Medicover AB

STO:MCOV B

Earnings Call Transcript 2019-Q2

[Operator]

Good morning, ladies and gentlemen, and thank you for standing by. Welcome to today's second quarter 2019 results presentation. [Operator Instructions] I must advise you meeting is being recorded today on Friday, the 26th of July 2019.And I would now like to hand the meeting over to your host, Fredrik Rågmark. Please go ahead, sir.

[Fredrik Rågmark, CEO & Director]

All right. Good morning, and welcome, everyone. Welcome to our second quarter 2019 results. So you will have the presentation in front of you. So we are very happy and very proud of our second quarter results. Medicover has always been a growth company, and I think you see that growth is even accelerating. So we reached revenue of just short of EUR 203 million for the quarter, which is a strong 26% up versus prior year, of which north of 14% is organic growth. So indeed I think, that is strong however way you want to look at it. The acquisitions, which as you recall was a good part of the reason why we did the IPO 2 years ago, to be able to step up that agenda, contributed almost half of our revenue growth. So that's a strong sign.The fee-for-service segment, which is particularly important to us, and again, as we have said many times, it's particularly within the fee-for-service segment that we have acquisition opportunities. You can see that now with the fee-for-service segment for the group being up a strong 31% versus prior year and is now representing just over half of overall group revenue, particularly in Healthcare Services, where we have been very active as well on the M&A front. You see fee-for-service as a share of divisional revenue raising to -- or rising to 40% versus 35% last year around and growing 51% year-on-year, some of that being organic growth and complemented by an active M&A agenda.On the Diagnostic Services side, where you know that fee-for-service has always been a larger proportion and we grew up to 66% versus 65% last year around, and again, growing 20%, which is also strong on the Diagnostic Services side. Certainly not of any lesser importance but the core business in Healthcare Services are funded employer-paid model, remains very stable and keeps growing well as you will see a bit further on in the presentation. Important as well, the Neomedic acquisition, which is the largest acquisition we have done now since we became, again, a public company, is consolidated from May.Then the second very important message and good news is that margins keep expanding. Not only do we very robustly grow our top line, we are also able to grow our margins, not just in absolute terms but also percentage-wise. So that's important that you can see.So EBITDA grew just short of 29% to EUR 27.3 million, 30 basis points expansion. However, we have also expensed unusually high M&A cost related to the Neomedic closing. So if one adjusts for that looking at the underlying business, we're more than 100 basis points up on the EBITDA level, which is significant. That's what we should do. But again, that's a reflection of the increased volumes and improving efficiency we can see throughout the business. Looking at the adjusted EBITDA, growing 100 basis points up to 14.5% or 35% growth, so significant. The EBITDAaL that we introduced together with the new IFRS 16 regulations, which you recall, is more akin to the historic EBITDA, which is more or less the proxy for underlying cash flow generation, grew some 33% up to EUR 17.5 million. That was a 40 basis point expansion. And if one would look at the adjusted EBITDAaL, that would be up 110 basis points. So more or less, all in the same direction around that 100 basis point growth, which all confirms in the same direction. We have the public financial profitability target of organic adjusted EBITDA growth of 18% to 20%, and we significantly beat that this quarter with 26.8%. So that's strong and good news. Finally, on the profit side, you recall that in the other income category, last year around, we had quite significant such income relating to the revaluations of -- on our options in the MaxCure Indian hospital business that we don't have this year around so net profit is down a little bit due to that. However, if we exclude the other income category and looking on the underlying business, the net profit growth is a significant 91% up. So I think that's a confirmation of indeed that the business is generating a stronger profit flow-through, through the increased volume, both in existing facilities as well as the efficiency in how we operate our businesses.Then if we go in specifically to the -- to divisions. So I start with Healthcare Services, where revenue was up a very strong 34% so just short of EUR 109 million, of which, organic growth was 17%, indeed a strong figure. And here, fee-for-service grew a strong 51% to reach, as I mentioned, just 