Fleury SA

BOVESPA:FLRY3

Earnings Call Transcript 2022-Q4

[Operator]

Good morning, everybody. I would like to welcome all of you to the results conference call for the Fleury Group for the fourth quarter 2022. With us today, we have Mrs. Jeane Tsutsui, the company's CEO; Mr. Jose Filippo, the IR -- the CF Officer, excuse me; and Mr. Renato Brown, the IR Director.

We would like to inform you that this event is being recorded, and we also have simultaneous translation into English. We will begin with the presentation of the company results. And ensuing this, we will begin the question-and-answer session. At the end of this session, Mrs. Tsutsui will offer her closing remarks. All of the numbers we're going to mention today can be compared to the same period of the year 2021, except when specified and they have been rounded off to the closest thousands.

Before proceeding, we would like to clarify that this presentation may contain information on future events. Such information is not just historical facts, but would reflect the wishes and expectations of the company's management. The words believe, expect, plan, anticipate, estimate, project, aims 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 or service competitiveness. Among the uncertainties, we also have acceptance of market services, service transactions for the company and competitor service transactions, regulatory approval, currency fluctuation, changes in the service mix offers and other risk described in the company reports.

I would now like to turn the floor over to Mrs. Jeane Tsutsui.

[Jeane Tsutsui, executive]

Good morning, everybody, and thank you for your presence here today. 2022 was marked by 3 record quarters in revenues and an increase of 51% in the annual gross revenue vis-a-vis 2021. This shows the efficiency of the strategy we have had for 3 years based on our diagnostic core business and the actions that we have in the new links.

As you can follow in our releases on Slide #4, we see for diagnostic medicine permeates the journey of our customer. We continue on with brands that are acknowledged for their quality positioned in the premium, intermediate and basic segments with a good rate of organic growth and market share in the 11 states where we act. Besides diagnostic medicine, we also offer services geared to prevention as checkup and vaccination, physical or digital consultations through telemedicine and secondary [ attention ] we have strengthened our services in medical specialties that we call new Link. And we also add in tertiary activities for no complexity surgeries. We have been able to develop our business through 3 growth avenues. The first is diagnostic medicine with the aim of the population [indiscernible] management of [Pandemic]. These have become very important as well as a follow-up of chronic diseases. In new links, we have had consistent growth in priority areas reinforcing diagnostic medicine and maintaining the customer in our system.

Third, in health, enabling customers to care for their health. We have a unique positioning in the sector. We offer medical excellence, reputation, outpatient services that are sustainable for the health system, the places, challenges.

Let's go to the highlights of the fourth quarter in Slide 6. We [indiscernible] BRL 1.2 billion in quarter revenue, a growth of 9.4% over the same period last year, 21% organic. This lower organic growth due to the World Cup and the recovery of seasonality for festivities of year-end. If we don't consider the revenues for COVID test, we had a growth of 14.7% vis-a-vis the fourth quarter '21. Mobile services continues to be a highlight with a growth of 52% when compared to the fourth quarter '21 and represents 8.9% of total revenue. EBITDA was BRL 232.7 million, a reduction 8.9% on adjusted revenue and 21% due to the operational deleveraging due to the lower number of exams carried out in the last quarter because of the World Cup and end of the year seasonality. Net Income was total BRL 31 million with a margin of 2.8%.

Now let's go to the highlight on Slide 7. We had a total growth of 15.1% in gross revenue compared to 2021, totaling a record of BRL 4.8 billion of annual revenues. If we don't consider the effect of COVID, the growth was 20.2%. This result comes from the contribution of our 3 growth avenues and the balance of organic growth which, in the annual comparison was 8% and acquisitions. The Fleury brand had a growth of 11%, showing the strength of a traditional brand that continues to innovate with high satisfaction of the customers and relationship with the medical community. In the new channels, mobile services had a growth of 31% through new sources in our portfolio, reaching 8.5% of the total revenues of the group and confirming the importance of this service because of the change of behavior of our customers. Now the ecosystem was strengthened with New Links with good orthopedics, ophthalmology, fertility and new medication. The health platform presented a growth of 84.8% for the year, representing 8.6% of the group's total revenue.

The EBITDA reached a record of BRL 1.2 billion and is in 2022, a growth of 9.1% compared to the recurring EBITDA of the previous year with a margin of 26.7%. Net income reached BRL 307.9 million with a net margin of 6.9%. In December, we concluded the operation to increase our private capital amounting to BRL 847.3 million, strengthening our cash and reducing our leverage to 1.2x compared to 1.7x in the third quarter '22, below the limit of 3x set forth by debt instruments. This puts us in a comfortable and sustainable financial position to face the high interest rates and to continue on our strategy to build the ecosystem with financial discipline. Throughout the year, we focused on operational efficiency and an increase of productivity, controlling costs and strengthening our capital structure.

