CareRx Corp

TSX:CRRX

Earnings Call Transcript 2022-Q4

[Operator]

Good morning, everyone, and welcome to CareRx Fourth Quarter 2022 Financial Results Conference Call. Please note that this call is being broadcast live over the Internet, and the webcast will be available for replay beginning approximately one hour following the completion of the call. Details of how to access the webcast replay are available in today's news release announcing the company's financial results as well as on the company's website at www.carerx.ca. Today's call is accompanied by a slide presentation. Those listening on their phones can access the slide presentation from the company's website in the Investors section under Events and Presentations by loading the webcast and choosing the nonstreaming audio option.

Certain matters discussed in today's call or answers that may be given to questions asked could constitute forward-looking statements that are subject to risks and uncertainties relating to CareRx' future financial business performance. Actual results could differ materially from those anticipated in these forward-looking statements. The risk factors that may affect results are detailed in CareRx' periodical results and registration statements, and you can access these documents in the SEDAR database under www.sedar.com. CareRx is under no obligation to update any forward-looking statements discussed today, and investors are cautioned not to place undue reliance on these statements.

I would now like to turn the call over to David Murphy, President and CEO of CareRx Corporation. Please go ahead, Mr. Murphy.

[David Murphy, executive]

Thank you, and good morning, everyone. Welcome to our fourth quarter 2022 earnings call. With me this morning is our Chief Financial Officer, Andrew Mok. In the fourth quarter, we delivered revenue of $94.3 million and adjusted EBITDA of $7.1 million. Full year revenue grew 45% and adjusted EBITDA grew 41% compared to 2021. This increase was driven by the acquisitions made in 2021 and 2022 as well as organic growth from new beds onboarded over the last 12 months. During the fourth quarter, we announced another stage of growth with our planned expansion to Atlantic Canada, where we expect to commence servicing homes in the third quarter of 2023.

Finally, subsequent to quarter end, we closed a bought deal in private placement financing for total gross proceeds of just over $16 million. This offering further strengthened our balance sheet and also demonstrates our shareholder support for the company and our long-term strategy.

Turning to some of the specific financial highlights. Revenue for the fourth quarter declined 3% to $94.3 million, and adjusted EBITDA declined 6% to $7.1 million compared to the fourth quarter in 2021. This was driven by the previously announced customer offboarding, which resulted in our bed count declining 3% compared to the fourth quarter of last year. Challenges in the health care labor market, which we've highlighted in previous quarters, also continued to impact our day-to-day operations, increase costs and slow our efforts to continue to drive efficiencies in our business. Andrew will speak in more detail on this topic in his section of the presentation.

We have made exceptional progress in growing our national presence and expanding our leadership position over the past 3 years. During the short time, we have more than tripled our revenue and adjusted EBITDA and our average bed count has grown at a compound annual growth rate of over 45%. Throughout 2022, we made great progress in securing customer contract extensions, and we now have long-term agreements in place with all of our largest home operator partners.

As I mentioned earlier, in the fourth quarter, we announced the signing of a multiyear contract to provide pharmacy services to residents in multiple senior living facilities in Atlantic Canada, initially serving up to 600 residents. We expect to commence servicing homes in the third quarter of 2023 and aim to grow our presence and market share in the region over time. Our expansion to Atlantic Canada is another significant step in our long-term growth journey and further strengthens our position as the national leader in providing pharmacy services and solutions to home operators and their residents. With our geographic expansion plans well underway and with all of our largest customers under long-term contracts, we are well positioned to continue on our long-term growth trajectory.

I would now like to turn the call over to Andrew to discuss our fourth quarter results in more detail. Andrew?

[Andrew Mok, executive]

Thank you, David, and good morning, everyone. Before I begin, a reminder that our financial statements and MD&A for the fourth quarter have been filed with SEDAR and are also available on our website. Revenue for the fourth quarter of 2022 declined $2.6 million or 3% to $94.3 million from $96.9 million for the fourth quarter of 2021. The revenue decline was driven primarily by the previously announced offboarding of a large customer contract, which was substantially completed by the end of the year. This contract loss was partially offset by the contribution of new beds onboarded throughout 2022.

