dentalcorp Holdings Ltd
TSX:DNTL
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dentalcorp Holdings Ltd
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Good morning, and welcome to dentalcorp's First Quarter Results Conference Call. [Operator Instructions]
At this time, I would like to turn the call over to Mr. Nate Tchaplia, Chief Financial Officer of dentalcorp. Please go ahead, sir.
Thank you, operator, and good morning, everyone. Welcome to the dentalcorp First Quarter Results Conference Call. I'm joined here by Graham Rosenberg, our CEO.
Before we start, we would like to remind you that all amounts discussed on this call are denominated in Canadian dollars, unless otherwise indicated.
Please note that the statements made during this call may include forward-looking statements and information and future-oriented financial information regarding dentalcorp and its business and disclosure regarding possible events, conditions or results that are based on information currently available to management, which indicate management's expectation of future growth, results of operations, business performance, business prospects and opportunities.
Such statements are made as the date hereof, and dentalcorp assumes no obligation to update or revise them to reflect events, disclosures or circumstances, except as required by applicable securities law. Such statements involve significant risks and uncertainties and are not a guarantee of future performance or results. A number of these risks and uncertainties could cause results to differ materially from results discussed today. Given these risks and uncertainties, one should not place undue reliance on these statements and information.
Please refer to the forward-looking statements and information and future-oriented financial information section of our public filings, without limitations, our MD&A and our earnings press release issued today for additional information.
For those of you who have dialed in to the call, the company has prepared a series of slides to complement our prepared remarks. These slides are available on the Investor Relations section of our website, in the Events and Presentations section.
I will now turn the call over to our Chief Executive Officer, Graham Rosenberg, for his opening remarks. Graham?
Thanks, Nate, and good morning, everyone. We are pleased to be with you today to review dentalcorp's recent developments as well as our financial and operating results for the 3 months ended March 31, 2024. For today's call, I'm going to share a number of those developments with you, and I will then hand the call over to Nate who will discuss our financial results in detail, after which I will provide forward-looking remarks about how our business is trending.
As a reminder, dentalcorp operates in a highly recurring essential health care industry that is cash pay, resilient through economic cycles, insulated from disintermediation by technologies. Importantly, dental expenditures have experienced strong relative growth during periods of higher than average inflation.
Accordingly, and in the context of the current macro environment, we believe that dentalcorp's favorable cost structure, high margins, low commodity risk and negligible capital expenditures provide support for the company's continued delivery of balanced double-digit growth in a CAD 22 billion dental industry.
Our confidence in the business is supported by our first quarter results, which met our expectations and provide a constructive outlook for the coming year.
Overall, I am pleased with our results for this quarter. As you can see on Slide 3, our results have been made possible by our deep and diverse network of maybe 10,000 health care professionals across the country. Our teams continue to deliver the highest standards of care during the reporting period, supporting more than 2.1 million active patients and managing over 5.2 million patient visits annually.
You will see that we completed our first quarter ended March 31 with approximately $1.5 billion of last 12 months pro forma revenue and $274 million of pro forma adjusted EBITDA.
As you can see on the next slide, we continue with our balanced approach to drive sustained double-digit growth, and we intend to continue growing our business organically through accretive M&A and by driving overall business efficiencies and operating leverage over the medium-to-long term. And this is a program that we have meticulously built over the past decade, and we believe we are able to thrive in any economic climate.
With respect to M&A, we acquired 5 practices in the first quarter for a total consideration of $17 million. These practices are expected to generate $2.6 million in pro forma adjusted EBITDA after rent. We are also encouraged to see that practice valuations continue to decline, down 10% in the first quarter of 2024 over 2023, as access to financing opportunities continue to tighten for many buyers across the industry. We remain the best positioned and capitalized partner of choice for independent dentists and we'll continue to be disciplined about the practitioners we acquire.
On Slide 5, you can see that our business operates with robust and expanding margins, low CapEx requirements and capped interest rate exposure on 100% of our existing debt outstanding. We continue to convert a high steady percentage of our EBITDA into free cash flow in any given period.
On Slide 6, and as we previously expected, we completed the quarter at 4.3x leverage, down 0.1x from the end of 2023, as we funded all of our acquisitions through free cash flow. We continue to pursue a medium-term target of under 3.0x leverage.