We go on to Slide 8, where we highlight our organic growth. We carried out the retrofit of 28 patient care centers with an increase of 20.2% in revenues per square meter comparing 2022 with 2019 before the pandemic. We inaugurated 10 units for diagnostic medicine, 6 of which are from the Campana brand. And New Links, we inaugurated 8 new units, including orthopedics, ophthalmology, infusion of medication and immunobiologicals. With the goal of expanding our service offer, we relocated 3 units of a mais diagnostic medicine in Sao Paulo. We see that in 2022, we carried out acquisitions, strengthening diagnostic medicines, such as Marcelo Magalhães in Pernambuco, methodos in Minas Gerais and New Links. We are focused on ophthalmology and infusions. And of course, we cannot but mention the announcement of the incorporation of shares of the Hermes Pardini Institute by Fleury carried out on June 30 of 2022, [indiscernible] the approval of the antitrust agency CADE.

The combination of businesses between Grupo Fleury and Grupo Pardini will end up in 1 of the largest companies in diagnostic medicine in Brazil with a combined revenue of BRL 6.9 million and an EBIT of BRL 1.7 billion. This complementarity of business and geography will mean that we will have 500 service units, more than 1,600 partner laboratories, 4,600 physicians, 600 laboratories and 39 brands. This union of groups enables us to capture synergies between 160 million and 190 million incremental EBITDA million per year after the implementation of the integration.

On Slide #10, we bring you news of our new technical center in Sao Paulo. This will enable us to position ourselves as a greatest diagnostic center for specialized exams in Latin America. This has been structured to expand productivity, innovation and differentiation for the company, giving us support for our growth in the coming 20 years. We have increased the area of 4,600 to 8,500 square meters, which will enable us to increase our production capacity threefold to 120 million exams per year. We have a new automation line simplifying the processes without human intervention. The entry and exit of this automated line, we're the first in the brand of equipment for laboratory medicine installed in Latin America. And the flow of samples has been designed exclusively for the center for Fleury.

We also have 30 mass Spectrographers and chromatography instruments. The largest part of equipment that grows 30% in terms of exam volumes a year and enables us to carry out differentiated test for the Fleury brand. We also have an area set aside for research and development, one of the pillars of growth of the organization. In 2022, we had a record generation of 602 new products, services and methodologies and increasing our differentiation and reducing the cost to process exams. Finally, the ESG principles have been a guide in the construction of all of this business.

The building has a 100% LED lighting, solar heating, the capture of water from rainfall, and we will be able to reduce 70.8% of tubes connected from the customers with savings of 2.7 million tubes every year and a reduction of 26 million biological residues generated a year. Because of all of these attributes, we are very confident in the contribution of this technical center of Sao Paulo to make feasible our ambition to be more accessible, more integrated and the most sustainable ecosystem for health in the country.

I would now like to give the floor to Filippo, the CFO, who will give you more details on our financial performance.

[Jose de Almeida Filippo, executive]

Thank you, Jeane, and good morning. I will continue on with the presentation, giving you more detail on the financial results for the fourth quarter 2022. On Slide 12, we see the quarterly revenue of BRL 1.2 billion, a growth of 9.4% vis-a-vis the same period last year. If we take away the effects of the COVID test, this growth increases to 14.7%. The organic growth of 2.1% reflects the effect of the World Cup with a lower [flow] in units and the resumption of seasonality expected in the festivities at the end of the year. The mobile service channel continues to grow with an expansion of 52%, representing 8.9% of gross revenues for the quarter.

In 2022, gross revenues reached BRL 4,800 million, an increase of 15.1% vis-a-vis the previous year. If we don't consider COVID exams, the growth was 20.2%. Organic growth was at 8%. For the year, mobile services grew 33.1%, representing 8.5% of our gross revenues.

On Slide 13, we see that once again, the contribution of COVID exams in gross revenues have had a drop in the fourth quarter vis-a-vis the same period last year, corresponding to 1.2%, reaching the lowest level since the pandemic. In 2022, gross revenues from exams of COVID represented 3.2% of the gross revenue of the group.

We go on to Slide 14. We show you that the gross revenue of the patient units reached BRL 925.5 million in the fourth quarter '22, an increase of 10% vis-a-vis the fourth quarter '21 with a highlight to the performance of a mais in Sao Paulo with a growth of 13.4%. In Rio de Janeiro, despite the contract in the number of beneficiaries, the brands grew 14.5%, indicating a market share gain. In the regionals, the growth of 16.8% in the period, reflects the integration of the operations of methods and

In 2022, gross revenue reached BRL 3.771.2 million, an increase of 15.9% year-on-year with a highlight for the Fleury brand that had a growth of 11.4%. We go on to the results of New Links and the health platform on Slide 15. Together in the fourth quarter, the gross revenues of New Links and the health platform reached a growth of 76%, reaching BRL 143.7 million, representing 12% of the group's gross revenue. In the fourth quarter, the gross revenue of New Links totaled BRL 132 million compared to BRL 69.8 million in the same period of '21. This represents a growth of 89.4%, explained by the effect expected from the acquisition of a Saha in the 2022, the revenues of New Link reached BRL 364.8 million, a growth of 101.5% vis-a-vis the previous year. The volume of medical teleconsultations carried out on the health platform was BRL 250.4 million, a growth of 52.2% compared to the same quarter in '21. Revenues reached BRL 11.5 million for the period.