Adjusted EBITDA for the fourth quarter declined to $0.5 million or 6% to $7.1 million from $7.6 million for the fourth quarter of last year. As was the case for revenue, the decrease in adjusted EBITDA was driven partially by the off-boarding of a large customer contract. Additionally, incremental costs associated with continued challenges in the health care labor market, totaling approximately $1.5 million impacted adjusted EBITDA in the quarter. I will speak to this in more detail in the next slide.

The decline in adjusted EBITDA was partially offset by the contribution from new beds onboarded throughout 2022. Near-term profitability continues to be affected by challenges in the health care labor market. Scarcity and increased competition for pharmacists, registered pharmacy technicians and pharmacy support staff has resulted in a higher number of open positions and a longer time to fill these vacancies. CareRx provides an essential service to a vulnerable population with complex medication needs and in order to ensure that the company is able to continue to provide these services to our customers, we've had to incur incremental costs to ensure that we continue to provide this essential service.

In the fourth quarter, these incremental costs totaled approximately $1.5 million. This consisted of $0.5 million related to wage adjustments and the creation of certain new positions and approximately $1 million related to overtime, contract labor and recruitment costs. We currently expect these incremental costs to persist to varying degrees for at least the first 3 quarters of 2023.

In the first quarter of 2023, we expect the incremental labor costs to be modestly higher compared to Q4 2022. These costs, combined with the first full quarter of revenue impact from the customer off-boarding are expected to reduce adjusted EBITDA in the first quarter of 2023 compared to Q4 2022. Our net loss in the quarter increased to $4.7 million from $4.4 million in Q4 of last year, primarily due to the commencement of the customer off-boarding, incremental costs incurred as a result of the labor market that I just spoke to, higher share-based compensation expense, the loss on the change in fair value of contingent consideration liabilities and income tax expense. These are partially offset by decreases in finance costs and transaction and restructuring costs and the gain on the change in the fair value of derivative financial instruments.

On January 11, 2023, we launched a bought deal for common equity for gross proceeds of approximately $8 million at a price of $2.70 per share. Concurrent with this offering, we entered into an agreement to issue common shares on a private placement basis for additional gross proceeds of approximately $8 million to Yorkville Asset Management under the same terms and conditions as the bought deal with the private placement to close in 2 equal tranches.

The bought deal offering and the first tranche of the private placement closed on January 18 of this year. And on February 24, we closed the remaining second tranche of the private placement. Total gross proceeds of the public offering and private placement were approximately $16.1 million, including from the partial exercise of the over-allotment option. These proceeds are expected to be used for debt reduction, working capital and general corporate purposes.

Turning to our balance sheet. Cash at December 31, was $28.4 million, up $10.5 million from $17.9 million at the end of the third quarter of 2022. The increase in cash in the quarter was driven primarily by cash provided by operating activities and the timing of certain working capital movements from the prior quarter. Net debt at December 31 was $66.2 million, a decrease of $9.1 million compared to the prior quarter. This was driven primarily by the increase in our cash balance. Net debt to annualized run rate adjusted EBITDA declined to 2.3x at the end of the quarter.

And with that, I will now turn the call back over to David for some concluding comments. David?

[David Murphy, executive]

Thank you, Andrew. As Andrew mentioned, we provide an essential service to residents with complex medication needs. The work we do is highly specialized and our customers need a partner that can provide incredible responsiveness while maintaining the highest quality and service levels. As such, our overriding priority is always to ensure the safe and timely supply of medications to our home operator partners and their residents. Our current strategic priorities reflect this commitment to quality and service while also positioning us to create shareholder value by increasing efficiencies, improving margins and cash generation and further leveraging our industry leadership position to drive profitable growth in the expanding senior living sector.

We are focused on optimizing our business operations by continuing to integrate our historical acquisitions and creating a best-in-class standardized operating platform. We believe that there are significant opportunities within our business to leverage our scale through automation, more effective and centralized procurement practices and the expanded use of lean principles to create a more efficient, high-volume operating environment.

During the first quarter of 2023, we commenced the packaging of medications dispensed from our high-volume fulfillment center in Oakville using the BD Rowa Dose medication packaging system. We expect that expanded use of this and other innovative technologies will drive further efficiencies and cost savings in the years to come.

As our recent equity raise demonstrates, we remain highly committed to strengthening our balance sheet, simplifying our capital structure, lowering our cost of capital and driving a meaningful increase in our EBITDA to cash conversion. We remain extremely well positioned to continue growing revenue through increased volume and breadth of the essential services we provide to our existing customers as well as leveraging our value proposition to win new customer contracts.