40% of divisional revenue. And this was the ongoing organic growth in our existing businesses as well as the various acquisitions that we have done over the past couple of years. Strong EBITDA growth, up 43% to reach EUR 15.3 million, a 90 basis point margin expansion. And you see organic EBITDA growth was just short of 19% of that. And if we look on the alternative performance measures, EBITDAaL, that increased 58%. So very significant growth or even 150 basis points margin expansion. And this you then should interpret as a reflection of -- you recall that this profit measure looks at actually bringing back all our leased costs. And then of course, the fact that this is expanding much more than the regular EBITDA is then a reflection that we are operating our facility usage more efficiently, i.e., we're pushing much more volume through the existing facilities that we have across the network. Then on the funded business, our employer-paid business saw members grew -- the member base grew by 13.5% to just short of 1.3 million. And that confirms the position, the outlook that we've had for a number of years. The employer market remains very tight, both in Poland and Romania. We have made the point in several of these calls that at some point, the economies will start to soften. And particularly in Poland, the issues around availability of labor, where the economy is firing on all cylinders. And at some stage, it will start to soften little bit, although it is not to the second next quarter. But into 2020 at some stage, we expect a little bit of softening in the growth of the economy in Poland. And of course, the results in this segment, the results in Healthcare Service is really driven by this ongoing strong underlying member growth and then the increased fee-for-service activity, which is really across the board. It's -- if you look at our -- certainly at our admissions into our hospitals, it's the fee-for-service activity in our clinics and it's the fee-for-service activity in our dental network as we are busy developing or expanding. So it really is across the board. And the demand remains very strong, both in Poland and Romania for private paid health care.If we then switch over to our Diagnostic Services side. Again, the private pay business continued to see strong growth here. Overall, revenue grew by 18% to just short of EUR 98 million, of which organic growth was 11.6%. And here, fee-for-service represents 2/3 of divisional revenue. It was up a strong 20% so -- as previously mentioned. So EBITDA grew well at 23.6%, an 80 basis point margin expansion here as well to 17.7%, reflecting good and strong underlying development. And the alternative performance measure here grew 50 basis points to 12.8%. So same dynamic as on the Healthcare Services side. So 8% growth in the number of lab tests, where most of the growth is coming out from the private pay markets. And the growth is weighted towards the advanced test category that, as you recall, is a very significant part of our strategy, and we see that playing out very well across all our main geographies.Important for those of you that were with us 12 months ago in this earning call, that's when we started to talk about softness in the German lab business on the back of a second quarter 2018 reform. And in the second half of last year, we were quite significantly impacted by that, and we have talked about normalization over the first quarter, and we can report even more so here in the second quarter, where we are more or less -- it's not 100%, but more or less back to the position we were before we were started to be impacted by that reform. So that's significant and good news for us. Overall, we added a total 24 new blood drawing points during the quarter across the network. So a total of 614 BDPs by end of the quarter.Then if we turn to India and MaxCure. MaxCure is still an associate company, as you know, so it's not consolidated in our numbers. MaxCure operates 11 hospitals in 3 states: Telangana, Andhra Pradesh and Maharashtra in India. They reached revenue for the second quarter EUR 16.4 million, and their local currency growth was 15%. We expect to be consolidating MaxCure into the Medicover group during the final quarter of 2019. Our current ownership amounts to 46.7%, Joe will comment on that later. We have slightly increased the ownership during the quarter. Two new cancer centers are under development, and they will be open towards the end of this year or early next year. And we also have -- are underway rebranding all of MaxCure's hospitals into Medicover. And you see there on the right-hand side of the slide, some beautiful images of recently rebranded facilities. So you now -- if you happen to tour around India, you will see some nice Medicover hospital facilities in a few states.So with that, I hand over to Joe to talk a little bit about the financial overview.