We go on to Slide 16. In the fourth quarter of '22, net profit was BRL 249.9 million with a margin of a 22.4%, a drop of 9.1% vis-a-vis the same period '21. Our total revenues were BRL 1.2 billion, a growth of 7.4% compared to the previous year.

In Slide 17, you can see that the operating expenses for the fourth quarter presented an increase of 17.9% vis-a-vis the same quarter last year, reaching BRL 141.6 million, equivalent to 12.7% of net revenues. This behavior is a consequence of an increase in general and administrative expenses, besides the effects of depreciation and amortization and a nonrecurring effect of repaying the insurance for a cybernetic incident in the fourth quarter. During the year, operating expenses totaled BRL 475.1 million, equivalent to 10.6% of gross revenue.

On Slide 18, EBITDA reached BRL 232.7 million with a margin of 20.9%. This is a return of 8.9% vis-a-vis the fourth quarter '21 EBITDA. This contraction can be explained by the operating deleveraging that occurred because of a lower demand for our services during the World Cup. We had a lower flow of patients at our units. We also have the effect of seasonality because of the end of the year festivities. There were nonrecurrent effects in the quarter.

In 2022 EBITDA reached BRL 1.189 billion, a margin of 26.7%. In the year 2022, because of the consultancy work for the combination of business, we incurred in BRL 13 billion in onetime expenses. If adjusted, they reached 27.0% of EBITDA margin. On Slide 19, we had a net income of BRL 31 million with a margin of 2.8%. It totaled BRL 30 million with a margin of 12.8%. In the fourth quarter of '22, the rate of taxes was somewhat negative, 0.6% with a decrease compared to the same period the previous year. This reflects the payment of interest on shareholders' equity of BRL 108.2 million. For the year, the tax rate was lower than last year, 23.8%.

On Slide 20, we can see that in the fourth quarter, our CapEx totaled a drop of 30.1% compared to the fourth quarter '21, reaching BRL 130 million. This reduction reflects a lower need for renewal of equipment and management. Our investments reached BRL 414.6 million, an increase of 0.3% compared to the year 2021.

We follow on to Slide 21, the fourth quarter '22, operating cash generation reached BRL 275.4 million, stable compared to the same period of previous year. The conversion rate stood at 118.4% of EBITDA. For the year, operating cash generation reached BRL 987 million, 3.1% less than in 2021. The rate of conversion was 83% of EBITDA.

On Slide 22, we see that net debt represented a slight reduction of 2.8% in the fourth quarter '22 when compared to the third quarter of '22. Net debt reached BRL 1.4 billion in December, a reduction of 30.4% compared to the previous quarter. This is due to the increase in private capital concluded on December 8, 2022, reaching BRL 847.3 million, leverage reached 1.2x at the end of the fourth quarter '22 compared to 1.7x in the third quarter '22, well below the limit of 3x established by our debt instruments and adequate to face an environment with higher interest rates.

On Slide #23, you see our schedule for debentures, funding and acquisitions. We have a strong cash position. We have a debt that is healthy with an average term of 4 years, without a concentration of maturity. In Slide #24, our ROIC reached 13.2% in the fourth quarter '22. When we follow up on NPS, our Net Promoter Score, the consolidated indicator reached 79.4%.

On Slide #26, in 2023, we received a Seal from APIMEC. If [indiscernible] APIMEC 2 companies that every year whole public meetings to render accounts to shareholders and other stakeholders. This Seal is the recognition of our commitment with good governance, transparency and equity in the disclosure of financial information. I would like to give the floor to Lucy.

[Lucy Sousa, executive]

I would like to greet the participants of this meeting of Fleury, especially Jeane Tsutsui, the CEO; Jose Filippo, the CFO; and Renato Brown, the IRI Officer. At this point, APIMEC brasil is very pleased to give the golden Seal to the company for 13 years of partnership with our association. We would like to thank you for this partnership, and we thank all of the participants that were with us during all these years. Thank you very much.

[Jose de Almeida Filippo, executive]

Thank you, Lucy. I'll be [ making ] for the recognition. Before we go on to the question-and-answer session, I would like to return the floor to Jeane to conclude the presentation.