Finally, we will focus on expanding our industry advocacy efforts by promoting the value of a long-term care pharmacy sector with key stakeholders and strengthening our government relations capabilities in order to ensure sustainable funding levels for our sector. We have made tremendous progress in growing our business over the past several years. While most of our efforts in the near term will be focused on managing day-to-day operations, increasing efficiencies and offsetting recent pressures on our cost structure, we remain very bullish about our medium and long-term growth prospects.

The demographic trends that exist in the expanding seniors market is highly attractive. The number of congregate care beds in Canada is expected to double over the next 15 years, and we expect to capitalize on this tremendous opportunity through a multipronged organic growth and acquisition strategy. We intend to grow with our existing customers as they expand their capacity, build new homes, win new bed license allocations and execute on their own acquisition strategies as well as expand our clinical and service offerings to these customers and increased revenue per bed. As the national leader in pharmacy services to seniors care homes, we are extremely well positioned to win new contracts with home operators while also accelerating our expansion efforts in other congregate care settings. We have an attractive M&A pipeline that will allow us to make accretive tuck-in acquisitions and further leverage our national footprint, increase our scale and benefit from additional operational synergies.

Finally, as demonstrated by our expansion to Atlantic Canada, we intend to continue expanding our geographic footprint in new markets where we believe there is a demand for our service offering. Through our growth strategy, we intend to create significant value for our stakeholders while continuing to build a compelling best-in-class service offering to our customers.

As we officially close 2022, I want to end by thanking our CareRx team members across the country. The services we provide are critically important and they demand both very hard work and an incredible service commitment. Our people understand how much our home operator partners and their residents rely on us. And in 2022, they worked tirelessly at times under very challenging conditions to support our customers and live up to our company values. Thank you for everything you do.

With that, I would now like to open the call to questions. Operator?

[Operator]

Thank you, sir. [Operator Instructions] Your first question comes from the line of Gary Ho from Desjardins.

[Gary Ho, analyst]

Maybe just start off with the labor challenges that you're facing. $1.5 million impact in the quarter, and it sounds like there's continued challenges so far in '23. Just wondering, are there other creative ways you can tackle the labor issues, maybe just higher from school or graduates, whatnot. Just want to see how else you can help alleviate this issue, not just in the near term, but maybe over the longer term as well?

[David Murphy, executive]

Good question. I think our team is already doing a lot of exactly what you say, is figuring out how to adjust to a market that -- although we're obviously hopeful that the macro picture will improve, we don't want to assume that. And so we're really doing a few things. The first is actually just changing how we work and that includes just streamlining processes. We're doing a lot more in terms of remote work and electronic workflow to be able to do work in different parts of the country and deal with the fact that perhaps staffing in individual sites is not at a full complement.

On the recruiting front, we continue to be innovative in terms of how to source talent. We have partnerships with universities, pharmacy schools doing more as it relates to both immigration and also tapping into what is a fairly significant pool of recent immigrants to Canada who are actually licensed pharmacists in other countries and doing a better job tapping into that. And also, fundamentally, the major driver of lower open positions is higher retention. And so as Andrew mentioned, we've invested in new positions. Those positions include things like more dedicated training resources, more frontline management support, just to make sure our new employees are trained, get up to speed quickly and ideally stay for a long time.

And so we're very happy with how we've adjusted. I think we see more underlying stability in terms of how we're managing the situation with each passing month. There is inevitably a bit of a lag between when that stability is achieved and when the cost pressures will abate and that's why to Andrew's point, we expect Q1 to be a little bit worse as it relates to the cost impact. But we do feel like we're getting our arms around the situation, and we're not waiting for the macro picture to improve. We are dealing with it and figuring how to do our jobs in a different and more innovative way.

[Gary Ho, analyst]

Okay. Makes sense. And then maybe just moving on to the [indiscernible] update. We did see the total synergies target -- you're now targeting $3.5 million versus $5 million previously. Just wondering what's driving the lower number?

