Nightingale Health Oyj (HEL:HEALTH)
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Earnings Call: H2 2024

Sep 20, 2024

Teemu Suna
CEO, Nightingale Health

Good afternoon and welcome to the webcast for the financial year of Nightingale Health. So today we will go through the financial year. We look at the key achievements, we go through the numbers, we see the business targets for the next financial year, and then we have the financial calendar and Q&A in the end. My name is Teemu Suna. I'm CEO and founder of Nightingale Health. So let's start from the first agenda point. I will tell briefly what Nightingale is all about. So Nightingale Health exists to build sustainable healthcare and reduce health inequalities. So why do we need a more sustainable healthcare system? Because the current healthcare system is not equal.

The healthcare system, if we look at the problem very briefly, the healthcare system is overburdened with too many sick people, and it's overburdened with diseases that could have been prevented. Now, we talk a lot about healthcare problems, we talk a lot about healthcare costs, and actually, it's the chronic diseases that is the core of the problem. So, let's look this a bit more in detail. So, the core idea with our healthcare system, our primary care system, is to promote health and prevent diseases. And actually, the healthcare system that we have today is doing it all the time. But the problem is really that the tools that we are using do not scale well. And because of this, the prevention doesn't work the way it should work. And interestingly, the kind of the goal to prevent diseases, it's in many medical guidelines.

It's something that everybody agrees about, but the problem really is that we don't have the tools to actually do it. And when we look at this in numbers, 90% of healthcare cost comes from chronic diseases. And the silver lining is that four out of five could have been prevented. So I think it's quite clear that change is needed. So what can we do? The answer actually is very simple. The primary care system needs better tools for prevention, because with better tools, we can actually reach towards the benefits of prevention. And as I showed in the previous slide, we are now talking about the biggest problem in healthcare. We fundamentally know what is the reason of the problem. We have too many sick people.

We know what are the diseases that are causing the problems, and we know that we can prevent the diseases. The only thing that we are really lacking are the tools to do the prevention better. And this is exactly what Nightingale is all about. This is what we mean when we say that we are building a more sustainable healthcare system. Because when we put prevention to action, that's the roadmap to have less sick people. And when we have less sick people, we are actually initiating a chain reaction that is yielding better health outcomes. It's building a better healthcare system.

If you look at this in a bit more detail, as I said, the current primary care system. Prevention is done all the time, but the tools require a lot of resources, and they don't scale very well. Now, if you look at the public discussion around healthcare, I think it's in the very core are the challenges with the resources. We don't have enough resources. We don't have enough healthcare professionals to take care of all the sick people. Consequently, it doesn't scale very well, because if you have to use a lot of healthcare professionals' time, it doesn't scale very well. Now, if we bring the better tools for prevention, we can do prevention more efficiently. We can offer preventive solutions to a broader group of people, even for entire populations.

And then when we detect the risks, when people are still healthy, we can help to reduce the risks, and with that, keep the healthy people healthy. So then this, what we can achieve with this reduction, the reduction in the number of sick people, then we have the cost savings. So ultimately, in healthcare, we can reorganize the way how we are taking care of the sick, and we should do that, of course. We can implement different information technology solutions, different AI solutions. We can do various things to optimize the current system that is taking care of the sick. But if you really want to change how the costs are accumulating, I think the only logical, only feasible solution is to have less sick people, and that we can achieve with prevention.

And then, of course, we need to build this in a sustainable and equal way. So it's not what Nightingale is all about. This is not the technology for the wealthiest one percent. This is a technology for everyone. This is technology that you can take to a population. We call it the Nightingale Health Check, and the Nightingale Health Check is a efficient and effective tool for large-scale prevention. And I will share with you, like, how does it work? Because what I just said, they are kind of big words. We are talking about one of the biggest problems in the world. Because, I mean, eventually, if we have more and more sick people all the time, I mean, who will...

If people are sick, who will go to work? How do we run the society? So it's not only a healthcare problem that I'm talking about here. It's a broader societal problem that we have to solve. It's not optional. It's something that we really have to solve, and we need to take actions quickly. And this is where Nightingale Health Check can make a significant contribution. So to give a bit of a context, let's have a couple of comparisons here. I think it's quite important to understand what the Nightingale Health Check is actually doing. What we are actually doing is that we are doing the same risk detection or risk assessment for the chronic diseases that is already being done by the current healthcare system. It's the same thing.

But what we do, we do it in a much more fundamentally more efficient way and more scalable way, more cost-efficient way. So the results that we provide, there is nothing, nothing new. It just makes the process much, much more efficient. And now, when, if you go back to what I said earlier about prevention, this is the way how we can actually scale the prevention to an entire population. This is the way how we are not using healthcare professionals' time for the risk detection anymore. And with this, we built the core foundation for the preventative healthcare system. So let's compare. So here in the slide on the left-hand side, we have the current risk assessment tools, and these tools are being used all the time around the world. We have for cardiovascular disease, here in Finland, we have FINRISK.

