Good afternoon, everyone, and thank you for waiting. Welcome to the video conference of results of the third quarter of 2021 of Dasa. Those of you who need simultaneous translation, we have this tool available on the platform. For that, you just click on the interpretation button through the globe icon at the bottom of the screen, and choose your preferred language, English or Portuguese. For those hearing the video conference in English, there is the option of changing the original audio, clicking Mute Original Audio. We inform that this video conference is being recorded and will be made available on the IR site of the company, where will be available also the complete material of our earnings announcements. During this meeting, all participants will have their microphones turned off. After that, we will start the question-and-answer session.
To make a question, please click on the Q&A icon at the bottom of the page and write your name and company to get into the line to ask a question. Once you are announced, we will ask you to activate your microphone to make your question, and then you should turn on your microphone to make your questions. So we ask that the questions be made all at once. We repeat that the information contained in this presentation, any declarations which may be made during the video conference relative to future perspectives of the business, operational and financial results of Dasa, constitute beliefs and premises of the administration of the company, as well as information that are based on currently available information. All future considerations are not guarantees of performance. They involve risks and uncertainties and premises.
They refer to future events, and though depend on circumstances which may or may not happen. Investors should understand that economic conditions, market conditions, and other operational factors can affect the future of Dasa and can bring two different results than those mentioned in future. I will now pass the word to Ênio, Director of IR of Dasa.
Thank you. Good afternoon, everyone. We will start our presentation today with the consideration of Pedro Bueno, President of Dasa, followed by Felipe Guimarães, Financial Director. After that, the directors will be available at the end of the presentations for a question and answer session. We also have with us today the two heads of our units of business, which are Carlos de Barros, General Director of Outpatient Clinic, Diagnostics and Health Management, and Emerson Gasparetto, General Director of Oncology.
We also have Sérgio Ricardo Sass , General Director of Strategy and Legal and ESG, Andrea Dolabela, General Director of Products and Marketing and Experience, and Ana Elisa Siqueira, Director of Care. Now I will pass it along to the team, to Pedro.
Thank you. Thank you all. Thank you for your participation in our results call in the third quarter of 2021. I am going to pass to slide three, please. We reiterate our mission and our vision. Dasa has been innovating and consolidating the model of ecosystems in Brazil, having as its principal objective to be the health that people need and the people want, and the world needs. We reach this objective potentializing the coordination of care, our brands, and our scale, and our platform, our technology platform.
Dasa has been demonstrating its capacity of execution in the results of this quarter and proves that the strategy adopted by the company has brought good results, even in spite of the challenges in the operational, especially with the lowering of the number of hospitalizations connected with COVID. We will do a brief presentation looking at the highlights of each business unit, as well as updating our strategy of navigation and digital platform. In sequence, Felipe will talk about M&A integration, and we will complete with the comments about the financial highlights of the quarter. Now I am going to look at slide five. The unit of outpatient care diagnosis and coordination has presented a good performance with gains in market share.
We have raised our gross revenue by 20% in relation to the same period last year, in spite of the COVID revenue, which lowered its participation in overall revenue going from 12.2% in the second quarter to 8.9% in the third quarter. Even so, the gross revenue in this quarter grew by almost 4% compared to the second quarter of 2021. The solidity of the Dasa brands has proven to be very relevant in the current scenario, as patients have been directed to the units which they most trust. Our NPS in the diagnostic sector has grown from 75.2% in the third quarter of 2020 to 77.1% in the third quarter of 2021, reflecting the higher level of satisfaction of our users.
During the third quarter, we also realized investments in technology which benefited our users, resulting in significant increases of 74% in the online scheduling of tests, reaching the brand of 2.4 million schedulings in this channel in the first nine months of the year. This number represents 24% of all of the examinations which needed to be previously scheduled. Beyond that, we deserved at the moment of the revenue coming from laboratory exams at home, with greater convenience for the users. The laboratory in Genera went up by 56% in the first nine months of 2021, with a corresponding growth of the revenue of that segment, as can be seen in the graph in the lower right-hand corner of the slide. In this business unit, we see various initiatives which contributed to the growth in the third quarter.
The segment of Dasa business units showed growth of 47% in their revenue during the third quarter of 2021 in compared with the third quarter of 2020. Genera, our division of direct-to-consumer of genetics with the market of tests for ancestors tests, DNA tests, changed their earnings year-on-year. Looking at slide six. The unit of hospitals and oncology in the third quarter of 2021 offered medical services, hospital and oncological services in 12 hospitals in the state of São Paulo, Rio, and Brasília, with a total of 2,700 beds. At the end of September, we finished the acquisition of the Leforte group. The gross revenue grew by more than 40% in relation to the same period of last year. Our occupancy rate and levels of average ticket have shown themselves to be resilient even in the transition into a post-COVID scenario.