Turning to the next slide. You can see a comparison of valuation and free cash flow yield versus our peers. Since IPO, we have seen a decline of 10.4x or 53% in our EV to LTM EBITDA trading multiple, and are currently trading at a 42% discount to our total peer group. At the same time, we are trading at a 10.6% free cash flow yield compared to our peer group of only 2.8%.
Turning now to Slide 8. I'm pleased to report that our business delivered revenue of $372.4 million in the first quarter of 2024, up 3.9% over the same period in 2023, and adjusted EBITDA of $68.1 million, up 3.8% over the same quarter last year. Our adjusted EBITDA margin came in at 18.3%, an improvement of 0.1% over Q4 2023.
We are also encouraged that same practice revenue growth was 0.9% for the quarter against what was one of the strongest quarters since our inception, as the extended 2022 flu season resulted in a higher-than-normal volumes at the beginning of 2023 as well as from the deferral of patient volumes due to the Canadian dental care plan.
I would like to take a moment to discuss the Canadian dental care plan, also known as the CDCP. As of May 1, the first cohort of patients became eligible under the CDCP. However, in anticipation of that start date, we experienced the deferral of patient volumes from the first quarter into the balance of the year. We also note dentalcorp's provider enrollment is tracking above the current national enrollment of 20% to 25%, and we expect that number to increase over the coming months.
Under the CDCP, we will continue to deliver services at rates consistent with our usual and customary fees. This will ensure the high quality of care that all our patients, plus new and returning, expect and rely on. Overall, we regard the CDCP as a favorable development for both the Canadian public and dental professionals and we expect it to be neutral to slightly positive for dentalcorp.
In addition, we have now completed our planned corporate investments, which will help to drive strong practice level performance in both our base business and our recent acquisition cohorts. The outcome has been strong adjusted free cash flow for the quarter of approximately $35.2 million, enabling us to fund the entirety of our acquisition program with free cash flow.
As we look to the second quarter of 2024, we anticipate revenues to increase by 7% to 9% over Q2 2023, while delivering 2% to 3% same practice revenue growth. We expect adjusted EBITDA margins to be materially consistent with the first quarter of 2024.
As we look ahead to the remainder of 2024, we remain optimistic on our same practice revenue growth returning to the 4% plus range in the second half of the year, along with our previous 2024 guidance of 15% to 20% adjusted free cash flow per share growth and adjusted EBITDA margin expansion of 20 plus basis points.
We also anticipate completing acquisitions, representing pro forma adjusted EBITDA after rents of approximately $20 million in 2024. Overall, this aligns with our balanced approach to strategic growth. Additionally, we expect to further deleverage our balance sheet as the company continues to self-fund its acquisitive growth.
I will now pass the call over to Nate, who will walk us through the details of our financial results, and then I will share some closing remarks before we open the call for questions. Nate?
Thank you, Graham. The diversity in our dentist space allowed us to deliver on our quarterly results and demonstrates the strength and predictability of our business.
Turning to Slide 9. Revenue for the 3-month period ended March 31, 2024, as Graham mentioned, was $372 million, compared to $358 million for the corresponding period last year, representing an increase of approximately 4%. The increase is attributable to our continued acquisitive and organic growth, offset by lapping a record strong comparable period and the deferral of patient visits from Q1 into the balance of the year due to the anticipated commencement of the CDCP.
As you can see, we reported first quarter adjusted EBITDA of approximately $68.1 million, compared to $65.6 million in the same quarter last year, and reported first quarter adjusted EBITDA margins of 18.3%, representing 0.1% margin expansion quarter-over-quarter. Looking forward, we continue to be confident about our ability to grow the business through acquisitions and organically.
Turning to the next slide, you can see our net leverage and liquidity as of March 31, 2024. On a net debt basis, we are approximately 4.3x levered at the end of the first quarter, deleveraging by 0.1x over Q4 2023. We ended the first quarter 2024 with liquidity of $407 million, comprised of $53 million in cash and $354 million in undrawn debt capacity under our senior debt facilities.