[Joe Ryan, Chief Financial Officer]

Thank you, Fredrik. So just having a quick look through the key financial data slide, just to pick out a couple of things there. So we use this measure, alternative performance measure EBITDAaL, equivalent to the pre-IFRS 16 EBITDA. We still get a little bit of front-loading effect from the lease accounting through that. But it's a number which is reconcilable back to the reported figures, so you can keep track on it. So this is pretty good. We came in EUR 19.6 million, so that's very strong growth there, 42% increase on the same figure in Q2 last year. And for the first half, EUR 38.6 million, so that's up 34%, so very strong momentum in terms of the key performance metrics for us. 9.7% margin for this quarter, so up about 110 points and 9.6% for the first half, so up about 70 basis points. We've also included here on this table a new figure for you. Some analysts have been asking for adjusted EBITDA, so we include that in there as well. That is EUR 13.7 million for the quarter, so up some 59%. And if we look through the first 6 months, that is EUR 26.7 million, up some 43%. So again, a very strong performance there. And even if I look back on an LTM basis, that's pretty good. That's up 26% on an LTM basis. So you can see there, we've actually got an acceleration of the performance for that number.So just flipping over in terms of the financial. Two points I'd like to make. Yes, I can't reiterate really enough that this is very strong growth. We're very happy with this. And on top of that, we keep the margin expansion as well. So definitely growing in the right area and firing away. The investments that we've been doing now over the last few periods are starting to come through. We continue to invest so we're continuing our capital program so we invested some -- just short of EUR 25 million for the first 6 months in capital investment, just short of 60% of that being in growth CapEx areas and just over 40% being in maintenance areas to maintain the existing business. Premises. We're increasing dental inpatient facilities, BDPs. We're doing some expansion of the hospital assets that we have in terms of the physical capacity. So we can continue to build and that will then be strong support for us for our future growth.Pricing. We've always been disciplined in terms of our pricing in the core employee benefit market with the high levels of growth that we have and dealing with that and making sure that we can maintain our service levels with our customers. We continue to have a strong pricing discipline, which is supportive of margins. Neomedic. We closed this now and consolidated for May. We paid EUR 69 million for that, including the debt that we assumed. And with expense, both in this year and in last year, we expensed some EUR 1.7 million associated with that in terms of M&A costs for the P&L account. So we're very happy with that. We recognized EUR 5.2 million of revenue in the quarter in respect to that for 2 months. So the other few things that we've done now after the quarter end, we acquired all of the shares of OK System, the employee benefit health card business in Poland, and we're underway expanding the gym network to support that business's growth. We acquired also then a dental practice in Poland in our continuing expansion, both organic with greenfield sites and inorganic with acquiring good-quality dental practices in Poland. The consideration for that is about EUR 3.6 million.Just going over to the next slide. Just to remind you, these figures are restated for IFRS 16. We did a full restatement, so everything that we've talked about here in terms of the comparators has been restated. So no confusion and full transparency for you to be able to understand the figures. Fredrik mentioned about the net profit -- the net figure being impacted, so we had a relatively low figure in terms of the other income. We had quite a high in the prior periods with the revaluation under IFRS 9 for our options in the MaxCure business. We now have increased by 1.6% our investment into MaxCure, so we took that up to 46.7%. So we bought some secondary shares under the arrangements that we have, so that's good for us, and we'll continue probably to pick up some more shares now over the rest of the year and our expectation probably in the fourth quarter that we would pass through the control barrier and we would then consolidate from then. Net interest, EUR 3.3 million for the quarter, EUR 1.8 million of that is the IFRS 16 lease interest charge, so that's a little bit up -- increased on the higher debt levels that we have compared to last year. Net operating cash flow before working capital/tax is good, so we're doing well there. And our tax rate, we're projecting 27%, not taking into account any of these fair value movements so -- which are nontaxable by their nature. Equity is being developed quite well. So we're just short of EUR 330 million on an IFRS basis through our equity, so that's the net profit falling through. Plus also, we had a quite benign situation in terms of the foreign exchange translation rates for our foreign subsidiary, so that helped a little bit there as well. Net financial debt, including lease liabilities, this has gone up, so we're EUR 332 million at the end of the period. The increase on this is also the acquisitions where we have to recognize the IFRS 16 lease liabilities as well and plus also our expansion of our own facilities as well. And if you look at the increase in lease liabilities, it's about half and half between acquisitions and between our own organic growth. Excluding lease liabilities, net financial debt, that came to 180 -- just short of EUR 186 million. And if we look at that in terms of the ratio to EBITDAaL, which is the correct figure to compare it to, then that came out to 2.8x. So that's picked up there. It spiked for this for now on the back of the acquisition that we have done with Neomedic, which is a little bit more sizable. So I'll expect that to trend downwards as we recognize through the year the profits from that and that spike goes away and also as we grow profits through the year, all things being equal without any other acquisitions.If we look at the commercial paper program, which we launched at the end of June. So we put in place a SEK 2 billion program. We've got an EUR 89 million funded under this. So this is quite cost-effective for us, and we should see a reduction in that cost of funding over the next 12 months so -- on the back of this and some other activities that we'll do in terms of our funding. This changes the profile in terms of the balance sheet with part of the debt being reclassified as short term. However, we have our revolving credit facility standing behind this program, so there is no risk in terms of funding. The funding risk stays exactly the same as we had before. So that's all managed.So just to recap in terms of our organic growth. We've been above our midterm targets now, so very happy with the development there, good strong momentum in the business. And I think if you look at the run rates, you can work it out yourself that we have very strong forward-going growth in terms of our revenue line. In terms of profit, we're above the targets again. I think as we mentioned, when we gave you updates last year with the reform processes in Germany that we expected over, that should maybe in terms of pick up and come back to our targets, and we're certainly doing that now in terms of picking up and catching up on those targets as we said we were going to last year. Capital structure. You can see here now we're deploying debt in terms of acquisitions, which is what our objective was, so we're executing on that. That spikes a little bit now, up to 2.8, but we expect that to come down, all the other things being equal, towards the end of the year.

