Good morning, everyone, and thank you very much for joining us and taking time out of your busy day. This is 25th year since the company was founded, and I'm very pleased to say that we have continued on in our mission to help hospitals and healthcare systems right across the whole of the U.S. improve and sustain their both operational and financial performance. I draw out that it's operational and financial performance, 'cause I hope no one is on the call that doesn't know us is expecting us to be writing clinical software. We don't. We are very much focused on the administrative and the back end of the hospital, and helping them and supporting them in all the decisions that they make to allow the hospital to run very smoothly. Why do we concentrate in there, you may ask?
Well, across our customer base, they spend roughly $500 billion on those operational costs in the back end of the hospital, and we believe that by very small improvements in the efficiency and the effectiveness of how they spend that money, can return many $ millions and even $ billions back into the healthcare ecosystem that can be redirected into better, better patient care. Over the 25 years of running the company, we have amalgamated and accumulated roughly 175 million unique patient lives in data. We are still relatively small company with 750 team members, and an additional 100 or so contractors on top of that. Split roughly, one third of our team members are here in the U.K., with the remaining two-thirds spread across the U.S. and working from our offices in Pittsburgh and in Florida.
We are very much a SaaS business model and have been for since 2005. We are fully in the cloud as of this year, and are profitable and cash generative. Those that have been following the healthcare industry in the U.S. will know that it has been under quite considerable pressure for quite a considerable amount of time. That pressure was definitely added to by the COVID pandemic of the last years, which officially ended only in May of this year. Underlying growth in hospitals is at least positive now, and is seen to be positive after some declines seen through the COVID period.
One of the latest McKinsey reports into healthcare predicts and forecasts that we'll see both across our two main areas, both pharmacy and across providers, which is mainly the hospital market, about 3%, compounded annual growth rate going forward through quite consistently to 2026. However, I think more importantly for us as an organization and something that I think is closer to what we started to witness and see in the last quarter, particularly of the year and following through into this quarter, is that as McKinsey drilled down into those profit pools and started to talk about the growth that they would see within there, that the technology adoption would drive probably about a 10% compound annual growth over that same period.
Particularly within the two areas that we work on, and we impact most with our customers, in both the platform space and the data analysis space, they would grow by both 13% and 19%, respectively, which gives us lots of headroom for us to be able to continue acceleration of growth and get back to the double-digit growth in relatively short order. So what is it we do? Well, this slide may be putting the hairs back on the back of the neck of some people up. They may think that I'm being very much a semantic pedant by calling out the difference between digitalization and digitization.
It's actually, it's a very important distinction, because one of the questions we're quite often asked is, there's a lot of big players in the marketplace that deal with hospital systems, particularly on the clinical side or on the patient interaction side, so the electronic health record, or on the administrative and clinical side, or maybe on the patient accounting systems and the financial systems. However, those systems themselves are very much about digitizing that transaction, and those companies are fantastic at that. And, nothing that I say on this slide is, is to take away from the, both the success they have had or the success that they will have in the future.
But where they specialize in is making each of those individual, whether it be a patient encounter or the recording of an individual patient's details, to get the medical information, to be able to make an insurance claim on that or however it is, is all about transferring the information from a real-world analog situation into a digitized format that can then be stored and accessed at a later date. They do a small element of digitalization in very specialist areas, and usually by influencing the individual care route. For instance, Epic will suggest to the doctor certain things that may be, that may appear within the medical notes. So there is some digitalization, and by digitalization, we define that as using data to change the process that you're doing.
Digitization is recording the transaction, digitalization is changing the process that you're doing. However, we would say that very much this is a greenfield site. Digitalization so far in hospitals has only been done at a very local level, and the reason for that is particularly on the administrative and the operational side, where we concentrate on, and I'm not referring to the clinical side at this stage, very few people have been collecting enough data to be able to do digitalization on a wide scale and across the whole of the operation of the hospital. That's one of the things that I would contend with our datasets, that we have the ability to be able to do.
I'll go into a bit more detail on some of the areas that we can do that in some later slides, but for just now, if you can keep that in mind, that it's both a greenfield site and that on top of that, that the majority of competition is really focused with either digitization or, if they are doing digitalization, they're very niche and very specific in the area, that they are very much a point solution. The other thing to take from this is that bearing in mind the amount of data that we've collected over there, again, we believe we are unique, if,
and certainly very rare, in that we are one of the very few sources of information, and this source on the administrative and operational side, that can actually be used to train AI and machine learning because of the scale and the quantum of the amount of data that we actually have. So what do we do for hospitals? So I've got a couple of case studies here, which I'll walk through very, very quickly, to give you a bit of a flavor for what we do. So this is a hospital group that were very fortunate enough to come and speak to us at our kickoff meeting and spoke to all our team members and enthralled us with all sorts of different anecdotes on how they deliver care.