Even though there has been a small reduction in revenue from COVID, we had an increase of 5% in total revenue in comparison to the second quarter of 2021. We have been improving the efficiency and quality of this business unit. As an example, you can point out the level of occupancy of turnover, which has had a great improvement in the first nine months in all of the hospitals of the Dasa group. This growth was extremely notable because the advances in medical practices, meaning that patients are able to get back home more quickly and gives us great operational efficiency, amplifying the capacity of hospitalization per bed. As we raise the number of occupancies per bed, we also reduce the need for additional CapEx to grow the business. Now looking at slide seven.
During the quarter, we advanced in a very significant way in our strategy of ecosystem and navigation, which effectively opens a new layer of growth for Dasa. Currently, we have 25 initiatives which have as an objective navigating with patients within our system based on their specific needs. During the first nine months of 2021, we registered 43,000 lives with portfolios that are coordinated from companies, telemedicine, and others. Even though this number of lives may seem very low compared to the total number of users, our strategy is to concentrate initially our efforts on the most serious patients and consequently the most high-cost patients which have the highest clinical benefits from our care. In this way, beyond the initiatives are still in their initial phase, we already have seen a contribution of several percentage points to our growth overall above the regular growth of our business.
It's important to reinforce that to consider a user as having navigated, it's important that he enters another service of our ecosystem and consequently has a proactive, intentional, and traceable action by Dasa. This number, we do not consider patients who use more than one service of the company spontaneously. These results mark the transformation of reactive health and inefficient to proactive and intelligent healthcare, which is the core of our thesis. Now looking at slide eight. The third quarter brought important evolution in quality and functions for our digital platform, Nav. Our priority during the quarter was to accelerate the development of the platform with the objective of preparing it for expressive growth in the near future. It's important to mention that during 2021, we registered a rapid growth both in the interface with the patients as well as in the interface with doctors.
The number of patient users increased by more than 10 times in the nine-month period compared to the same nine months last year. The use of by new users grew by five times in this quarter in 2021 compared to the third quarter of 2020. Higher involvement by the patient reflects in the growth of the online scheduling for laboratory exams, scheduling of telemedicine, and check-ins for examinations. As we mentioned previously, the online scheduling increases by 74% in the nine months compared to the previous year. The number of teleconsultations in the nine-month period, it grew expressively, arriving at 128,000, three times more than the previous year. In relation to doctors, we registered a total of 9,000 users in the first nine months of 2021.
Our internal analysis shows that the revenue coming from doctors on the Nav platform, coming from what we call involved doctors, is growing in a most relevant way, which brings an increment in the lifetime value of our patients. In the fourth quarter, up until now, we have experienced a strong growth in the volume of users and patients and doctors with the potential for acceleration due to an increase in our actions of directing patients so that they can pick up their results directly through the platform. Now we are going on to slide nine. We want to talk about our M&A strategy and the updates of the operations recently performed. Going to slide nine. In relation to our mergers and acquisitions during the quarter, we observed the addition of important infrastructure and resources necessary to increase our ecosystem.
In the first nine months, we concluded the acquisition of three new hospitals. The biggest was Leforte Group, whose acquisition was completed in the third quarter of 2021, in the month of September. It is worth reinforcing that Leforte contributed in one month to the results of the third quarter, showing its impact on EBITDA and operational indicators. Now looking at slide 10. Looking at the future, we see that we are expecting to close four acquisitions, which were announced and are awaiting the final paperwork to close. Presuming the regulatory approvals, we will add more than 800 new beds, and with that, we will raise our total number of beds to more than 3,500, almost doubling the size of our capacity in beds in a period of one year.
Now I am going to pass it along to Felipe, who will give us an update on the integration of our recent hospital acquisitions, and will briefly discuss the financial results of the third quarter. After that, I will be back for my final observations. Thank you, Felipe.
Thank you, Pedro. Good afternoon to everyone. We can now look at slide 11. We have seen important advances in our integrations with our hospitals, which were incorporated during the year. We have the success of the Dasa playbook in three areas. The first, on the strengthening of the teams, the renegotiation of contracts, looking for a lowering of prices, reductions in G&A, and also standardization of medical protocols. The second stage is more focused on the increase of the operational complexity, improving the portfolio of services, and the implementation of systems, our IT playbook.
