Good morning and welcome to the audio conference of Oncoclínicas. At this moment, all the participants are connected only as listeners, and later on, we'll begin the question-and-answer session when the instructions for you to participate will be given. You should remember that this audio conference is being recorded. I'd like to now pass the word over to Dr. Bruno Ferrari, founder and CEO of Oncoclínicas. Dr. Bruno, please go ahead.
Thank you. Good morning, everyone, and welcome to one more teleconference of results for Oncoclínicas. If I had to define the year of 2024 for the company, I would say that it was a year of transition and necessary adjustments to have a company that's more healthy and solid for the coming years.
We started the year at the beginning of a very difficult scenario for the health sector, but we ended with a reduction, organic reduction of our net debt and leverage under control, and larger, higher diversification of our revenue. In first place, we completed an important increase of capital of BRL 1.5 billion in the middle of last year, already foreseeing a macro scenario of more difficult capital costs for the country. The increase of capital, we said, was priced at a premium significantly above the price of our shares in the stock exchange. This brought us a more tranquil capital structure as we see on slide three, reducing our net debt from the first to the second quarter of last year. At the same time, we were able to finalize payments for relevant capital expenditures, which will sustain our next cycle of growth during the coming next few years.
In parallel, we saw the increase of capital giving us greater liquidity, helping us to do our initiatives for commercial redirection. It involved temporarily reducing our exposure to more intensive working capital to buy with longer periods of receivables so that we could migrate from a dynamic of cash burn to generation of cash. Several quarters later, we believe that this strategy has started to become more clear to everyone. Once we've delivered an organic reduction of net debt of approximately BRL 112 million in the fourth quarter of 2024 in relation to the third quarter, as we also saw on slide three, we're able to see the reaction transformation another way through the slide four.
We see that Oncoclínicas presented a higher rate of consumption of cash during the first half of last year, not just as the commercial scenario was very difficult in terms of receivables, but also to the cycle of CapEx, which was already under contract, which pressured our cash flow. Starting the third quarter of 2024, the tendency inverted drastically. Consequences of all of this, as we see on slide five, was a relevant reduction in the leverage in the second half of last year and a tendency for stability going forward. The trajectory of the leverage not only has been going down, as well as our EBITDA was penalized by the deceleration selective in our growth of our revenue and by the additional expenses related to the restructuring and realizing that we did in the second half of the year, looking for a higher level of operational efficiency.
Nonetheless, there's a series of initiatives underway, both commercially as well as operationally, which need to be addressed, maintaining other priorities of sustainability in cash generation. 2024 was also a year of accounting adjustments, which were necessary due to the environment, which is more challenging, through which we were going through. We're always looking for best practices of governance and higher accounting practices and transparency for the market. Cristiano, our CFO, will cover this topic in more detail going forward, but it's something that also I would like to mention. In the context of the current year, which we do for the test of recoverability of its balance of goodwill and intangibles, we identified the need to make an impairment, non-cash and non-recurring expense.
It's a photograph of the moment of our cycle, which the administration of the country judged that it would be correct to correct and revise this in light of its future operations and projects, in line with transparency and the conservative look that we have always used in our relationship with the market. Finally, we saw that there was an improvement, a gradual improvement in the sector and our provision for doubtful receivables, a tendency which we see as encouraging on slide six. Before passing it over to Cristiano, who will cover the rest of the presentation, I would like to once again thank all of our patients, clinicians, workers, and partners and investors who have supported us in our daily job of conquering cancer, defeating cancer. Thank you.
Thank you, Bruno. Good morning, everyone. Starting with slide seven, we'll comment about our growth of volume and average ticket.
The volume of procedures in the fourth quarter grew 6.2% year-on-year, a deceleration in relation to previous periods, principally due to our strategy of reduction of exposure to payers that are more capital intensive. The strategy adopted by the company principally starting in the third quarter of last year had as its objective the prioritization of the generation of cash for the company, aligned with the long-term desires for sustainability and financial discipline. As a consequence of this strategy, the average ticket was reduced sequentially, but has maintained its tendency for growth year-on-year, in line with medical inflation in our segment of oncology in this period. On slide eight, the gross revenue of the company reached BRL 1.7 billion in the fourth quarter, a growth of 9.2% in relation to the same period of the previous year.