They're in the Midwest, relatively rural overall, short-term acute care, disproportionate share hospital. So that means it mainly deals with people that are that on the socioeconomic scale, are further down the pecking order and may not have their own individual insurance or may be self-pay or can't afford care. They have about 30 sites spread across, actually across the Dakotas. They are the lifeblood of their communities. I mean, some of the areas where they actually serve, they are the only hospitals within any distance around. They were going through an electronic health record change, so they were moving to the Epic system, which is quite common for our customers.
At the same time as them doing that, they embraced the Trisus platform, and they embraced the Craneware ethos of looking at digitalization at the same time as looking at digitization. Within that, they saw quite significant improvements through their operations. Their health statistics just for their chargemaster improved by more than 60% and 62% on both the hospital side and the professional side. They managed to reduce the number of team members that was dealing with the chargemaster itself down, but allow the software to be actually proliferated throughout the whole of the healthcare system, which meant they were joining together communities within the hospital system to be able to really question what they were doing and improve what they were doing on a system-wide basis.
Within a matter of days of us being with the software being in there, they'd already identified one individual intravenous charge which was being incorrectly captured throughout the healthcare system, and that paid for all of the software pretty much right away. It was about $500,000 for that one mistake that was spotted and had been missed by all of their other systems and by the Epic system from there, because it doesn't look in quite the same way. And they then went on over the course of the first three months to find about $3 million worth of revenue opportunities within there. At the same time, something which is highly scarce just now is labor resource. They were able to just increase their labor efficiency significantly.
95% reduction in the cost on supplies around coding skills in there as well. So being able to make people far more effective. Interestingly, they didn't actually reduce the number of staff overall in the hospital, but what they did was they reassigned them into more direct care roles, where they were impacting patients more effectively, rather than having nursing staff and nursing personnel being involved, doing some of the coding and things as well. So a real success in there of the software paying for itself and supporting a very well-needed community member. Our next case study is going to the other end of the scale. This is a standalone rural hospital.
It's one of probably about 38 hospitals in in Arkansas that all have a baby unit, a labor and delivery unit. Typically, to make the metrics work and the unit economics work in a maternity unit, you usually need to be delivering about 1,000 babies a year to make it actually profitable and justify having that baby unit. With 38 other competitors in the area in the rural community that this hospital serves, they were delivering about 750 babies a year, so it was very much a loss-making service. However, to not deliver those services in the community meant that people were facing anything up to a 60-mile drive in one direction or a 30-mile drive by as the crow...
Well, 30 miles as the crow flies, and about a 50-mile drive in the other direction to get to the next nearest hospital from there. Anyone who has either had a partner or themself has given birth would know that they wouldn't want to be doing that on rural Arkansas roads. What we did with this hospital is we partnered with them for the 340B Program, and this is really to demonstrate that 340B Program, although it is a drugs program, has a real impact on our hospitals and on the communities that they serve. Because of this, they were able to support the baby unit and continue to keep the baby unit open, despite it being loss-making, because of the extra money we were able to deliver for the 340B Program.
Over the course of the last 12 months, we're in excess again, in excess of about $1 billion of hard cash that we've been able to return back to our hospitals, that have then been able to be rediverted into better healthcare and supporting units like this as well. So I'm just about to come to the end of my section on this. Just a reminder, in terms of the robust performance that we had through the course of our fiscal 2023 for us, we've really underlined and given us the opportunity to be able to base and start to grow and accelerate that growth going forward into the future.
We've continued with very strong levels of customer retention, greater than 90% across all measures, and actually saw a modest improvement under some of those measures, taking us into 95% plus in some of those. We've continued to invest in R&D and in innovation. We believe that that is the course and the route to significant scale for us in the future as well. However, we have managed to do that in a profitable manner as well, as Craig will demonstrate as he comes through the financials themselves. We've migrated our customers onto the Trisus platform, and that gives us a foundation to then be able to grow the offerings and support them even further in their endeavors to serve their communities with the best possible healthcare that they can.
Underlying this is really strong financials of $169 million of ARR, and in the year, that represents about 92%-93% of our revenue in the year, was actually repeatable and rolls forward into this year. It gives a great start into this year. And equally, the last quarter, and coming into this quarter, we have seen an improving trading trajectory, and as the McKinsey report suggests, it tends to suggest that we are trending into a market that is growing at a double digit and for us as well, and edging up the double digits. So very positive from there. And with that, I'll hand over to Craig. Thank you, Craig.