The third stair looks at brownfield opportunities to increase the number of beds, where historically, these investments are significantly slower than in the rest of the M&A market. So the recently acquired assets generally go into the asset, the Dasa Group, with the implementation of our playbook, and integration permits them to improve their performance in short, medium, and long-term performance, increasing margins for our business. It is important to mention that the M&A of the last nine months represents 11% of growth from the 53 that we saw in this year. We see just a small contribution from the Leforte Group because it was only consolidated in the month of September. Looking at slide 12, we have a summary of our results. We concluded the third quarter with a strong expansion of our gross revenue and EBITDA.
As you can see, the sales grew by 28% compared to the same period last year, accumulating in this way growth above 50% in the year. A similar performance can be observed in terms of profitability, where we reached BRL 544 million in adjusted EBITDA, at 2.6% more in margin compared to the third quarter of 2020. In the year, we are growing more than 11% compared to 2020, reaching an EBITDA above BRL 1.6 billion. On slide 13, we have a summary of our cash and our debt. We have debt with net debt of an adjusted EBITDA of 1.5 x, showing a solid financial position. When we include the effects of the adjustments and stock options, where we have the effects of the adjustments to the quarter of this year, this indicator goes to 2.9 x.
Another point to mention is that with the closing of the third quarter, we have had a new emission of debentures in the value of BRL 2 billion in the domestic market, with three series with terms of five, seven, and 10 years, reinforcing the cash position of the company, which now is at BRL 2.2 billion in the end of September, and lengthening our duration of debt by 50%, the average life of our debt. Now I am going to go to the question-and-answer session, and afterwards, be back for a few final observations. Thank you.
Remembering that to make questions, you should click on the Q&A icon on the bottom of your screen and write your name and company to get into the question line. When we announce you to turn on your microphone will appear on your screen. Please use your microphone to make questions.
We ask you to please make all of your questions all at once, and then we will go on to our first question. It is from Fred Mendes, sell side analyst at the Bank of America. Fred, please open your audio so you can make your question. Fred, go ahead.
Good afternoon, everyone. Thank you for the presentation. I have two questions here. The first is an update on the part of synergies from the incorporation of the Leforte Group. I do not know if this is already included in what we saw for the third Q, if it is 100% included, at least the principal values. The second question is to understand better the shift of beds from COVID beds, which are now going to a more sustainable type of use in the occupation.
Just want to confirm, first of all, if these COVID beds had a lower margin due to the different types of care, and now that you have a more sustainable level with beds with a higher margin, if this can expect a margin expansion with these beds now more profitable beds. Thank you for the answers.
Very good, Fred. Thank you for the question. Yes. In fact, we have had an integration in the first and second semesters, and we are seeing the positive effects of this integration already, especially in the first stage of the playbook of integration related to the gains of price lists and purchasing and the standardization of processes and G&A. So in G&A, we already see reductions of about 15%-20% on the price list of our purchases also, which weigh on two smaller assets compared to what we have acquired.
The biggest was Leforte, which we incorporated in the third quarter, but with an impact, it is very limited because we incorporated it during the month of September, and our expectation is that we will be able to contribute to our results with the leveraging of our revenue starting in the third quarter. In relation to the beds, I am going to pass it over to Emerson to answer your question.
Thank you for the question, Fred. You are correct. There has been in the third quarter, we saw a fall in the number of COVID patients, which are patients who have a margin a little bit lower than our usual margins. The challenge is that we have been occupying well the hospital. You will see that we have been able to occupy the hospital relatively well with a reduction of only 3% in the production overall.
We are able to occupy the hospital, and with that, we have had this exit of site of COVID with the patients that are non-COVID patients, and we now see in the fourth quarter the stabilization in the number of beds with COVID in our operation.
Perfect. Very clear. Thank you very much.
If you have any other questions, please feel free. The next question comes from Samuel Alves, sell side analyst from BTG Pactual. Samuel, please open your microphone so you can make your question, please. Thank you.
Thank you all very much. Thank you, Pedro and other directors. Two quick questions from my side. First of all, in this subject of the margin of the new hospitals, we see a sequential fall in margins. You even mentioned it in your release that Leforte wound up helping in this dilution of margin.
Just to understand, in the fourth quarter, what do you see that these integrations will start to show their fruits more quickly, and you will be able to improve your margins, or do you think that this dilution will also affect other hospitals for a while? That is my first question. The second question is a little bit more financial. You mentioned already the lines of credit that you have just acquired, and to understand if the funding of all of the recent acquisitions that are already signed is already balanced, and what will be the average cost of debt of the company after all of these recent acquisitions?
Thank you, Samuel. Felipe here. In relation to the first question, the hospital, as you commented well, Leforte has diluted our margins.