During the annual period, during the period of the year, the growth was 13.5%, below our CAGR of 32.5% of recent years. It is important to remember that in previous years, it counted with an inorganic growth coming from acquisitions and new commercial partnerships, as well as organic growth, more accelerated and deliberately reduced in the recent last two quarters. Similarly, on slide nine, we see the growth of net revenue in the same levels as gross revenue, ones that our doubtful receivables was in line with that which was observed in 2023, 2.6%, as we see in slide 10, returning in direction of the levels that were closer to our historical levels.
On slide 11, gross margins reached 32.4%, below those levels observed in previous years, principally due to the commercial policy, which is more restrictive adopted by the company, and also the mix of medications which have been incorporated. Looking at 2024 for the entire year, the gross margin was 33.3%. On slide 12, we see the operating expenses still impacted by the restructuring of the company, which we implemented starting in the third quarter of 2024, which helped together with our lower revenue than that which was resulted in a lower operational leverage and an increase of this indicator as a percentage of our top-line growth. As a measure, we have substituted this volume with new clients. This relation should return to a descending trajectory. On slide 13, the adjusted EBITDA was BRL 272 million, with a margin of 17.4%, principally due to the factors mentioned previously.
In other words, less revenue and one-time expenses, which were higher. On the period for 2024, as a full year, the margin was 18.5%. Net revenue, ex-PLP and ex-impairment, was BRL 42.6 million, an improvement in profitability when compared to the previous quarter. In the annual period, the net revenue on these bases was BRL 106.3 million. It's important to mention that the company realized annually a test of recoverability impairment test, referring to the goodwill paid in its recent acquisitions. The management revised its expectation for some of its operations due to results below those expected initially and initially projected as far as the retrospective acquisitions, due to a sectoral ambition and macroeconomic which was more difficult, which impacted our projections for growth and profitability.
In the period of 12 years, ending 31 December 2024, the test indicated that the recoverable value of these operations was below their accounting value. Therefore, we recognize the loss, non-recurring loss, non-cash by impairment in the amount of BRL 796.1 million. This is, again, an adjustment which is non-cash and non-recurring adjustment, which reinforces our commitment to conservative and transparency in our accounting, the company's accounting. Slide 15, the company reached a cycle of working capital net of 40 days in the fourth quarter, the best cycle of the year, showing the results of diverse initiatives, internal initiatives, as well as the prioritization of the commercial relation of the more demanding payers who were more demanding of working capital. On slide 16, we demonstrated an operating cash flow of BRL 291.6 million, the best of the year.
This operational cash flow was enough for the payment of interest, annual and yearly and semi-yearly interest payments. It's worth remembering that the second and fourth quarters are the highest in terms of payments of interest since our debts have semi-annual and annual coupons. In relation to CapEx, which in the quarter was BRL 32.8 million for the period, the lowest level for the year, reflecting, as we already mentioned, the financial discipline in the company's investments. On slide 17, due to the generation of cash of the company, we had a reduction, organic reduction of our net debt and of a little bit more than BRL 110 million sequentially. This is the priority of the company, and we continue firmly in this direction of the financial sustainability of the business. Finally, on slide 18, we have a chronogram for the payment of the financial debts and of our acquisitions.
We see that we have a position which is comfortable, a cash position enough for the covering of the payments during the coming years. With that, we close here the expositive part of our presentation, and we open the session of questions and answers.
Thank you. Ladies and gentlemen, we now begin the question and answer session. Make a question, please raise your hand through the button "Raise Hand," which is available on your screen. First question comes from Vinícius Figueiredo from Itaú BBA. Vinícius, please go ahead.
Thank you for taking my question. I have two questions here. The first is in relation to the expectation for margins. I have EBITDA margin for 2025. We have several parts that are moving, several moving parts, as you mentioned.