Thank you, Keith, and good morning to everybody. Keith has outlined the macroeconomics, the macro environment that all industries have, have faced through the pandemic. The U.S. only formally declaring the public health emergency over in May this year. I think it's equally fair to say that the macro environment post-pandemic has had its own challenges, too, albeit in a somewhat different way. But healthcare, I think, like all industries, is evolving. Hospitals are reshaping how they go about their business, and that's exactly where we fit in, and hopefully, you'll see the early signs of this in the results we're presenting here today. So let's jump straight into the key financial performance metrics indicators. Fiscal 2023 for us has been a busy year. We have completed the...
or we've certainly had the migration of our customers, and completed the migration of our customers to the Trisus platform. We've continued to progress the enlarged Craneware group and completed the second year since our acquisition of Sentry. We've successfully navigated the macroeconomic challenges on our own business. So I'm hoping in what, in the slides, the financial slides I'm about to present, there's no surprises here. The results themselves are very much in line or ahead of the trading statement we issued, back in July. So here goes. Revenue is up 5% to $174 million. I'll run through a breakdown of this revenue in just a couple of slides' time. At the half year, we talked about the impact of professional services, and those revenues not returning as quickly as we expected.
So factoring that in, that revenue growth is absolutely in line with our expectations, especially as we were continuing to focus on our existing customers and their Trisus migration. We remain committed to delivering an above 30% EBITDA margin, and we've carefully managed our cost base to deliver this. This has resulted in EBITDA increasing 6% in the period to $54.9 million, a top of the range, 31.5% EBITDA margin. A further impact of the macro environment has been the interest rate increase. And again, at the interim stage, we identified the impact this was having primarily on our adjusted earnings per share. At the time, our adjusted earnings per share had come back 6%.
However, the full year, we've seen this limited, and that's limited now to 2%, resulting in an EPS, an adjusted EPS of $0.87 per share. Our annual recurring revenue. Again, back at the interim stage, we tightened our definition of the annual recurring revenue to make that as prudent as we possibly can, which I think has proved to be a very sensible thing to do. So, the way we define annual recurring revenue is the annual value of licenses and related recurring revenues, that includes transactional revenues as of the balance sheet date, that are both subject to underlying contracts and where revenue is being recognized at that date.
This has allowed us to confirm that the growth in our ARR, it's grown from 166.4 back at the interim stage to the full year number of $169 million. It has also allowed us to calculate a net revenue retention, I apologize, and that is 100% for the period. Again, achieving this in a year of cloud migration and a challenging macro environment for our customers. Moving to cash. We retain healthy cash reserves. The combined cash reserves the group are currently sitting at balance sheet date, we're sitting at $78.5 million. Our operating cash conversion.
Here, we do adjust for the amounts we are due to distribute to our customers as part of the 340B reimbursement program we operate, and I'll provide a bit more detail on that in a slide or two's time. So factoring in those reimbursements, we've achieved a 92% EBITDA operating cash conversion over the 12-month period, so up significantly from the 80% we reported last year. And finally, for this slide, our bank debt. We continue to pay down our term loan at $2 million per quarter. However, in the current interest rate environment, it makes little sense to hold too much cash on our balance sheet. So as a result, we've reduced our RCF by $20 million.
That will reduce our interest rate cost going forward, while still retaining the facility available if we require it for any sort of M&A type transaction. So as a result of all that, our bank debt has reduced to $84 million in the period. We still have significant headroom to all our covenants, very good banking relationships with all our banking partners, and the Board is very comfortable with the level of debt we have, but we will be looking to reduce that again further in the future. If I can have the next slide, please. We've reviewed the headline growth rates, covered most of them on the previous slide, so I won't repeat them.
However, while we are still a small company, it is worth noting the graphs on the right-hand side and the considerable change in the scale of the Craneware Group that came about with the acquisition, that acquisition now being fully integrated, and we've transitioned all our customers to the cloud. If I can move to the next slide, please, Keith. Again, in regards to cash, I've covered certainly the headline details. I did mention a 340B reimbursement program. Here, this had very small beginnings last year. It was just over $1 million we had on our balance sheet, but that program has grown significantly in the current period. Under that program, we help distribute cash as part of the 340B, returning it back to our customers for the savings they're making of the 340B program.
With this cash, we bring it onto our balance sheet. We have the right of setoff, so any amounts customers owe us, we're able to collect from these cash amounts. So that very much further reduces any bad debt risk we'd have there. And then we distribute the balance to them in the normal course. As I mentioned, last year, these amounts were immaterial, so they were excluded and shown separately on the face of the balance sheet. This year, the program, with the success that's come, the balances are far bigger, and as a result, it's no longer possible under GAAP to show these separately. It is company cash, so we include that in our cash and cash equivalents number, but we clearly show the amounts due out to customers on the face of the balance sheet.