[Jeane Tsutsui, executive]

Thank you, Filippo. We ended the year with sound positioning, and we already observed a resumption of the pace of growth at the beginning of 2023. We have an entered the new year with the infrastructure of new offices that will give us sufficient scale to fully absorb the demands of our growth curve for the coming 20 years. Our comfortable cash position and deleveraging show us that we are prepared to face the challenges of 2023. With this new home, we continue on towards a very promising year, confident in our development strategy for the ecosystem for integrated health with financial discipline and rigor in cost control. Thank you very much. We are now at your entire disposal for questions and answers.

[Operator]

[Operator Instructions] Our first question is from Vinicius Figueiredo from Itaú BBA.

[Vinicius Figueiredo, analyst]

I would like to explore the effects of that component of seasonality compared with the increase of New Links that explain the drop of margin in the fourth quarter. When we look in the rearview mirror, we observed that your cost of personnel of medical services and direct material for exams, also has stability, perhaps a minor drop. Now these 2 line items increased in the fourth quarter 2022. I would like to try to understand why you had that higher margin drop, specifically attributed to New Links in the fourth quarter? And if this stronger margin pressure is a pressure on the core business itself?

And in 2023, this is a makeup that we should expect for New Links that will pressure the EBITDA margin. Although you will have several gains again in efficiency and better synergy.

[Jeane Tsutsui, executive]

Well, thank you, Vinicius, for the question. You are right in the following. We had 2 factors that reduced our margin in the fourth quarter, but these are onetime effects. The first point that you mentioned is that seasonality in the World Cup that truly impacted our structure in the fourth quarter. We remind you that our organic growth was 2.1%. If we look at the Fleury brand until the third quarter, it was growing 12%. In the last quarter, it grew 5%. We have a cost structure of 70% fixed cost, a lower volume of exams, a lower flow of customers led to this reduction of margin. And we do expect to resumption in the first half of 2022, where we see a normal flow of patients in our patient centers.

The other aspect mentioned are the New Links. Structurally, they have a lower margin than diagnostic medicine. They represent 8.6% for the year. And specifically, in the fourth quarter, we had a reduction in the revenues of diagnostic medicine. Therefore, proportionately, New Links reached 12.6% of our total revenue. We also have the entrance of Saha. Saha, a new businesses still represent an opportunity to optimize our structure, whether it is for MA for the account of medication to improve our margins. So specifically, in the fourth quarter, we had the entrance of Saha that led to an increase in direct material as observed which is the outlook for 2023.

First of all, a resumption that we have already observed in the first quarter for diagnostic medicine. This greater volume allows us to dilute fixed cost and maintain a very healthy margin for diagnostic medicine. We're always trying to gain productivity and maintain a sound margin for diagnostic medicine. As a consequence, we will have a lower participation of New Links while we gradually work towards increasing the margins of New Links.

Of course, it's a year with strong pressure when it comes to inflation, as we have mentioned, we do have a robust capital structure to face a year with higher interest rates. Simultaneously, we work constantly to control our cost. We're highly disciplined when it comes to cost control and productivity gains.

[Operator]

The question is from BTG Pactual, Yan.

[Yan Cesquim, analyst]

I have two questions. The first, I would like to gain a better understanding of the growth of the brands in the field of diagnostic medicine. We know that there was a seasonal effect perhaps exacerbated by the World Cup. But other brands had good organic growth. If you could give us more color on the performance of your verticals? If they were sustained because of your mobile services and if you could explore what you have already perceived in terms of frequency in the first month, January, February and month of March of this year. If there will be a true resumption of flow in the Fleury brand and in your regional units. These are our two questions.

[Jeane Tsutsui, executive]

Thank you, Yan, for the questions. As you were able to observe, the greatest impact of seasonality that we had during the World Cup was on the Fleury brand. This is a segment where people tend to travel more, not only the customers but also the physicians at the end of the year. We had an exceptional performance of 11.4% growth for the Fleury brand. This as a result of medical relationship, innovation, retrofit of the units and service expansion. We see a good performance of the service units. We also had growth of the a mais brand in Sao Paulo, growing 16.6% during the year and 13.6% in the last quarter. We still have a good outlook for growth. In Rio de Janeiro, well, this is a difficult market. We don't have an increase in the number of beneficiaries, but we were able to have good growth for the year, 9.3%, especially in the last quarter. This happens in the a mais brand in Rio de Janeiro as well. We have an increase in the number of live service. We carried out new commercial contracts.