[David Murphy, executive]

Yes. I mean, fundamentally, we've achieved the $3 million, as we mentioned, the additional $0.5 million will come from a deferred but now planned for 2023 site consolidation. Fundamentally, the remainder of the synergies that were reflected in the deal model were labor efficiencies. And so we don't regard it as the right thing to do to push forward with those just given the broader labor challenges we're having. We believe, and I think we have a long-term track record of driving efficiencies over time and offsetting cost pressures to our business. But the current environment probably does not create the conditions for us to push forward with that right now.

[Gary Ho, analyst]

Okay. Got it. And then just my last question. Maybe I'm reading too much into this. Just looking at your Slide 17, just in terms of the market share, the total addressable market. You've increased your TAM from, I think, 329,000 beds to now 0.5 million senior housing beds. Maybe you can -- can you elaborate? And are there other verticals you're now looking to enter?

[David Murphy, executive]

Yes. So I think it's a couple of things. One is the market is expanding, there's been a lot of capacity investments in a number of provinces across the country. The other thing, as I mentioned in my remarks, we are making a more aggressive push into other congregate care settings, and so things like group homes, corrections facilities, those sorts of things. And so I think the market definition reflects our best attempt to capture what our current addressable market is, which is larger than it was a year ago and I think growing at a faster pace than it was a year ago.

[Operator]

Your next question comes from the line of Justin Keywood from Stifel.

[Justin Keywood, analyst]

Just within the MD&A, there was mention that the 3 largest customers are contracted for over the next 5 years to 2026 from 2021. And that represents from what I read, about 20,000 beds. So I'm just wondering about the remaining 74,000 or 70,000 beds, if I'm doing the math correct. Is that just widely spread with smaller customers? Or how should we look at that?

[David Murphy, executive]

Yes. Good question, Justin. I mean, the good thing about our business is -- our distribution list from our customers is fairly widely spread. And so as I've always said, I think when you look at our top 10 or top 20 -- 800 beds would get you in our top 20. So it is a very diverse -- widely dispersed distribution, which is good because it means no single customer is a huge portion of our overall beds.

We made good progress last year was a heavier renewal year than usual. But with the exception of the one off-boarding that we mentioned, we've been able to secure our long-term extensions with most of our largest customers. I think actually, at this point, our top 5 customers are now under contract until at least 2025 and in some cases, as late as 2028. But it is the case that our top 10 customers are generally only perhaps 20% of the most of our overall business.

[Justin Keywood, analyst]

And the renewal rate with that larger base of smaller customers, how should we look at that? Is it typically very rare to lose one of these smaller customers?

[David Murphy, executive]

Yes. I think in general, I mean, retention rates across the industry historically have been quite high. They're usually on 2- to 3-year contracts, which we're obviously always trying to proactively renew and extend. So yes, I think our track record of retention is quite high over the last few years. And the other good thing is it means competitive contracts for small -- smaller home operators are also renewing on a more regular basis. And that's candidly a big source of our current pipeline is winning 200 to 500 bed customers which -- there's always a decent amount of contracts available.

[Justin Keywood, analyst]

And we've seen a bunch of announcements and there's the new funding over the next 10 years through increased federal transfers. And I believe some of that could be earmarked for long-term care. Are you seeing any near-term projects that's perhaps an opportunity for CareRx to bid on in expanding that bed count?

[David Murphy, executive]

Yes. I think even before you talk about the federal transfer payments, the provinces themselves and I would -- Ontario, in particular, which is our largest market, but I think across the country, there has been a surge in the last year of shovels in the ground on new projects, redevelopment, expansion, net new homes. And so certainly, as I think about how we thought about the growth trajectory of the sector even a year ago, we're significantly more bullish. Occupancy is up in long-term care post COVID, the amount of redevelopment and expansion activity has increased.

And the good thing for us is we are literally partners with virtually every home operator partner that is growing in the market. And so as they add capacity, as they win new beds, we will be their pharmacy partner. So yes, I think very bullish around bed count growth prospects for the next couple of years.

[Operator]

[Operator Instructions] Your next question comes from the line of Prasath Pandurangan from Bloom Burton.

[Prasath Pandurangan, analyst]

First, I understand the adjusted EBITDA is going to be pressured in the near term from the contract loss as well as the labor cost effects. So how do you look at the adjusted EBITDA margin for the full year relative to what it was in 2022?