So that's there available to the analysts who are listening in, to factor into any working capital movements, et cetera. It is also worth noting that we had a share buyback program in place towards the end of the year, and again, I will provide further details in a later slide. We do continue to pay our dividends, we continue with our progressive dividend policy, and we are increasing our final dividend to 16 pence per share to give a total dividend of 28.5 pence. Thanks, Keith. If we move to the next slide. To our business model. Business model, very much consistent with prior periods. We operate a SaaS business model, supported by long-term underlying contracts, and with that, the high level of renewals that we deliver.
So that business model delivers to us prudent revenue recognition focused on long-term growth rather than short-term gain, high levels of cash generation, often upfront at the start of any annual license period, and high levels of future revenue recognition that is shown outside. It is not shown on the balance sheet, it is outside of our balance sheet, available to us to recognize as we deliver that systems, deliver that service to the customers. We do have transactional revenues. These result from our 340B hospital customers, and that's due to their interaction with the retail pharmacies. Though those transactional revenues go alongside the licenses, the hospital customers we have contract with us under a long-term basis. It's to do with how they interact and move the data between the hospital and the pharmacy themselves.
While there is some variability in these amounts month-on-month, they are very much long term and recurring in their nature. So we do include these in our annual recurring revenue. In the table on the right-hand side, we break down these revenues by our type. Here you can clearly see that our professional service revenue did not grow in the period as we talked to at the half year, either in totality or as a percentage of our revenues. But far more importantly, this confirms the statement Keith made, that over 90% of our revenues are recurring in their nature. Again, building that foundation for future growth. Finally, on this slide, if I just go back one, that would be so please. The new addition to this slide is other revenue.
Here, we are looking at new and innovative ways to leverage the Trisus platform and the extensive data it holds. This can be using our own data assets to directly support our customers, or we can be hosting third-party applications, giving them a quicker and easier route to market, but still handling the data transaction through the platform itself. In these initial stages, we'll recognize revenue as we're able to invoice and collect it. However, longer term, we'd expect our successful revenue streams to generate future AR, so we'll see that move up into the recurring revenue section of our revenue. Move forward, if that's possible. Conscious of time, so I will move quickly through these primary statements. Already talked to revenue and EBITDA growth.
Margins, exactly where you'd expect them to be, at the 85%, rounds up here to 32% EBITDA. So again, confirming our successful navigation, the macro factors, including our own labor costs. R&D continues to be the lifeblood of a software company, so that will generate the future revenue growth. We can do even more to support our customers, especially now they are looking forward post the pandemic. So we, we still believe it's short-sighted to do any reduction on R&D spend. And I think, Keith will talk to the Trisus Labor and Productivity product that we launched this year, and that clearly demonstrates how we can quickly adapt and how we can quickly help our customers. R&D spend the period, there was a small reduction, largely down to exchange rates and just timing.
So $50.6 million in the year versus $51.5 million. So very much still in and around the 30% of our revenues. Where we are developing products that have future economic benefit, we will capitalize the cost. So about 30% of our cost any one year is capitalized. In the period, that equates to $15 million, up from $13.5 million this time last year. And finally, our effective tax rate. With Sentry, again, we have a greater proportion of our profits being derived in the U.S., combined with the increasing U.K. tax rate, delivers an effective tax rate of 29%, largely in line with the 28% we had in the prior period. If I could move to the next slide. Just at EPS, not a huge amount to add here.
We've talked about it coming back 2%, as against the 6% we saw at the half year. We clearly lay out the adjustments we make in the adjusted stat on the right-hand side of this slide. So the adjustments for acquired intangibles and also at any exceptional items. We have the number of shares in issue, no significant change in the number of shares in issue, but as a result of the share buyback program, we are holding approximately 214,000 shares in treasury as at the year-end. To the next slide. Balance sheet, and still a very strong software company balance sheet. I've already talked through the movements in our cash reserves and the reduction in our outstanding bank debt. For the eagle-eyed among you, there is the word restatement on the top of the comparators.
That can often be a worrying word in a set of financial statements, but here it's a complete non-event. Had the timing of our Sentry U.S. tax returns fallen within the 12-month fair value window, you wouldn't even have seen these come through. They'd have simply been netted off. What we have under our restatement is, one, is a purely disclosure, moving $4.8 million of deferred income that was previously described as, due in, due to be recognized in less than one year, moving that to over one year. The rest purely relates to tax movements. They, they identified they're largely down to deferred tax provision. All those net down, and there's no impact whatsoever on the profit/loss account.