[Fredrik Rågmark, CEO & Director]

All right. Well, thank you, Joe. So that was a run-through of our results for the second quarter, and we're happy to take any questions you may have on this.

[Operator]

[Operator Instructions] And we do have a question here from the line of Kristofer Liljeberg of Carnegie.

[Kristofer Liljeberg-Svensson]

I have 3 or 4 questions. First, could I ask -- talk to you about the operating leverage differences between the 2 business areas? It seems much stronger in the Healthcare Service relative to diagnostic that I thought should have a higher fixed cost. So what's the reason for that? Is it just because of the much -- or much -- even better growth in health care or you're doing some investments in diagnostics? If you could maybe talk a little bit about that.

[Fredrik Rågmark, CEO & Director]

No. I think, Kristof, how you should view that is that Germany, it really is on the diagnostic side, Germany is a big piece of diagnostic as you know. And although I say, it's -- we're basically back normalized for the corresponding period last year. If you recall, we said this really started to hit us from May. So the relative comparison with last year for the 6 months, it's basically 2 out of 6 months, and for the quarter, it's 2 out of 3, that was impacted last year around. So on a relative comparison basis, we are just still quite significantly impacted on Germany, although on a run-rate basis going forward, we're more or less back, so I think -- that's given. The size of Germany and the diagnostic division, that's the largest explanation to that. Then the operational leverage in Healthcare Services is really because we have much more square meters there. So by filling all of those with more volumes, you -- from that point of view, you will see more leverage coming through. So those would be the 2 reasons for that.

[Kristofer Liljeberg-Svensson]

And for the Healthcare Service, how much more volumes could you fill with -- in the next existing facilities?

[Fredrik Rågmark, CEO & Director]

Well, I think you've -- you can't really give a good answer to that because it's no good use, because it really depends on where the facility is. If you have an average utilization, it's not going to tell you very much because if you are chockablock full in one city and empty in another one, the averages tells you nothing. So the -- I think the right answer to give you is that we keep expanding our facility network as we fill them, and we -- I'm sure we're going to continue to grow our facility base next year. But the fact that you see more operational leverage coming through this, and particularly, you see on the EBITDAaL line in Healthcare Service, that's because facility in general are more full than they were a year ago or 2 years back.

[Kristofer Liljeberg-Svensson]

And also for the Healthcare Service, the membership growth still very impressive, almost 14% but somewhat slower than last year. Is that then a first sign of a cooldown of the economy as you mentioned? Or is this just maybe normalization after exceptional strong growth?