We have had an increase of 1 million live service by our brands at the end of 2022. And these contracts bring in volume and the opportunity to make the best of the afternoon period, increasing revenues per square meter of the units that exist. You mentioned the mobile services that have had excellent performance, 33% for the year, 52% growth in the last quarter. Mobile services has grown in all of the brands. Of course, in the Fleury brand, it was a more mature line of service. During the pandemic, we expanded routes, the portfolio, and we optimize the routes of our service. And mobile service continues to be a good growth lever for the year 2023. To respond to your question, the answer is yes. We don't offer any guidance, but in the first months of 2023, all of this growth shows a change of behavior in people. People are more concerned with their health. We also have a higher number of patients with chronic diseases. We're quite confident of the growth of our diagnostic medicine units as a whole in the Fleury brand as well as in regional brands.

[Operator]

Our next question is from Goldman Sachs.

[Gustavo Miele, analyst]

I have two questions. The first is a follow-up of some comments made by Jeane in the presentation and in Q&A, which is the implicit complexity at the beginning of the year. You have said that in these first months of 2023, we see a volume similar to the historical average, more normalized volume. Now if you could comment on this, it would be interesting. There has been an increase in the COVID cases at the beginning of the year which will we see the impact of this on your operation regarding test and the impact on the core business? Does this differ materially from what you saw in the mix at the beginning of the year, especially for the Fleury brand. .

A second question, if you allow me, we have seen health providers, hospitals, laboratories quite concerned with the issue of inflation because of the increase of cost, because of CapEx, we speak about the impact of inflation on cost. How has this variable impact of the company's CapEx. We have a normalized EBIT of BRL 130 million for the semester. And in the fourth quarter '21, it was somewhat higher. In 2022, we saw a reasonable increase. So which is the normalized level of CapEx for the company? And if there has been inflationary impact?

[Jeane Tsutsui, executive]

Well, thank you Gustavo. Regarding the volume and mix, what we observed at the beginning of the year was not a significant rise in the COVID test. We remind you that last year in the first quarter of 2022, we had a significant increase because we had the Omicron peak. And we had 6.2% of revenues coming from COVID in that first quarter. We're not observing this. We have a very low level of COVID exams. We ended the third quarter with 2.1% of COVID test, and we have not had an increase now and its resumption of our service, volume for diagnostic medicine, we have the same combination of clinical analysis and images. We have observed that in the late acquisition we have made for diagnostic medicine assets predominantly, we focused on clinical assets. We acquired a company Pardini in dos Santo, Méthodos at the south of Minas and Marcelo Magalhães in Pernambuco. in All of these are assets for clinical analysis. We see a higher percentage of clinical analysis now compared to imaging. If we compare this in a traditional brand like Fleury, the mix remains the same.

We have grown new routes for clinical analysis, and we have made the most of the square meters of our units and our expansions to increase the portfolio of imaging exams. I bring you the example of the [ day ] care unit where we increased 27% the use of square meter through a retrofit in a traditional brand, the mix remains the same. Therefore -- and we have more assets for clinical analysis that are now part of our portfolio, and they justify the increase in the volume of exams. And a discrete slight reduction in revenue per exam because of this higher mix of clinical analysis and mobile services also contribute with clinical analysis. And we have a somewhat higher percentage of revenues from New Links, which also has an impact on this mix, as we have mentioned. But this is it for diagnostic medicine. I will give the floor to Filippo to answer the question on CapEx.

[Jose de Almeida Filippo, executive]

Well, regarding the CapEx for the year 2022, we had level similar to the previous year. To remind you, in 2021, we had a carryover from 2020 when we made some investments. And we then had an increase because of the investments in the technical operational part. And this 2022 mix, our CapEx has an important share of the digital part increasing our management in digital channels and our relationship with customers. So we have a slight deformation. And this is because of the Polaris project that was implemented and that we use in our operations.

Now regarding the inflation, this is not a pressure that we have felt. We carried out negotiations in the past. We have a significant focus on costs. This enables us to work arduously on negotiations, seeking the best situation with suppliers to be able to leverage our growth and -- of course, we do try to avoid this increase in costs on what we do. Of course, there is a negotiation underway, which is natural, but we have not felt a heavy impact of inflation on these negotiations. We have had a growth of volume, and this helps to offset our capacity for negotiation.

[Operator]

The next question is from Leandro Bastos from Citibank.

[Leandro Bastos, analyst]

I have two questions. First, on your negotiations with the payment sources. If you could comment on what the last cycle was like? And which is the environment of the negotiation? The second question, returns to the costs, especially line item that has been increasing because of the New Links during the semester. If you could give us more color in terms of how we can think about this new line item going forward? You mentioned that you do have some opportunities of improving your procurement systems. How can we imagine this line item going forward?