[David Murphy, executive]

Good question. We don't generally provide that much in terms of forward-looking guidance. I think the one thing I would say, I think Andrew mentioned on the call is, the 2 things that have really affected adjusted EBITDA in the last 2 quarters of last year were the customer off-boarding and the labor market challenges. And so as Andrew mentioned, we expect both of those things to be a slightly worse impact in Q1 than in Q4. And then we're very confident from there that we can grow and expand both the top line and EBITDA margins. The pace of that expansion really will come down to 2 things. One is the pace of bed count growth. And then secondly, obviously, the extent to which we can continue to wrestle these labor cost challenges down. But I think Q1 is the sort of the place where these costs are fully flushed through and we'll build back from there.

[Prasath Pandurangan, analyst]

Got it. And then on -- you talked about high retention rates across the industry. Now talking about the flip side, when you try to win new contracts, could you talk about your pipeline, specifically in the 200 to 500 beds, provide us with those number of beds. What's the number of potential contracts that could come online this year? And how much do you look to win?

[David Murphy, executive]

Yes. It's a good question. I would say, I don't know if we normally provide that much precision, but there are literally dozens of those opportunities in every province that we operate in. I think we have a good feel and a sense of not just what the opportunities are, but what the more likely opportunities are to convert. The sector has been through a lot the last few years in terms of COVID and their own labor challenges. So we're certainly seeing that home operators are looking for a higher caliber, more sophisticated, comprehensive pharmacy services provider.

So we're very bullish on those opportunities. I think as we look at our -- even our January 2023 bed count, which I think was exactly in line with what our January 2022 bed count is. And that's despite the fact that we lost an almost 6,000-bed customer. So I think that gives you an indication of how much of those smaller bed opportunities exist in the market where we added 6,000 beds in 12 months to offset a customer loss, mostly from those smaller opportunities.

[Operator]

Your next question comes from the line of Tania Armstrong-Whitworth from Canaccord Genuity.

[Tania Gonsalves, analyst]

Just following questioning here. On the large contract loss, could you specify what the exact impact on EBITDA was in Q4?

[David Murphy, executive]

I believe we said it was about $1.5 million, which is consistent with what we projected in -- earlier in the year, Tania.

[Tania Gonsalves, analyst]

Okay. Perfect. And then outside of organic growth, on the M&A front, now that you're kind of winding up all your integrations, are there any chunkier targets out there that you could see yourself looking to transact on?

[David Murphy, executive]

Yes. I mean, good question. The pipeline is still very active. Chunky, it depends on the definition. I don't think there's anything sort of higher than, say, 7,500 beds. Most of our opportunities are from the 1,000 to 7,000 range, but we continue to have active discussions. I think the -- obviously, the macroeconomic environment in terms of rates and capital markets perhaps mean those might progress a little more slowly. But we still see our ability to do a deal or 2 a year in that size range over the long term.

[Tania Gonsalves, analyst]

Perfect. And then on the BD Rowa machine and megasite rollout, I think you updated that this year, you commenced packaging using one of those machines. Could you just let us know how that fulfillment site consolidation and that rollout is going?

[David Murphy, executive]

Yes. Good question. So unfortunately, it was delayed unrelated to the technology just because of the fact that we wanted to get to a more stable place from a labor and operations perspective. But those machines were started in January. We're adding beds every week or every couple of weeks. So I would say the early feedback is really, really positive, but I don't have a lot of data to attach to that yet.

The good thing is that we -- and we now expect that at some point this year, that entire Oakville facility will be operating using only those machines. And so that will give us an ability, I think, just to not only update and communicate what the efficiency savings is, but also use that as a proof of concept for determining whether we want to do a broader rollout across our network. So more to come on that.

[Tania Gonsalves, analyst]

Okay. Excellent. And sorry, around when this year would you know that?

[David Murphy, executive]

I think by the third quarter, I think we will be fully operational in that Oakville site using only the BD Rowa technology, and that should give us an indication by then.

[Operator]

There are no further questions in the phone line at this time. I will be turning the call over back to Mr. David Murphy for any closing remarks.

[David Murphy, executive]

Thank you, and thank you, everyone, for participating in today's call and for your continued interest in CareRx. We look forward to reporting on our continued progress next quarter. Thank you.

[Operator]

Thank you, sir. Ladies and gentlemen, this concludes your conference call for today. We thank you for participating and ask that you please disconnect your lines. Have a lovely day.