First quarter and last 12 months adjusted free cash flow was $35 million and $129 million, respectively, which supports our strong balance sheet position.
On the debt side of the ledger, in January 2024, we increased the hedge portion of our bank debt from 75% to 100%, and the debt exposure is carrying a fixed CDOR rate plus margin for an all-in cost of approximately 6.65%. In addition, we continue to see strong interest rate coverage as defined by our LTM pro forma adjusted EBITDA after rent divided by net interest expense of 3.2x in Q1 2024.
Turning to the next slide, you can see our 2024 capital allocation program. We are committed to continuing to self-fund acquisitions using free cash flow and expect little to no debt drawn for our 2024 acquisition strategy. We self-funded the entirety of our acquisitions in the first quarter from cash flow, not drawing on any additional debt.
Overall, we are pleased with our first quarter 2024 results. We increased organic growth, in part through in-sourcing efforts, created ongoing operating efficiencies, closed accretive acquisitions, and continued to develop our pipeline.
With that, I'll turn the call over to Graham to provide some closing remarks. Graham?
Thanks, Nate. Turning to Slide 12. We remain highly confident about our future opportunities. We expect to return to a 4% same practice revenue growth in the second half of 2024 and expect to deliver on $20 million of acquired EBITDA for 2024. In addition, we continue to expect to deliver adjusted EBITDA margin expansion of 20 plus basis points and 15% to 20% growth in free cash flow per share, while we continue to drive deleveraging throughout 2024 and beyond.
Thank you all for our call today. This concludes the formal part of our presentation. And I would like to now open the call to questions. Operator?
[Operator Instructions] Our first question comes from George Doumet from Scotiabank.
Based on your Q2 guidance, I think we need closer to mid-teens revenue growth in the second half. So can you maybe talk a little bit about the building blocks to get there, and maybe perhaps the cadence between Q3 and Q4 growth?
Yes, absolutely. I think just to take a step back and kind of reiterate the performance in Q1, as we got closer through to the end of the quarter, and there was more information around CDCP, and patients began to receive their cards and educate themselves about their opportunity for participation. And it really wasn't just the 65-plus cohort that became eligible May 1. What we saw is a behavior of all patients that would become eligible both through the balance of 2024 as well as 2025, begin to defer, reschedule their appointments as, again, they began to apply and understand the benefits of the program.
So in the short term, ultimately, what we saw is a bit of a change in behavior as it relates to those patients that would be eligible. And again, those deferral of volumes from Q1 through to the balance of the year.
As we see it continue and as we sit here really roughly 10 days into the program, we are seeing a return back to -- a trending towards back to normal levels. We're not all the way there yet. And again, there isn't a, call it, full participation from the dentists across the country. As mentioned on the call, our dentist participation is trending above that 20% to 25% enrollment rate across the national average. But again, there's still work to do as far as information to be provided by the government around the CDCP, as well as further enrollment changes that are being put through that will begin in July.
So as far as the pacing of growth and the pacing of our expectations through the year, reiterating that 2% to 3% for Q2. And our expectation is, as the program continues to mature, as enrollment continues to increase across dentists in Canada, and patient behavior does return to normal through the balance of the year, that 4% plus organic growth is our expectation.
And would you expect to see more growth in Q4 versus...
It's difficult to say. I think depending on how the program pushes through. This is obviously a program that is new to all. I think it would be reasonable to expect that, as the program continues again to mature through the balance of the year, more patients receive their cards and return back to the office, I think that's an expectation that is true.
I think as well, if we take a step back and look at the total population in Canada that the CDCP would serve, it's obviously a significant increase in the total addressable population for dentistry. It is $15 billion of increased funding for the industry. So as we get through the balance of '24 and into '25, again, we do look at this positively both from an access to care to patients in Canada as well as for the industry at large.
Okay. Just for my follow-up, we saw a bit of a decrease in the gross margin. I think you guys called out higher revenue share and also higher prices and consumables costs. Can you elaborate a little bit on that? And how should we think of the normalization in that margin over the year?
Yes. I think that margin, it just trends from quarter-to-quarter. There will be some difference and some movement. It really is related to the mix of goods that are purchased both on the consumable and as well as the types of services that are being provided. I think in the long term we expect it to continue to be well within the range that we've seen historically.