Finally, for me, to the cash flow statement, again, confirmation, the significant improvement in our operating cash generation as we expected to occur, so that did improve to 92% in the period from 80%. The amounts relating to our 340B reimbursement scheme, again, are completely separate, but they are included in the cash flow now that they are material. You will see that coming in in the current year in the reconciliation at the bottom. Reduction in the tax paid, that reflects. We were careful last year to make sure we did sufficient payments on account to make sure we could work our way through the various U.S. filings that followed the acquisition. Having made those payments on accounts last year, there was less tax due this year. Bank debt, again, you can see just how much interest paid has increased.
That increased from $3.1 million of cash paid last year to $6.5 million. Hence, our plan to reduce our overall debt levels quicker than we originally planned. Then finally, share buyback program, we had that in place towards the year-end. We've made up to GBP 5 million available. In the period, we had spent $3.8 million of that, and as a result, had the 214,000 shares in treasury. Then finally, for me, we have a progressive dividend pay policy. However, overall dividend paid in the year went down as a result, in dollars, as a result of Forex movement. So higher levels in sterling, but lower levels recorded through the cash flow statement itself. And with that, I will hand back to Keith.
Thank you, Craig.
So if we look at our growth pillars and our growth strategy going forward, it really breaks down into two areas. One is all about product and creating product, creating the platform, and then adding to the quality of the platform, and our ease and access of our customers onto that platform. And then the other pillar is then taking the output from the platform to drive what we call value-driven customer expansion.
So that's using the data from the platform to not only create new products, so to give us insights that we can base new products around, for instance, our Trisus Labor and Productivity product, but also to drive third-party vendors coming to the platform to be able to provide insight for our sales team and for our hospitals on where they would get the benefit from other applications sitting on top of that platform, as well. So a very important part of our two-pronged approach. We talk about the Trisus Power of One, and this is where we believe we're able to deliver something that the hospital CIOs have typically been looking for and have not been able to be satisfied with.
So what we tend to find in any healthcare, in any software environment, but particularly within healthcare, because the very nature of healthcare itself is very fragmented, both operational and clinical, but within both of those areas, it's very fragmented. Hospitals then tend to buy point solutions that meet a very specific need. Then it gets to the point where hospitals have a huge number of vendors that they're trying to meet. Typically, those vendors in each of those point solutions all require data to be fed into them. They're all different experiences. It's very hard to swap data between them. There's very little interoperability, and they only provide limited insights within that individual department. And so then the CIO, the chief information officer, will say, "Well, hold on.
It'd be more efficient if we sought a vendor that just does all of this in one place." And so, as we've seen through the last 25 years, the pendulum keeps swinging backwards and forwards between best of breed and between single vendor, single source vendor, so trying to reduce those vendors. The problem historically with going to single source vendor is that you're then compromising on some of that specialist knowledge and some of that specialist information, and those very specific insights that take experts in that area to be able to deliver. And so you lose some of that, and then you then have dissatisfied customers within the hospital. So the CIO's customers are dissatisfied, and they say, "Well, we want to go back to best of breed," and the pendulum swings backwards and forwards.
What we believe we can deliver, and we're proving to deliver with the Trisus Power of One, is the best of both worlds in there. Single vendor, so single layer of security, taking away a lot of the cybersecurity risk that they have by one vendor that can provide a high trust environment for them, that being Craneware. A single platform, so only one data lift coming from that. And then on top of that, a combined and unified experience for the customer, so reducing their cost of education for being able to pick that up, increasing the amount of interoperability between the data and the data exchange that's coming across, and then lastly, being able to give them enterprise-wide insights into their operations.
So this is something that's been very successful over the course of the last several years as we've described it, and over the last year, as we've been able to start to really execute on the ground and really deliver this for our hospital customers. As such, we've then driven our hospital solutions and pushed our hospital solutions into solutions that match directly to hospitals' needs, and we've broken them into six what we call optimization suites. I've put them onto both slides, 'cause actually the information below each of the products is actually as important as the name of the individual suites. Unfortunately, due to time, I don't have the opportunity to go through them all.
However, our core business in the past would've been, probably been seen as a mix of, Trisus Data Integrity Suite and the work that's done in there, and probably in our Charge Capture Suite as well. Since then, we've expanded out into our, Pricing Integrity Suite and our Business of Pharmacy Suite. Now, in some of these, you'll notice the same icons coming up on a regular basis. And the reason for that is the same foundational software tools still power each of these suites. So they all give us a hook into the hospital, and the ability to then be able to solve multiple problems in different areas of the hospital, for them with these software products.