Without doubt, we have the expectation Leforte will, in the next quarter, generate better results, and we see that it will be diluting in relation to our current operations. However, there is a ramp up for the growth of these margins, which is already underway starting in the fourth quarter. That should help our growth. Together with that is the growth of the occupation, both in our hospital as well as in the turnover of these beds. As this continues to grow, this helps with the dilution of costs and the recovery of our margins. In relation to financing, we did the emission of BRL 2 billion with an average cost of CDI + 1.5%. This is incorporated to our current base of debt, which was described in the last slide of our presentation.
Okay. Thank you, Felipe.
The next question comes from Mauricio Cepeda, sell side analyst from Credit Suisse. Mauricio, please turn on your audio so that you can make your question. Please go ahead, Mauricio.
Thank you, Pedro and other directors. This is Cepeda from the Credit Suisse. It is interesting to see you. We can see you, but you cannot see us. I have a few questions, a little bit more about strategy going forward. We see that Fleury has returned to make changes, make moves in terms of acquisitions, come back a little bit to its core business. My question is, how are you in relation to this plan of expanding in the diagnostics area? Are you seeking the same types of targets? What do you think in this question? Obviously, you have a very strong position.
Also in the part of diagnostics, if you feel any pressure for targets from the operators, if the operators are not so favorable, and have you felt the pressure of costs for material, the price, the inflation and the dollar going up so much? Looking at the hospital, I also saw in previous moments that you were able to do very well in the third quarter, even in relation to. I see that you have a lot of potential in your hospitals, and I wanted to ask you, at what point of maturity do you think you are going forward? What are you able to still get in terms of revenue from these assets that you have without any inorganic movements? Without wanting to exaggerate and insisting a little bit more, if beyond the reinforcement of the cash position, if you are going to use that cash to make any other inorganic moves, any strategic moves.
Okay. I am going to pass the first part over to Carlos, and then I will look at the question of the hospitals.
Thank you, Cepeda. It is good to talk with you. First, talk a little bit about the M&As and also the performance. Let me see if I can get my camera. Also the performance of the question of price and margins as well. Starting with the M&As, we look at the targets within the BU2, especially we look at diagnostics, but also we look at other assets which will complement our strategy of an integrated network or with that vision of treating the patient in an integrated way.
We are being very conscientious and selective in relation to these targets and conscious with relation to valuations. We know what has happened in Brazil. We understand the power of generation of value when we purchase certain assets in M&As, some diagnostic assets, both in synergies. We are selective when we look at valuations and we look at brands, understanding that our brands are very relevant and very strong here in Brazil. So we are looking at these opportunistically. In relation to questions and readjustments of the operators of the health plans, we think about the reality. We have always had negotiations, very important negotiations over the years. These negotiations continue, and we continue passing through close to inflation. Specifically, what we have done, we continue to do that.
Again, we understand the value of our brands and the importance that they have for the beneficiaries of the operators of the health plans, and we are very strong in these conversations in relation to price. These are some of the points that have been helping us in relation to your third question, in relation to margins and our operation here in the BRL 2. This point of re-passing price together with the operational leverage and a reduction of the dependency of COVID tests. When you look at this last quarter, we reduced even more the number of the COVID in the BRL 2, making it possible to work on our gross margins of operations and close to what we have seen with the market when we made our IPO. This has all been helping our margins to recover in the BRL 2. It is a very positive scenario.
What we see here is a very positive scenario. Now passing it over to Emerson for the other part of your question regarding the hospitals.
Cepeda, in relation to our hospitals and the growth of revenue of the hospitals and the current assets, we have a route going forward, a very clear path. The potential for brownfields in the hospitals which we have acquired. We have more than 1,000 beds of potential beds. Of these 1,000, we have by the end of the year, the approval of these investments and execution of 18 - 24 months for the expansion of these assets was already in-house. Beyond that, we see the predictability in the turnover of beds.
It is an expansion without CapEx because you start to make the patient strictly the time necessary in the hospital bed, and you occupy that bed with a more complex, and you have a positive impact in relation to fixed costs and the increase of the average ticket due to the higher level of complexity. So the turnover of the beds, the better occupation of the hospital, which is still ramping up post-COVID, and in the brownfield expansion, as well as our models of operational efficiency, which are being put into practice with the Modelo DASA, the DASA hospital model, and along route of organic growth. Without a doubt, M&A will always be something important in our strategy as well as he mentioned. This is true for the hospitals, and we have several assets which are currently evaluating here within our pipeline, our M&A pipeline.