Our next question comes from Gary Ho from Desjardins Capital Markets.
So yes, good to see you self-fund your acquisitions here. But when I think about your capital allocation with shares where they are, how do you balance between putting the next incremental dollar to buying back your stock versus purchasing another practice? Maybe just refresh us how you think about the economics there?
Absolutely. So really, it's 2 parts here as to how we think about it. One, as we look to the individual economics of a deal, we look to it as far as the return on invested capital that we're able to drive. And we continue to drive return on invested capital that's in excess of our cost of capital in the mid-teens as we look at it.
We're able to, from a valuation perspective, given our purchasing power, negotiated contracts, as well as the revenue synergies and efficiencies and programs, we're able to bring by that multiple down fairly quickly within that first 12-month period. So on a stand-alone basis, unit economics on an acquisition do drive positive returns, and that is how we evaluate it.
Further to that, as we look to it in the long term, each acquisition ultimately continues to build our terminal value. As mentioned on the call by Graham, we are trading at a significant discount to our peers from both an EBITDA valuation multiple, we're trading at nearly an 11% free cash flow yield. So from an intrinsic value, our view is to continue to build the business, continue to maintain our leadership position -- and our significant leadership position as the partner of choice for dental in Canada. And as we look to each allocation of dollar for acquisition or share buyback, we don't look at one, call it, taking away from the other.
We reiterated our $20 million of plus acquisitive growth in 2024, and we'll continue to stay on that path. $2.6 million is what we acquired in Q1, and by the end of H1, expect, again, to continue on a pace that will provide us that pathway to $20 million.
Okay. And then my second question, maybe a follow-up to the last CDCP question there. Just in terms of what you're seeing, it sounds like you're seeing some rebookings in Q2, Q3. Last quarter, you've given us a 9.5% to 10.5% target for full year revenue growth in 2024. I guess with these deferrals, does that lower that range a bit, or no, that's more of the timing maybe?
From a full year perspective, it would lower it given the reduction in volumes in Q1 to the deferral into the balance of the year. So if we look to the 0.9% in Q1, the 2% to 3% in Q2, with the balance being in that 4% plus range, that would drive a slightly lower total annual year-over-year.
Our next question comes from Stephen MacLeod from BMO Capital Markets.
Just looking at the CDCP impact in Q1, and Q1 same practice revenue growth came in slightly below the guidance range, would that all be attributed to the CDCP?
Yes, Stephen, it's totally fully attributed to the CDCP. I'd say the 4% plus without the deferrals of those patients that would otherwise not be eligible and now have become eligible, it has changed their behavior as they await their participation cards as well as their clinics' participation and servicing of their program.
So there's full confidence on our end as it relates to the return back to that pacing and, frankly, an increased potential for our organic growth given the opportunity for that new patient growth. But in the short term, it has changed a little bit of the behavior and created that deferral of volumes from one period into another.
Okay. That's great. Thanks, Nate. And then my second question, just on the margins. You've talked about having the infrastructure you need to drive incremental growth. So just wanted to get some sense of visibility into the margin in Q2 with the guidance that you've given as well as the back half leading to that full year margin of 20 basis points or more. Just want to get a sense of visibility into that.
Yes, absolutely. We're seeing very strong margins at the practice level, continue to be provided. And further, our corporate leverage now, with that fully invested base, we've returned roughly 50% of our expectation on margin expansion in Q1 at that 18.3% margin level. So I feel very strongly about achieving that 18.4% through the balance of the year.
Our next question comes from Scott Fletcher from CIBC.
I wanted to ask a question on the acquisition pipeline. We've got -- we've seen there's changes to the capital gains rate in the '24 budget and rates staying higher for longer. Are you seeing any change in sort of willingness to sell or sellers' behavior in the pipeline?
Thanks for the question, Scott. We have. And the change to the capital gains rate is obviously something, with dentists all being small business owners and being sensitive to it, it has been a catalyst for conversation. It has been a catalyst again for them thinking about the -- crystallizing their value and thinking about their future outcomes. So it has absolutely been, I'd say, a positive driver here.