And the last of our six optimization suites, as it stands just now, is then our Revenue Protection Suite, our Charge Capture Suite, and our Value-Based Margin and Productivity Suite. In these areas, you start to see some of our newer products coming through, particularly in the Value-Based Margin and Productivity Suite. That drives us very clearly into our Trisus Labor and Productivity application, which was launched earlier this year. And as we talk about that, what that's doing is something very different to what hospitals have had historically. Hospitals, for a long time, have had a number of different options in being able to control payroll and look at timesheets of all of their clinical staff.
However, one of the things that they've not been able to do is then maximize and model out what that payroll contribution is going to look like, compared to both the revenue opportunities coming in and the patients coming in, so that they can assign those correctly, not just from a utilization perspective, but also from a cost and a margin perspective.
So what we're able to do with labor and productivity is combine that with our foundational Trisus data services team, and bring the margins in from there with the ADT feeds that are coming in and all the payroll feeds that are coming in from the likes of, like, Kronos or various other ADP systems or elsewhere, and then combine the two of them together to be able to model out where these resources should come. The reason this has become so important is because labor has been historically the largest cost item for hospitals.
However, in recent times, with cost of living and wage inflation, has become disproportionately growing through that period as well, and been a real challenge for hospitals to understand the right staffing mix ratios and labor expenses as they move forward, and we're able to give them real insight in that for the first time. So this product was launched in June of last year, and as you'll see from the next slide, we've actually already had some wins in here as well. We titled this one the Craneware Group Win Fiscal 2023, and it's a bit of a messy slide, but it's actually to try and show the strength and depth of both our offerings and our customer base, the kind of customers that we're dealing with.
On here, I'll come to the colors in a second, but on this slide, you'll see a number of hospitals, from small individual rural hospitals like the one I described in one of the case studies earlier on, all the way up to large academic health systems and community health systems that cover the whole of a state, for instance, or our large metropolitan systems that have many hundreds of thousands of users and potentially millions of users flowing through their doors. So we really cover all sizes of hospitals. We also, you'll see on here, many product names. So we've had a really good year of selling lots of different products as we've gone through here.
Then lastly, the colors in here show the kind of mix that we've seen from a kind of sales that we've had. We've had, you know, a high proportion of competitive takeouts in that piece. And again, this is really the testament and the power of, the Power of One that we've talked about, where we're able to demonstrate that although someone may have a competing point solution to one of the many solutions that you see on this sheet here, that they can't offer the strength and breadth of the offering and the solution that we're providing in there. We're able to displace that point solution and bring them onto our platform. We're also seeing expansion sales of what was the historic Craneware business and expansion sales, the 340B expansion sales of the historic Sentry business.
And then equally pleasing, we've seen expansions of, customers that were joint customers as well, where they've added on new products as well. So right across the board, I think we've had a really healthy mix, in there. And I like to think that kind of a mongrel mix, where it's no one kind of sale and no one individual product, points to real strength, and solidity for the future for us to grow on and continue to build on. That then resulted in, a significant amount of expansion sales. Our expansion sales in the period were about 81% of our new sales. Our new sales were 19% of our... Of our new hospital sales were 90% of our total new sales, coming through there.
As Craig and I think myself have alluded to earlier, you know, a really high retention rate across all metrics. More than 90% as a retention rate, and actually in some of those metrics in the upper half of the 90s as well. So a very pleasing solid foundation for us growing on and driving forward. This takes us to our last two slides before we hand to Q&A. You know, our priorities for fiscal 2024 is to continue to execute on this considerable expansion opportunity for our customers, where we're providing software solutions which will solve their real-world problems and return money back to them that they can redirect into better care for their patients.
Maintain that high level of customer support and that award-winning, class-leading customer support that we have. Progress our Data Foundations program, which is a way where we can again slim down and reduce our footprint for the hospital and make it easier for us to onboard new customers in the future, and also expand out the offerings of that we have to customers as they go forward from there as well. And then lastly to expand our third-party channels. We really see this as being a way of providing best of breed to our customers without the risk of having lots of individual vendors on there. That what we can do, is we can actually mitigate that risk with our high-trust platform and add them on for both our benefit, but for the hospital's benefit and for those vendors' benefit.
That then gives us to. It takes us to our outlook, which we're very confident in. It's underwritten by our $169 million of ARR, and that strong retention rate and strong net revenue retention. We're seeing an improving market backdrop, and we are expecting that the growth in that will get to double-digit very shortly in the underlying market, and therefore, we can follow and we can accelerate our growth. We've continued to be very disciplined in our capital allocation, and our commitment is to continue to do that to return shareholder value as we go forward. Our move to the cloud has been successful.