Up front, we have the revenue, a growth in revenue, which is more focused on the payers who have higher quality in terms of cash conversion. This also winds up having an impact on the gross margin. At the same time, you mentioned that the process of optimization of G&A. What does that show? How do these two things talk to each other, and what is your expectation for EBITDA margin for the company in 2025? Another question I wanted to mention, and a little more of a long-term question, is we have here in São Paulo a partner where Porto has been growing quite a bit in the base of beneficiaries and a very relevant part in your network of also Hapvida. If you could comment a little bit on the Hapvida, if that would be good.
Also, another point would be, what do we think, what can we think about for growth in São Paulo if we need to open an additional investment in relation to set up more clinics, changing perhaps the cancer center plan? An update in this area would be very good.
Thank you. Hi, Vinícius. This is Bruno Ferrari. Let me start, and then Cris can help, can complement, can add. I'm going to start at the end. Porto already has 700,000 lives, and we've seen here this week in their post a plaque for the help in the oncology project. Recognizing this growth, Hapvida is a project that we have been negotiating with them for several months, almost six months, for us to find a way, a formula in which we could become a cost-effective supplier, not only in São Paulo but also nationally.
Since we are doing this now and planning the hydrotherapy, we want to be rational for them from the standpoint of oncology. We also have been discussing, and I, as I mentioned to him in my presentation about the CapEx in the first half of the year, the first half of last year, and part of this CapEx with our units here in São Paulo in the peripheral areas of São Paulo, outlying areas, to attend what we already had for repressed demand and two new units which are under construction: Angélica, 12,000 sq m, and Augusta, 15,000 more sq m. These are being concluded in May. In other words, we do not need anything. It is all ready to start receiving all of these new patients. Everything that needed to be done is done.
This converses a little bit with the first question, which I'm going to speak a little bit. We had a huge airplane which was slightly empty, and this affected our margins. Now we have a large airplane, and we're going to be able to fly with a full cargo, which will help us to improve our margins and bringing a higher number of clients from Porto going to new markets. As Cris usually says, we're doing a paradigm change, going into verticalized payers to be their preferred supplier of oncology services for them. We wind up having an addressable market which we never considered. Only Hapvida has millions of clients in the private market which are not even considered as possible to be attended by us. This will wind up improving our gains of scale together with the pharmaceutical industries, our operational efficiency.
At the end of the day, a plane which is a larger plane flying with more passengers and more clients, we think that this will be reflected in the medium term in better margins. I wanted Cris to add, and perhaps he has some more technical numbers.
Hi, Vinny. Adding to Bruno's points, when we look at this combination of revenue, a top-line growth which has been softer rather than what we have seen in practice, what we saw was a reduction. What we have done is to make a reduction of about BRL 30 million per month, BRL 30-35 million per month in the reduction of our exposure to a series of healthcare plans and operators, this new commercial policy of prioritizing cash flow and preserving our working capital.
The net impact was not that bad because we have been substituting this volume with new volumes coming from new clients. It is clear the deceleration that we had in the growth of revenue if you look at the second half of last year compared to the same period of the previous year versus the first half of the year in the first half of 2023, for instance. We will take a little while to—it is nothing that we can do from one day to the next to replace this volume, but initiatives like these, such as Hapvida, will come to address these questions. We hope to have an interesting ramp-up of this new commercial agreement, just to give you an idea. Comparison from the size of this operation, it is in line with what Bruno said.
Hapvida has 600,000 beneficiaries just here in the Greater São Paulo region, which is where our scope will initially be concentrated. Remembering that radiotherapy is national. It is an agreement nationwide since the beginning. We are starting already with a volume of beneficiaries almost the same as the size of Porto today, just for this initial phase. The expectation is that we will return to a reacceleration of our top-line growth over 2025. We do not have any number or guidance for that, but just because of this dynamic, we should have a reacceleration of this top-line growth. At the same time, due to that, we should return to gain operational leverage, even though we have reduced through a right-sizing program and restructuring in the second half of last year, more than 400 head counts which were reduced in the company over the whole company.
This impacted, in fact, our G&A and our severance costs and restructuring expenses in the last two quarters of last year. This also has been—it's already been—it's already in the past. We should not have a repeat of this starting in 2025 going forward, where we retake the growth of the top line in a more robust way. We hope, which is what we're hoping for, and we hope that management is—our ambition is that we will recover our margins during 2025.