Ultimately from an overall pacing, we continue to say we can do more than the $20 million plus, and we've displayed the ability to do so. But we'll continue to focus on our balanced approach to growth, really around organic growth, around acquisitive growth, and really focusing on driving free cash flow and deleveraging. So don't expect to really drive acquisitive pacing above that $20 million level.
Taking a step back, from an overall pipeline perspective, it continues to be very strong. Conversations continue to build. And given our strength, dominance, as well as balance sheet strength and ability to transact, we continue to be the partner of choice and the acquirer of choice in the industry.
Great. And then to push that one step further on the multiples, you called out sort of down 10% year-on-year and quarter-over-quarter. Is that anything specific to the quarter? Or do you think that, that can sort of continue at those numbers going forward?
I think we continue to find great opportunities with great partners. I do believe that valuations will be in that 7 to 7.5x range over the medium term across the board. Obviously, valuations on any given quarter might move up and down a little bit. It was only -- it was 5 transactions this quarter. But expectations internally over again the medium to long term is in that 7 to 7.5x range.
Our next question comes from Brian Tanquilut from Jefferies.
Nate, just as I think about your comments on the cadence for sort of same-store revenue growth. As we consider the sequence of the Canadian dental plan rollout, is it contemplated that there's a little more delaying that happens in Q2 and some procedures might be pushed into Q3, into that commentary? Just curious.
I think absolutely. I think some -- the program launched in May 1. Not all of those that are eligible from a patient perspective received their cards. Obviously, there's administrative constraints on the government side in pushing that through. So they deferred their appointments until ultimately they did receive their ability to participate.
Further to that, as it relates to the enrollment on the dentist side, which had its complexities, the enrollment across the country, not unique to dentalcorp, is in that 20% to 25% range. So even if those patients are eligible and do have their cards, if their dentist isn't signed up, then they're deferring until ultimately they do.
The government put a new pathway for servicing patients that will begin July 8, which will reduce some of the administrative complexity around it. So absolutely, there will be some deferral from Q1 into Q2, and more so beyond into the second half. So the way that I would look at it is it's really a tale of 2 halves, whereby through Q1 and Q2, working through some of the kinks in the program on both sides, and Q3 and Q4 having a greater availability and ability to service that patient base.
I appreciate that. And then, Nate as I think about that, at the end of the day, right, this still expands the TAM. So is there anything that you guys need to do in terms of investments to try to capture a greater share of the new lives coming into market?
Yes. No, and that's a great point. I think just given our national scope and scale of our business, I think we'll be able to capture our greater share. We've created channels of education, channels of communication to those patients that will be eligible, to ensure they understand where to go, how to go and how we can service them. And it's something that we as a network are excited about.
Again, as the program more so in its early days rolls out, I think it's creating that slight disruption. But in the long term, this is absolutely something that, in our view, will be additive to our overall growth and ultimately additive to the Canadian population's access to care, which is again something that we're very excited about and happy to see.
Our next question comes from David Kwan from TD Cowen.
I want to talk again about the CDCP. I was wondering for some of these patients that have been deferring their appointments or whatnot, and you talked about, I guess, the uptake of your dentists. For a patient goes to a dentist that hasn't signed up for it yet, have you seen any material data points that say these patients might look to go somewhere else? And in those situations, are you telling your dentists that haven't signed up to do the direct billing option with Sun Life?
Yes. So we haven't seen much of that. I think it's an open and trusting dialogue. And again, the beauty of dentistry and the relationships that dentists have with their patients is it's high trust, it's very sticky. And ultimately, the cohort of patients here that are eligible in that 65-plus range have been seeing their provider for years and years and years.
So there really isn't that desire to change. I think it's an open and honest dialogue on both ends as to what they're working through and to how they can support them. And given our network scale, if there is a current, call it, dentist or practice that hasn't enrolled, but there's a practice that's nearby that has, then there'll be referrals across to ensure that the patients are being able to access care as quickly, as timely as they can.
So really haven't seen any significant attrition at all. It's more so deferral, again, of those appointments from those patients in -- from one period into the next.
And just to confirm, because the government is, I think, the coverage is somewhere between 80% and 90% of kind of what the market rate is. Is the plan still to have patients pay for that difference? And has that been conveyed to the patients that qualify for the plan?