It has been painful at times, as any company who has gone through this will or should be able to tell you or will tell you. But we are there, and it's opening up a lot of opportunities for us. Those opportunities, though, really are just the start of our journey. We're very pleased that those building blocks are in place to be able to allow us to power on from and go forward from. With that, I'll hand it to Q&A.
Thank you. We will now begin the question and answer session. We have a question submitted via the Spark Live platform. The question is from Roger Phillips of Investec. Can you talk about the nature of the Trisus partner revenues from third parties? What types of third parties these are, and what this revenue relates to? Maybe giving some examples, please. What are gross margins on this, and how might this revenue scale? Could it be $10s of millions over several years out?
So thank you, Roger. I think there was about nine parts to that question. So first of all, yeah, we brought the first partners onto the platform, and as you've noted, within the statement itself, and as Craig drew out, it's about $1.1 million so far. Yes, that's certainly... And our expectation is that over in future years, that could grow to certainly several million and tens of millions, as is the opportunity for us within there as an additional revenue stream on top of what we have.
Just now, we would see it as definitely supporting and underwriting all of the numbers that are out there in the market and that have been put out by all of the analysts through the course of today. So thank you very much for that. It's a mix of different revenue. Currently, we're classing it more on the transactional side, so that's why it's and separately identifying. I think our idea is we'll separately identify it going forward into the future. There's none of this in ARR at this stage. However, if we bring on a partner that then has a more predictable revenue stream coming forward from that, we would certainly do that.
Some of it is, one of the examples we've talked about so far is what's called a drugs rebate program. So in the same way as anyone who's maybe worked at home over the COVID period and had to buy a printer, HP have a mail-in voucher for you getting so much off of your first set of ink cartridges if you sign up for their program. Basically, what this third party does is it looks for the equivalent of the mail-in voucher for certain drugs purchases for hospitals, based on all the drugs purchases that flow through our platform. They then do the back-end administrative work to get that rebate.
That takes between three and six months to come through, and so the small amount of revenue that we've seen or part of this, the revenue that we've seen, a small amount of that is actually the first of that revenue coming through and starting to flow through. We do our revenue share with the hospital and with that partner on that, and so on a hospital-by-hospital drug-by-drug case, we get flow through coming through and that's there. If that becomes more predictable and we get more insight into that, we may be able to call some of that ARR, but just now, that's not, that's not an ARR. Could that be considerable as it goes forward? Yes, it certainly could be, but it's early days with all of our partners.
So it's really about, on that platform, it's about leveraging our data assets, but leveraging it in a way where we're not actually selling that data out to a third party without the hospital agreeing that it's going via that third party on a, on an individual case-by-case basis. So it's a really, really powerful and different model that hospitals aren't used to right at the moment. Just now, what tends to happen is insurance companies have that data and utilize it for their benefit, and the provider, the hospital provider, gets no benefit out of it. So again, we're trying to differentiate ourselves from the rest of the market by doing that, and hopefully that answers your question.
Thank you. The next question is from Lawrence of Blackfinch: Progress has been made on reducing the debt. Could further progress be made, given the growing cash position? Is this high priority?
... Craig, do you want to answer that one?
Yeah. No, certainly with the cash generation we see as a business, and the business model we have, we are in a position where we can continue to reduce the levels of debt. That makes far more sense in the current high interest rate environment than it did maybe at the time we took the debt out when we did the Sentry acquisition. Not specifically guide into how much or how far down we'll pay the debt. The net debt, as it sits at the moment, is quite low. But we will certainly continue to look at our options and utilize our cash in the best possible way. Hopefully that answered your question.
Thank you. The next question is: How much white space is there to grow within your existing customer base?
A huge amount. Almost too much to calculate and quantify accurately. If we think about that half a trillion dollars, just a very small... Where we try to get to is, with any software solution we're putting in, to get between a three and a five-to-one return on investment for our hospital clients, because then that pays for the whole life cycle of our software being in place, if we do that. So on half a trillion dollars, we only need a very, very modest efficiency increase to give us many billions of dollars opportunity out there, white space out there. In total, McKinsey have $81 billion for automation and for platform and data on the operational administrative side by 2026.
I almost said 2006, that shows my age. By 2026, in there. So there is huge opportunity for us going forward. And certainly just now, it is not a limiting factor by any means in terms of our growth. It's all about us being able to address that and get out there and do what we need to do, rather than that being a piece from there. Thank you. Next question, please.
Thank you. The next question is from Alistair Young of Panmure Gordon. Thanks for the presentation. Post-integration, could you possibly give us a sense of Sentry's revenue contribution? Did it grow at a similar rate to the rest of the group?