[Jeane Tsutsui, executive]

Well, thank you, Leandro. Speaking about the payment sources, everybody is following up on what happens in the health sector, the increase in claims and the problem of sustainability. This has never been a easy issue. We are able to pass on a percentage of the price increase but not all of inflation. Now first of all, diagnostic medicine has a positioning, especially with our services of offering solutions that contribute to the economic financial balance of the entire health system. If you invest more on prevention and early diagnosis, you avoid the higher complexity areas and diagnostic medicine traditionally corresponds to 20% of the total cost of health operators in places where we have the best health indicators, the percentage is somewhat higher for diagnostic medicine. So our positioning of offering prevention diagnostic solutions as well as other solutions to the customer journey, integrated journey, an offer of services, taking away the patient from high complexity, carrying out lower complexity processes in the hospitals has been important. This negotiation is not simple.

We do negotiate broadly with health operators. We have also carried out more flexible negotiations with new models. Ever more, we are carrying out our contracts so that we can bring about more volume from the a+ brand, the brand from Rio de Janeiro. We're making a better use of the available afternoon periods with specific meals. We are able to displace demand we have no period and this helps us dilute its cost. And it helps us to have better competitiveness in our negotiations. This is what we have done. Doubtless, it will be a year with several challenges or negotiation have to be better prepared. Regarding the cost of material and medication, I will give the floor to Filippo for clarification.

[Jose de Almeida Filippo, executive]

Regarding the costs in the last quarter of last year, we did have that situation, the entrance of Saha altering our mix and Saha came in with revenues but also brought us an initial cost that will improve during our evolution in terms of productivity gains. Now because of this, we have had a lower margin, and this will be adjusted when it comes to cost and material Saha because it works with infusions does have higher cost items. And this has been influenced in the last quarter because we had a decrease in diagnostic medicine because of the seasonality. Now as we evolve New Links gains efficiency, enhances its margins, and as an initial vision, we should maintain the margins going forward. And of course, this is simply an expectation. It is not a fact. We have gained productivity in New Links. We have also increased the volume in diagnostic medicine. This will enable us to better manage our costs. And we imagine that this is how we will proceed throughout the year 2023.

[Operator]

The next question is from Caio Moscardini from Santander Bank.

[Caio Moscardini, analyst]

I have two questions. First, regarding capital allocation. You had a very good capital increase. Now will this money remain in cash for some more time? Do you already foresee an opportunity to work with this capital through M&A? My second question refers to the extension of your debt. All payers are being pressured because of claims. And of course, receivables, they are a problem. In our case, this has improved in 2022 and 2021. What can we expect in terms of your receivables? And which would be your counterpart if there is exacerbation in this situation, if any?

[Jeane Tsutsui, executive]

Now we do not observe any changes in terms of our receivables. We continue on with the same terms in this and continuity as we said, perhaps a minor adjustment in days of receivables, but a continuation of what we were working with. We have a very good management with this here low levels of default, and we have a good performance in receivables. When it comes to capital allocation, last year, because of M&As, we have a significant expense. And at that time, our target was that our leverage should at the utmost reach 2x between 1.5 with the capacity to reach 2x. Well, the scenario has changed.

We're facing a scenario of differentiated capital costs. All of this caused because of the increase in interest rates. And because of this, we will have to become ever more conservative and work with onetime leverage. This is part of our strategy because of what happened last year, what happened at the end of the year. We have just reported a leverage of 1.2x. It doesn't mean that we can't carry out acquisitions. We will be more selective and prioritize the opportunities. We will not allow opportunities to go by if they can add something to our strategic growth plan, of course. This is a scenario we see being somewhat more conservative with a lower leverage and higher liquidity to face this very challenging moment that we are going through at present.

[Operator]

The next question is from [Rafael Baslos] from XP.

[Unknown Analyst]

We have two questions here. The first I would like to understand your vision of the competitive environment in Sao Paulo, the main market in Brazil. There has been a slower increase in the revenues of Fleury. And do you fear that a competitor will be more aggressive in this market? The second question, you have a good situation in terms of capital and leverage. It is very comfortable in this sector. Do you deem this as an opportunity for the company to go to the market now that there is a higher stress level in the market?

[Jeane Tsutsui, executive]

Thank you, Rafael for your questions. Now regarding the competitive environment of the premium sector, a clear strategy for the growth of the Fleury sector. Well, much of our growth was due to seasonality. And as I mentioned, we have observed an resumption of the Fleury brand in the first month of 2023. The Fleury brand carried out a retrofit in several units. We have expanded services, expanded service per square meter. Through time, we have been able to maintain an excellent relationship, a reputation, very high NPS levels for the Fleury brand, and we continue to gain market share. This is the data that we follow up in this premium segment. We're going to continue on with a very strong Fleury brand and the presence of New Links surrounding the Fleury brand helps us in the growth of diagnostic medicine.

My example are the expansions in orthopedics. We have clinical and physical therapy units besides our Fleury units and because of this, the connection between the clinical service, the exam and the returns of the medical physician can be a more of a [Fleury] experience, bringing higher revenues to the Ferry brand and helping us in the integrated solution for the customer. And in orthopedics or in ophthalmology sorry, we have some [indiscernible] offices within a Fleury brand. So Fleury brand is strong and doing very well. Now in terms of capital and our robust capital structure. Well, yes, this is an opportunity to maintain our organic growth strategy.