[Fredrik Rågmark, CEO & Director]

No. I would say, it is not, Kristof, a first sign of slowdown. I think Joe had in his commentary price discipline. And if anything, we have always been certain to maintain price discipline and -- so we haven't seen any slowdown. I keep mentioning that the economy is firing away on all cylinders because I think probably us, as most other people perhaps, are somewhat surprised how long this economic expansion just keeps on going. And I've mentioned it because at some stage, it's going to start to weaken in Poland. Although, we have no signs of that happening yet. So the fact that it's slightly slower this quarter, it will vary from quarter-to-quarter depending on how much new contracts come in, et cetera. So there is nothing other than that this time around.

[Kristofer Liljeberg-Svensson]

Okay. And then just 2 short ones. Could you comment on the profitability also in MaxCure? And then on M&A contribution, do you have a figure how much M&A in total contributed in 2019 based on acquisition done so far? That would be helpful.

[Fredrik Rågmark, CEO & Director]

You want to take that, Joe?

[Joe Ryan, Chief Financial Officer]

So just the 2 questions there, but I'll take the MaxCure one. In terms for the MaxCure, they're expanding quite well, you see there in terms of the revenue growth. So we have the new hospital which we opened in Maharashtra and that's going well. That's still obviously not profitable, so we're still in -- it have been opened, what, just less than a year. So normally it would take 2 years to get to a level where you've got an okay level of profitability. So that's still a drag in terms of the overall numbers. And then we're also expanding with the -- with 2 cancer centers as well. So overall, profitability has -- is -- in terms of the net number, we're still in a position where we haven't really got anything to pick up in terms of the net line. We're bringing on debt to fund these acquisitions. And so on a net basis, we're still not producing anything.EBITDA. With those investments we're doing, that's a little bit softer. But we're quite happy with the development. We're quite happy with how that's going. We feel that we're creating value and developing.

[Kristofer Liljeberg-Svensson]

But yes, I can fully understand, of course, margins are under pressure then due to this expansion. But for modeling purposes, if you're now going to consolidate that from -- at some point in the fourth quarter, it will be good to know what type of margin we should assume modeling this.

[Joe Ryan, Chief Financial Officer]

Yes. You need to be somewhere in -- so in the double digits, but in the low end of the teen range.

[Operator]

[Operator Instructions] And we also have a question from the line of Carolina Elvind with Danske Bank.

[Carolina Elvind, Analyst]

I just have a short question on the financial expense. Is that -- the financial expense you saw in Q2, is that a good proxy for the next coming quarters?

[Joe Ryan, Chief Financial Officer]

Yes. I mean in terms of the lease side, yes, definitely. Well, I mean we will continue to expand our facilities as we continue to invest, so that number will keep going up. But it's a baseline and it's -- that's the sort of same number you're going to see recurring. In terms of the cost of debt, our aim is to actually reduce that in terms of the cost of debt and not necessarily as an absolute number. The commercial paper program we've put in place should help us in doing that, and we also expect to do some more actions over the rest of this year in terms of our debt structure to both increase maturity and reduce cost. Mr. Draghi yesterday decided to help us in that endeavor as well. So...

[Operator]

[Operator Instructions] And we do have a follow-up from Kristofer Liljeberg.

[Kristofer Liljeberg-Svensson]

Yes. Just my last question about M&A contribution, if you have that?

[Joe Ryan, Chief Financial Officer]

We have quite a bit of disclosure in the back of the report there, Kristof, in terms of net acquisition and what that's contributed, so there's full IFRS disclosures in there. So I think there's quite a bit of information that will answer your questions in that.

[Operator]

There are currently no further question. Please continue.

[Fredrik Rågmark, CEO & Director]

Okay.

[Operator]

Sir, there are no further questions.

[Fredrik Rågmark, CEO & Director]

All right. Good. So thank you for listening in. Again, we're very happy with the second quarter and that we look forward to talking to you again at the end of our third quarter. So thank you all very much. Bye.

[Operator]

That concludes the presentation today. Thank you for participating. You may disconnect.