Very well. Thank you. Thank you, Bruno. Thank you, Cris.
Our next question comes from Caio Moscardini from Santander. Caio, please go ahead.
Hi. Thank you for taking my question. Two quick questions. Can you comment a little bit about what do you expect in way of exposure to your principal client? We saw a falloff of 16% in 2023, 15% of your revenue in 2024.
What can we expect in relation to this for 2025 and the earnout of CRIO of BRL 289 million in the fourth quarter? I imagine that this will affect your impairment. If you could say, what is your expectation to have to really pay for these earnouts?
Hi, Caio. I'm going to start with the first question of your question and the exposure, concentration of exposure to our biggest clients. We have a strategy being executed since the IPO and going forward, and we've said this repeatedly, consistently, which is the idea to increase the diversification of our base of revenue and the pulverization of this portfolio of clients. If we were to look at a longer history in the IPO, at the time of the IPO in August of 2021, Unimed-Rio, at the time, which was our biggest payer, was 19% of our revenue.
This number today is closer to 10%. It is in the low double digits, much closer to 10%. We have this as a goal. We have had this as a goal that during 2025, at some moment, our biggest payer would not represent any more than 10% of our revenue. Now, with these initiatives, additional initiatives that we have accelerated in 2024 for the diversification of revenue, this movement should continue, remembering that we already were a player with relevantly diversified state revenue. We had more than 20 health plans due to our capillarity, 44 cities, our exposure to different operators and plans. However, we have the ambition of more than that. We want to have, in fact, a pulverization even greater of our portfolio of clients. This should continue to happen in relation to the reduction of the amount of earnouts within our sellers and our debts to pay.
This is related to the exercise of the impairments because as we have revised downward, the expectation of financial projections of various of these assets, this converses with the expectation of being able to pay or not certain earnout payments. This dynamic, remembering that the impairment is a photograph of 2024, it takes into consideration these projections revised downward. It takes into consideration a discount rate and cost of capital, which reflects a moment in which we live today in the macro universe. It is difficult to say effectively if these amounts will be paid out going forward or not because this is the dynamic which could change. This could oscillate. However, if we had to give a photograph today, what is our perspective that the management has today? The reduction of these amounts, these earnout amounts, reflects our expectation of the company at the current point in time.
Thank you.
Our next question is from Gustavo Miele from Goldman Sachs. Gustavo, please. Please go ahead.
Hi, Bruno, Cris, Isaac. Thank you for your presentation. I have two questions. First, I would like to hear a little bit about the pre-increase this year. We see the medical inflation running a little lower than historical levels. I wanted to hear from you how this has reflected in the level of stocking, which normally happens in the first quarter as a seasonal effect. That is my first question. My second question, you mentioned the example of what happened in the second semester, a reallocation of part of your receivables as part that migrates again into the non-cash fruit of some renegotiations which you are doing with specific clients.
I wanted to understand, looking at these perspectives for 2025, if you are addressing new agreements in this sense and how we should think about this non-cash part during the coming year. Thank you.
Hi Mieli, this is Cris. As far as the pre-increase, it's not something that we think makes sense as this makes sense this year. It was last year. We took a great deal into consideration what is the CMED will be announced, the medical inflation announced during the period, but it's already something 0.8 versus the cost of capital of making this pre-stocking, this pre-acquisition. So this cost-benefit at this moment in our evaluation does not justify remembering that the priority of the company has always been to preserve cash and to be very disciplined in the allocation of cash and working capital.
We saw this. We haven't seen this happening this year in this cycle, a pre-stocking of material as a possible benefit of this pre-increase stocking. In relation to this reallocation of receivables for the long term, this still reflects some of the renegotiations of receivables for the structure of receivables in the longer term so that this can integrate with the cash flow of the payers that are under consideration. We were not able to have the visibility, and we do not expect at this time that there would be any more movements in that sense.
We think that what had to be done of renegotiation in relation to eventual late payments, which were converted into long-term receivables, we concluded these negotiations by the end of 2024, and we do not have any notifications from what we can see here in the scenario of receivables that there would be more migration of receivables in this line to the long term.