Absolutely. So that balanced billing and really billing towards what the practice would otherwise bill under their customary fees, that is how the program is being administered really across Canada, and it's how the dental associations have also communicated to other constituents across each province as to how to administer it. So that's not a dentalcorp approach. That is a national approach that is being conveyed and coached and educated by the dental associations.
Next question comes from Daryl Young from Stifel.
Question is just around some of the insourcing agendas and, I guess, more cosmetic services. I think Invisalign has called out some green shoots and recovery in demand for some of the cosmetic ortho services. And just curious what you're seeing here in Canada on a grassroots level here on demand for more cosmetic services and yours, ortho insourcing?
I think it's a great question, Daryl. I think across the board, if we look at our in-sourcing initiatives, both ortho as well as, again, the early days on the implant side, we are seeing a significant uptake on those fronts. We've been working with Align to update and continue to improve our in-sourcing initiatives and training programs and support programs for our network. So really excited about launching that next phase through the balance of this year.
We are continuing to see, call it, that stable strength across the network. And reiterating here that really only 300 or so of our practices have participated in our Invisalign acceleration program. And as we continue to roll out that next phase, not only are we going to see, call it, practice on practice organic Invisalign growth as they continue to become more comfortable as the technology continues to improve and it rolls out through their patient base, as we add on additional locations to the program, very excited to see how that plays through.
As well from our implant side, we're going to be continuing with our cohorts of education here. So expecting a good number of practices and practitioners to begin rolling through the program in the second half of the year, which is something that we'll be sure to update you on.
Our next question comes from Allen Lutz from Bank of America.
I want to follow up on the last question on the specialty side, on clear aligners implant. What's embedded in the updated guidance? Did anything change there from the guidance last quarter? And do you need to see any improvement in utilization or change in order to hit the updated guidance around the specialty side?
That's a good question. As it relates to the updated guidance, the change is solely attributable to the CDCP and the patient deferrals of appointments from Q1 to Q2, so ultimately first half into second half. As it relates to the specialty penetration, and the performance of both dental and hygiene in the normal course, there has been no change and no expectation for that through the balance of the year.
Our next question comes from Tania Armstrong-Whitworth from Canaccord Genuity.
Another question on the CDCP. I'm just wondering, since it doesn't cover all procedures, do you anticipate the rollout will kind of shift your service mix as new CDC (sic) [ CDCP ] patients enter your network? And will this have an effect on your ultimate EBITDA margin?
It's a great question, Tania. So to start with the second part of the question, just given the approach to billing and ultimately from the patients, will be covered and charged the same fees as customary in each practice. There will be no effect on margin. It will be margin consistent.
As it relates to really the types of services that are being provided. For the most part, the CDCP is quite comprehensive. There's a few specialty services that would be outside of the scope of the CDCP. But otherwise, it's a very robust program that is, frankly, has more coverage than certain provincial programs that maybe these patients were previously eligible for. So if anything, it would actually increase the types of services that they would otherwise be able to consume and provide them, again, with better access to care from what is for us a margin-neutral to maybe slightly margin-positive patient growth.
Okay. Perfect. And then as my follow-on, focusing on margin again, I'm wondering, I think there was a bit of a change in wording in your management circular about how you guys are paid. So there's more of a focus being put on adjusted free cash flow instead of pro forma adjusted EBITDA acquired. Can we take this to mean that you're becoming much more focused on driving margin expansion and operational efficiencies versus previously just growing the top line with M&A?
I think that's exactly it. I think we're looking at holistically as to the drivers of value. And what we're very excited about and happy to see in Q1 is that increase in our adjusted free cash flow is that expansion of margin and ultimately deleveraging. So as we focus on driving the free cash flow and the growth and the free cash flow per share, ultimately, that too will drive all of the other levers for value creation. That doesn't take away from our continued focus on acquisitive growth being in that $20 million-plus range and really focusing on that balanced growth throughout.
Yes. It's just a more comprehensive assessment of value creation, growth and capital deployment.
We have no further questions. This will conclude today's conference call. Thank you for your participation. You may now disconnect.