have.

So once part of the customers are served with our mobile services, that means that I can use our units better, our square footage better to add other potential services, such as infusion. We started organically within our units, and now we have acquired a clinic for that. But yes, we're always looking at new opportunities to open units and also the possibility of extending our existing units, and some of them are at the top of their service capacity.

Now about your second question, some initiatives may have lower margins than our current business. So we've been emphasizing that as part of our growth vision, the composition of new revenue flows or new businesses that have lower margins and percentage terms may happen. So margin reductions are expected as time goes by, but we're very confident about that. It's part of our strategy. But I'd also like to emphasize that new businesses also attract revenue and margins to our diagnostic medicine business. So we need to emphasize that what we want is to have an integrated offer, anything that patients need to take care of their lives. And as time goes by, we'll gain synergies inter and intra businesses, and the margin composition will result from that mix. But our main goal is to grow and establish this integrated system that looks at the patient journey as a whole from end to end.

[Operator]

If there are no further questions, I'd like to turn the floor over to Mrs. Jeane Tsutsui for her final remarks.

[Jeane Tsutsui, executive]

I would like to close this conference by saying that we're very optimistic about the new cycle of growth for our company. As you heard today, the execution of our strategic positioning is happening quite fast. And it's enabling us to create an integrated, preventive and hybrid health ecosystem combining physical and digital offers. The organic growth, the development of our Saúde iD platform and the acquisition of services and solutions to make up that ecosystem, combined to the significant increase in the number of potential customers, have been bringing results that clearly show that we are on the right track.

Once again, I would like to thank Fernando Leao for his great contribution throughout his journey with us. And at the same time, I would like to welcome José Filippo, who will joined Grupo Fleury starting next Monday. Thank you all for your participation in our conference call, and have a great weekend.