In the year 2022, we had an increase of 18 units for diagnostic medicine with the Campana brand and New Links units. And we intend to keep this organic growth strategy by opening up units where we already have a very high demand, and we need to expect services to capture this demand. We continue on with the retrofit in units, expanding our portfolio. And our vision in terms of expansion, we opened 2 additional Campana units this year one of [Vita] in the region of And organically, we have entered in [indiscernible] with commercial negotiations that will help us leverage all this. This comfortable capital position means that we can continue to grow and capture more markets.

[Operator]

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

[Frederico Mendes, analyst]

Two questions at all on the same line. Well, you have a great deal of new things, New Links, Pardini, global service, Campana. I would like to know which is your mind said in terms of opportunities? And which is your relationship with the Board regarding this -- of course, you have a highly seasoned and experienced Board, but the Board might be more conservative. So which is your alignment with the Board?

And following the same line, a second question, if these projects don't work out, which will be the company utility to readdress its metrics? Will you focus on other areas that will have a more productive return? Perhaps focus on other projects that have a greater chance of success.

[Jeane Tsutsui, executive]

Well, there's a word that we say here every day, which is discipline in execution. We have executive directors that focus on each front for growth. Executive Directors focused on diagnostic medicine, looking at the different segments, with managers that have clarity in terms of what we have to obtain when it comes to growth and profitability in our units. We had executive directors looking at New Links, the opportunity of integrating their journey, growing and being more profitable. And executive directors looking specifically at our B2B segment. So executives are very clear about which their goals are. As a group, we follow clearly established management routines, and this includes points of governance. We have committees that advise the Board where the strategy is discussed very openly. We said for this plan, this mission for growth and the construction of an ecosystem in 2021. We follow up on all of the projects that are strategic with discipline so that they reach a point of governance, and we have a Board of management that is quite aligned with our strategy.

Now you spoke about the possibility, and we're awaiting the approval of the CADE our significant integration of businesses with Hermes Pardini. We had made an initial attempt towards putting together synergies. We have executive of both organizations, cautiously moving along so that we don't impact any of the issues of antitrust, but we are carefully planning this integration in such a way that when we receive the approval and do the closing, we can fully capture those synergies. So the year 2023 has been fully structured with focused teams, devoting their time to the integration and the union of business with Hermes Pardini, and this also works on other fronts. And -- what we're doing constantly is discussing priorities. Priorities in terms of capital allocation priorities in terms of time and how to work with these growth levers. We have done this in a very organized and structured way. Now if we have clarity in terms of what we have to execute and deliver the decision-making has to be very rapid. And this is what we see ever more in our organization, Fred.

[Frederico Mendes, analyst]

And that was very clear and regarding B2B, if you allow me there was a contract that matured last year, I believe. What do you expect for 2023?

[Jose de Almeida Filippo, executive]

Well, in B2B, we had an impact in the fourth quarter of 2022 of the end of that contract that we had mentioned. We are no longer part of that contract. And we're constantly attempting to have a portfolio of hospitals that are being prospected. We have a presence in 3 hospitals. We have other hospitals, which enables us to constantly renew our portfolio. We have a hospital, [indiscernible] another hospital where we have closed a deal, and we're prospecting larger hospitals in Sao Paulo. We hope that soon we will offer you news on the closing of these contracts so that we can replenish our portfolio through time. In B2B, the combination of business with Ms. who bring in revenues and volume. 75% of the revenues of [indiscernible] comes from revenues with partner laboratories, 660 throughout Brazil. And of course, we're simply awaiting the approval by the antitrust agency, and this will increase our volume in B2B as a whole.

[Operator]

Our next question is from [indiscernible] from Credit Suisse.

[Unknown Analyst]

I'm going to insist on the purpose of understanding your volume. But in a specific dimension, which refers to the patient. In the fourth quarter, there is a slight decrease in number of exams per patient. And of course, a drop and the COVID exams. COVID is not distorting the average, and this become a trend, tend to have more exams, you would require having a higher number of patients. Is it due to other factors? And we see that you're growing very well with Fleury in other regions. If you could give us some update in terms of your market there, and you can give us an update on your oncology agenda with Bradesco?

[Jeane Tsutsui, executive]

Well, thank you for the questions. Regarding the examples per patient. As I mentioned previously, we had a minor change in our mix. We have a higher number of clinical analysis. And this increases the number of exams per patient Now we have seen a higher number of patients with chronic diseases. Patients with chronic diseases traditionally had a higher number of exams when compared to younger profiles, people with less diseases. This is a trend that will increase the number of exams per patient. When you take away COVID, traditionally, when we work with COVID, we had several patients coming only for COVID exams. And we have a change in the mix when you lose revenue from COVID. You have an increase in number of exams per patient.