Cepeda, as far as your last question, acquisitions, we also continue with a strategy which is very reactive of organic growth and inorganic growth. We have a pipeline of M&As which is weekly. We have several targets that we are looking at, and we understand that to make this a little more clear to the market, that our leverage is very low when we normalize the non-recurring effects. We still have to consider that the EBITDA of all of these acquisitions, which we are doing, will start to come in going forward.
So when we normalize the pro forma EBITDA of the M&As, we are at a leverage which is very low. So we think there is space to continue doing a lot, even with debt. Just with debt. This is an important aspect of our strategy that we will be able to go forward another two years easily, just with raising debt.
We remind you that to make a question, you should click on the Q&A icon in the lower part of the screen. Write your name and the company to enter into the line. Please wait while we collect the questions that are coming in. Thank you. We have the next question from Fred Mendes from Bank of America. Fred, please turn on your microphone. Go ahead.
Thank you again. Sorry to take advantage to take one more question. Would you speak a little bit more about the coordinated care? It seems that is evolving very well. I know that sometimes it may not be possible due to the operators, but they are partners, but there are some of the health plans.
If you are able to attract new health plans, new payers, if you have any feedback with your partners, how do you look at your visibility in this case going forward, especially together with the attraction of new health operators and new payers going forward?
Fred, thank you for the question. This is a theme that we are very happy to talk about, so I thank you for the question. We are very, very animated. As we have been saying to the market, this is a business which has 10 years of experience. 10 years ago, nobody talked about coordination, and now we already do this, and this is an important part of our ecosystem and of our thesis. Since last year, we started to enter into performance contracts where we have no downside risk, and we only win, and we are only remunerated if we perform well.
We have a very large contract, which started in the middle of last year with an operator in Rio. We are not opening it Rio, claim by claim, about 35,000 lives, and we are able to reduce in that list, in the emergency room care, 25%-30% reduction of tests. Felipe is helping me. 18% in hospitalizations. It is already generating a positive impact in our P&L, and important with a contribution margin very high in this performance contract. We have closed other contracts, which will start to perform at the beginning or middle of next year. So we are very, very animated with this business, and it connects very greatly with our proposal of making this good medicine, helping to maintain the people healthier. Clinically, they are better cared for, using less services, and more satisfied in generating positive margin for Dasa.
It is also worth mentioning that in these portfolios, once we are coordinating these lives, they are also more involved with us so that when they need a hospital or they need a diagnosis, we navigate with these patients within our services, and we charge the normal prices for our credentials for our signed-up patients. So as well as the upside for the performance contracts, we also increase our market share for laboratory and diagnostics and consumption in the hospital within these portfolios. So we are continuing to expect a high growth in that business in the high double digits year- after- year.
Thank you, Pedro. That is very clear. If I could just finalize this topic. When you close a contract, of course, the gain of that contract takes a little while to be able to come in to see the improvement.
When you close the contract until it starts to operate, what is on average the time of ramp-up between the closing and the operation?
Once we close the contract, we start the capture of life. The capture of life takes three or four months, about three months. Once we have these lives captured and we start to, in fact, exercise all of our care and assistance, this portfolio starts to perform, and we see a lower level of claims. After six months, it arrives at a maturity, or after about 12 months.
Very well. Thank you. Very clear. Thank you very much.
The next question is from Mauricio Cepeda from Credit Suisse. Mauricio, please.
Hi. Sorry to come back with another question. They cut my audio a little earlier, and I wanted to thank you for the opportunity for your questions.
The silence was a little strange at that time. Just want to remind you that to make any questions, you should click on the Q&A icon at the bottom of your screen and write your name, the name of your company to get into the line for questions. To take your place in line. The question and answer session is now closed, and we would like to pass the word for final considerations of the company.
Everybody, thank you very much for connecting. Want to tell you all that the synthesis of this quarter, our business has been improving, gaining efficiency, gaining share, even in a scenario which extremely challenging with COVID, almost to zero at the end of this quarter. Advancing our thesis, navigating our users, our most critical users, and this has been contributing importantly for our organic growth.
Our platform is, as you will see in the next quarter, we're scaling it up quickly, and we believe we're going to have good results to show you. Also observing that the users and doctors who are involved in our platform have an important uplift of lifetime value. Therefore, it's been a year that is very positive for us. I want to reinforce that our commitment with the long term, to continue investing in spite of the challenging scenario in the financial markets, as a company with low leverage, which still has lots of potential for consolidating and advancing all these investments that we have been making over recent years, which are starting to pay off now and over the next year especially. Thank you all very much. Until the next results call of earnings call and have a good weekend.
The video conference of results referring to the third quarter of 2021 of Dasa is now closed. The Department of Relations with Investors is at your service to answer any other questions or doubts you might have. Thank you all very much, and have a good afternoon.