Very well. That is clear. Thank you, Cris.
Our next question comes from Leandro Bastos from Citi. Leandro, please go ahead.
Good morning, everybody. Thank you. I have two questions here. First is about if you could speak a little bit about the average ticket, which has been a little bit weaker in this quarter. Is that from the effect of mix? And also a comment, where do you see an acceleration of top-line growth for this year?
How should we think about the difference in relation between volume and ticket? Also, the question of leverage, if you could give us a little direction of what you're working with, if you have any orientation from last year, which wind up not happening as was foreseen. If you could let us know how you're looking at it now with this focus during this part of the year. If we could see how this will affect your leverage during the year.
Good morning. This is Isaac talking about the ticket. It's clear that our focus from several months up until now has been the prioritization and cash generation. It's clear that in the last two semesters, the stronger direction of our growth for clients with lower working capital cycles.
It is natural that we have some impacts as we have had in this quarter of the reduction of margins and also the average ticket. Some of our clients who had a working capital cycle more higher had average tickets which were higher as well. In any event, what is important for us at the moment is that the average ticket for the year has come in above inflation. We have been able to repass inflation to our final clients. The focus of the company in terms of cash conversion is showing results and is showing a little bit more strength, and it should continue in this way for the rest of the year going forward.
Aligning with your second question, as far as leverage, of course, we did not publish any guidance for the year, but the tendency that we see with this focus on cash generation and this higher focus on conversion of revenue into cash is a tendency that we're able to reduce our net debt during the year and with that increase our leverage over the next few quarters.
That's very good, Isaac. So you think your average ticket and the composition of the mix, which does not pass through inflation or repassing inflation, you have not found difficulty in passing through these prices?
That's exactly right. We've been able to accompany inflation with no problems.
Our next question comes from Yan from BTG Pactual.
Good morning, Bruno, Cris, Isaac. Two questions from our side. One is the recurring expense of restructuring expenses.
We understand that this is at a higher level of these expenses, is provisional, temporary, but we wanted to understand how long do you think that this effect will affect the P&L of the company and when will this focus on restructuring should continue. My second question is recovering a little bit the theme of possible investments, even with a cross part of the hospital for diagnostics. If this agenda is more or less present today in the strategic vision of the company. Thank you.
This is Bruno. This is in August of last year. We started the process of right-sizing in the company, and this started in the holding and began with the elimination of several management groups, six directors, and approximately 400 people in the holding. This has cascaded downward. That is the first aspect.
This was during the second half of the year, and we believe that this period has now ended. The machine is now lighter. The structure is lighter, more cost-effective. And we did not change people. This is changing people for a system. We are now more efficient than we were. At the same time, we have been speaking about the process of back-office processes being substituted. Oncoclínicas for Accenture in the first phase is concluded, and the second phase is underway and should finish during the year. I think that the most difficult part has passed, and the reflexes of this on the P&L will end now in the first quarter. Now it is ball forward, and we are going to be able to see these numbers better, more clearly, and more consistently starting in the second half of the year, starting with the second quarter this year.
In relation to about the deinvestment, it's not even a matter of deinvestment. It's a question of realigning what would be the correct word of our investments. It's bringing to some of our investments partnerships which are more aligned with the practices and activities, non-oncological activities. We're not here trying to sell anything. We're not trying to deinvest in any asset, but to bring restructuring and more body to the assets we have. The correct word, I think, is that sell is easy. Selling assets is easy, and there are buyers, but it's not what we're trying to do. It's not what we're going to do because what we want to do is a realignment of these investments, bringing to us strategic changes for some of them, and it will wind up becoming more robust.
We will care integrally with the oncological line and for who has a greater expertise in other areas and helping that these structures be more cost-effective for the group.
Very clear. Thank you, Bruno.
We now close the session of questions and answers. I would like to pass this now over to Bruno Ferrari for his final consideration. Dr. Bruno, please go ahead.
I want to once again thank all of you for your participation in our teleconference of results. Have a good day, and thank you very much.
The audio conference of Oncoclínicas is now closed. We thank you for your participation. Please have a good day.