Yeah, I mean, the group all grew about the same rate across there, roughly. So, about 50/50, slightly, just slightly more than 50% would have been the Sentry contribution. Just, it was slightly larger than us when we acquired them. Thanks, Alistair.
Next, we have two questions from Damindu Jayaweera at Peel Hunt. Question number one: The grouping of products into suites make it easier for a non-expert like me to understand the value proposition under various strategic scenarios. Does that help the sales process, given you have so many products now, and good sales is about clear value propositions? Secondly, on the Trisus Labor Productivity Solutions, how do the hospitals address the issues you point out today? Do they use any software, or are you-
Creating, something new in there?
-category.
So, Damindu, thank you very much. And sorry, Simon, I didn't say thank you to you earlier, but thank you as well. Damindu, yes, one of the reasons for going down the suite route is it allows the salespeople to become experts in the solution that they're solving without having to get into the real weeds with each of the individual software applications themselves. And then we have software experts and application experts that come along behind them, and then can answer the individual technical questions around the software application. So it should allow us to be able to scale our sales efforts increasingly faster, going forward into the future as well. So it's a good thing from there, and it as it goes forward.
Second question was about Trisus Labor and Productivity. We believe we're doing something different and novel and new here. We believe we're one of a very small number of companies that can provide true activity-based costing, which we've talked about before, for hospitals. And we believe we are the only company that is combining both activity-based costing and labor and productivity together, to be able to look at the margins from that. So we do think that this is a new and novel approach to this. It supplements rather than replaces the likes of Kronos and ADP, that do all the payroll, timesheets, and all that kind of stuff. And even, some of you may have long enough memories to remember someone like a Manpower Software, that I think are now called Allocate, and went private.
They tried to get into the U.S. marketplace a number of years back. Even their credentialing kind of piece, it all supplements everything they're doing and adds a margin dynamic and a margin dimension that's never been able to be done before. And then combining that with all the data that we've got for that digitalization, it allows us to then create staffing models as well. Now, there are people creating staffing simulations as well. It's just, this is again, adding a dimension from the margin and from the operational and financial piece, which has been something that people just have not looked at before. It's typically always been on the just on the nursing side and maybe on the doctor and the clinical side. Hopefully that answers your question. Next question, please.
Thank you. The next question is the third question from Damindu Jayaweera. Any color on how sales conversations have changed now, post public health emergency, versus what the conversation were a year ago?
... Ah, yeah, yeah. So thanks, Damindu. They, they, they're definitely far more strategic. Again, I think they were very much just firefighting. "How are we gonna get through this month, this quarter?" was what hospitals were asking us before. During COVID and during the peak of it, it was obviously just how is anyone- how are we gonna survive this? They've become far more strategic now, and also a realization that it is a new world. I think Craig touched on this a little bit, that they are evolving as well, and the way that they're evolving is they are expecting and seeing more pressure from the insurance companies, so from the payers, to move down this value-based world.
Now, what they're terrified of is losing their shirt, if they move down that way, and so they are actually historically and up to date, have been, unfairly, disadvantaged compared to the insurance companies, because the insurance companies just have so much more data, and what we're trying to do is just redress that balance. Now, that, that- those conversations are being very welcomed, by our, by our hospital C-suite, and that's where we're... That, that, that's where they're tending to get- to go now. Hopefully, that answers your question there.
There are no further questions, and I will now hand back over to Craneware Group for closing remarks.
Well, listen, everybody, many thanks for your patience and investing the time this morning to listen to our fiscal 2023 results. We've. It's been a really challenging but rewarding year for the team. We believe our customers have come out of the other side of what was a real industry-defining pandemic and public health emergency in May, and are looking towards the future. I mean, there's a lot of trepidation still from looking forward to the future, but there's also a lot of optimism, and in the main and in that time in between as well, I think technology has favored them and has shown advances that we can make and where we can do.
In the meantime, my, I've been very fortunate in that the team right across the company has been working hard to enact and bring together our vision of really transforming healthcare by making the operational and administrative side more efficient, and therefore being able to redirect costs into clinical care. And that's fantastic to see. We've been very privileged to work with some phenomenal hospitals and hospitals' healthcare systems that are doing a power of good in the community, and long may that, long may that continue. We believe we're in a unique and very good position to be able to see an acceleration and growth going forward. We are starting at modest levels just now, but we believe that that opportunity still exists ahead of us.
As it stands just now, it is pretty much greenfield site with no one else apparently competing and coming into that area. So we do think we've got a good first-mover advantage. And with that, I'd just like to say thank you for all the support from the people that are on this call, and really appreciate you taking the time out to listen to us today. Thank you very much.