The drop that we had in the fourth quarter '22 was due to seasonality, which we mentioned, not only the seasonality, but the World Cup that led to a reduction in volume and a reduction in services. If we look at the year 2022, we had a growth of 16.6% in services, 26.5% in exams and a growth of 8.5% of exams per patient card. And this takes us to the following the trend where we see a similar mix in the year 2023, less COVID exams, a resumption of volume and exams per patient part.

When it comes to market share, we have explained to you that through time, we have increased the total addressable market, the number of customers with access to our brands, bringing in new contracts. At the end of the year, we mentioned more than 1 million lives with new contracts. And this, we observed in Rio de Janeiro, mainly where we have had a market share gain and the growth of 9.3% for the year, higher in the fourth quarter. All of this is due to market share. The total number of beneficiaries in Rio does not grow. We do have new contracts with lives with access to our brands and we have increased our market share. If we look at the last 5 years, the number of beneficiaries in supplementary health has remained stable. We ended the year '22 with 50.4 million beneficiaries. Of course, it was growth during the year. But if we look at the last 5 years, we already have that figure, there was a drop on the pandemic, a slight increase at present, but the number of beneficiaries has remained the same we have a CAGR in the last 5 years of 16%.

So yes, through time, we have been able to obtain network and inorganic growth with market share gains. In terms of oncology, the JV, this is a very new JV. In January, we announced we were able to close that joint venture. We went through that approval [indiscernible] at present a company has been set up, and we're working intensely on structuring the management, the brand, the positioning, the technology to be able to achieve it. We have an initial business plan for greenfield growth, of course, this doesn't discard the possibility of M&A. We were thinking of having oncological centers in the greenfield model, and we're aligned with what we have planned in our business plan.

[Operator]

The next question is from Vinicius Ribeiro from UBS.

[Vinicius Ribeiro, analyst]

We have two calls to -- 2 questions, I'm sorry, as usual. I would like to address a very specific topic. You had higher volume and clinical analysis in 2022, creating a vocation in the core business. Going forward, how will the -- how will this impact your operational leverage? You have already inaugurated a much greater structure that is not fully scalable and we expect some sort of pressure or change in terms of your gross margin because of this? And the second question, if we go back to your margins once again, clinical analysis have been a subsegment to have grown more than the imaging segment because of some structural factors and other factors as well. For 2023, is there an expectation of resuming the volume in images? And if you could work at a different level in images in the company?

[Jeane Tsutsui, executive]

Well, thank you, for the questions. First, regarding the [indiscernible] in our technical area in we could no longer grow. It was inaugurated in the year 2000 with the expectation of lasting 20 years. In 2022, we saw that we were limited in terms of growth. So the NTO that we have just inaugurated enables us to look forward and capture the gains that we want in the growth of volumes in clinical analysis. The NTO will service all of Sao Paulo, processing clinical exams. It is also a specialized area that receive samples from Brazil and Latin America. Now regarding the cost, we know that in NTO, our margin for clinical analysis is quite sound. We're going to dilute the cost of the new NTO, and we're quite convinced that this strategy will prepare us to have the ability to grow. We're analyzing the possibility. And of course, we need the approval of but we will with be able to make the most of the areas where we see great synergy, perhaps in the processing of exams in new regions. We're very attentive to this, and we're not very concerned with the margins.

Through time, we will bring in volume and value cost. Now regarding clinical analysis, this mix was due to the acquisitions we carried out. There are two components. We carried out companies for clinical analysis, which is very good for us. And mobile services, as you mentioned, has ended up being a leverage for growth. What we have done these is to make the most of our [indiscernible] needs to grow in image exams. We already have the equipment installed and to increase the volume in periods where we can service patients will dilute our fixed costs. And those businesses where we have the infrastructure for imaging installed, we're going to continue to increase the volume of exams and optimizing them in the more recent contracts. Well, they involve clinical analysis where we do have the capacity to expand from mobile services and work with imaging, where we can work in the afternoon periods with optimization. So we intend to grow in our existing units in clinical analysis as well as in imaging.

[Operator]

At this point, we would like to end our question and answer session. I would now like to give it or to Mr. Jeane Tsutsui for her closing remarks. You may proceed, ma'am.

[Jeane Tsutsui, executive]

We continue to be very confident with 2023. We will deliver the growth strategy for Fleury with financial discipline and a good capital structure. Our unique position in the health segment enables us to offer several services to patients, physicians and health operators. I would like to thank all of you for your attendance in this call, and I hope to see you in the call for the first quarter 2023. The video conference for the Fleury Group. And here, we would like to thank all of you for your attendance. Have an excellent day and a very good weekend.

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