The same thing in the United States is ASCVD. We are using SCORE 2 in Europe. We are using Framingham SCORE in multiple countries around the world. This is for cardiovascular disease. We have for every disease, we have these clinical standard risk tests. What do they do? Their risk detection capability, they have good performance. The input that they require, in order to do the test, you need to collect many data points. You need to do lab test, you need to do questionnaires, you need to do clinical examinations. For example, with cardiovascular disease, you need to measure blood pressure, you measure BMI, you ask body mass index, you ask for the family history, and then you do the lab work. It takes a lot of, like, healthcare professionals' time to evaluate the risk for the disease.

The current way of doing things is also evaluating always one risk at a time. If you are being, and all, everyone, I think everyone knows this. If you go to see your doctor, they evaluate your risk for cardiovascular disease. They don't evaluate your risk for disease risk for other diseases. One disease risk at a time, and every disease risk that is being evaluated or assessed requires different data points to collect, and the more risks you evaluate, the more time you spend. In summary, the current way, it's inefficient because it's very resource intensive. It takes a lot of time for the healthcare professionals. That's why we don't run risk assessments for, like, population-wide. In some countries, this is being implemented, but I mean, it's very expensive and the scalability problem is still there.

The fact is that we would like to run this for everyone, because the better we detect the risks, the better we can take the early actions. Let's compare this to the Nightingale solution. The risk detection capability, the performance. Our test has equal or superior performance, so we match. And as I said, it's the same thing. If you run ASCVD, if you run FINRISK to assess the cardiovascular disease risk, you can run also Nightingale. It's the same risk detection. You are doing the same risk assessment. Now, the difference why this scales in a completely different way than the current risk assessment tools: we need just a single blood sample, and we need age and sex as clinical parameters. Nothing else. Nothing else. It's a fundamental change how the risk can be assessed. And then, and then there is more.

So, the current way of doing things, which assess only one disease risk at a time, it has a lot of challenges because what do you want to do? You want to create this, like, a holistic picture of the disease risks that people may have. So now, the Nightingale test, it detects multiple disease risks every time, automatically. Still, one blood sample, age, and sex. So, I mean, the difference is, now, if we compare, make it a bit more concrete. So assessing the risk with current risk assessment tools, it takes 15 to 30 minutes per disease. With Nightingale, because you don't need to collect any clinical data, it's basically like couple of minutes. You just need to draw the blood sample, and then you are good to go. Now, so it requires way less resources from healthcare professionals.

Importantly, now, with the Nightingale approach, the time of the healthcare professionals can be targeted to people who actually need the help from the healthcare professionals. Because when we know the risks, we can also target the healthcare services to the ones in need. And this is when you look at this in the bigger picture, this is extremely important. I think we actually have enough resources in healthcare. The problem is that the resources are not targeted in an optimal way. But to target the resources, you actually need to know how to target, and that's basically in the primary care side of things, is to know the risk. And now we can do this large scale, even for entire populations. So what happens here is that Nightingale Health Check replaces the current risk assessment tools.

Now this is not, this is not the vision like, "Oh, we're gonna do this in 10 years, and then amazing things happen." It's already in nationwide use in healthcare, in primary care. It's already happening, and the results are very strong. I want to show another slide about the same thing because I think this is the key, this is the core thing about the Nightingale's technology. This is the core thing, how we are helping to build a better healthcare system worldwide. This is all about the competitive advantage with this technology. This is something that, to my knowledge, no other company in the world can do in a similar level. Let's compare again, use the risk-taking as a use case, the risk assessment in Finland.

So in Finland, we have this technology in a nationwide use in primary care system as a part of the occupational healthcare. In Finland, occupational healthcare is part of the primary care system. So let's have the current risk assessment tools first. The same thing as in the previous slide, but now I go into more detail. So the current clinical methods to assess risks for chronic diseases in Finland, we have FINRISK, which is for cardiovascular disease. We have FINDRISC, which is for type two diabetes. Then we have a test for kidney disease, liver disease, lung diseases. How these tests are being done? Now, this is the clinical standard. This is from the guidelines. So here you can see every disease.

So with FINRISK, you need to collect all of these data points that are being shown in there. So now, if you imagine the time that it takes to collect those data points. With FINDRISC for type two diabetes risk assessment, you need to collect all of these data points in the slide. For chronic kidney disease, you collect the data points in the slide. Now, imagine that you do all of these tests. You test the risk for CVD, type two diabetes, chronic kidney disease, liver disease, alcoholic liver disease, lung cancer, COPD. So, nobody, nobody does it. Nobody does it. I mean, come on, it's... The time needed to do this is, like, unbearable. It's, you don't really do this. And now I'm talking about primary care and national use.

You can go to a private clinic, and you can buy this if you have the money. But as a kind of a scalable primary care tool, this is not doable with the current risk assessment tools. However, this is something that should be done, and I think there is a very good alignment that detecting the risks early on should be done. So now let's take Nightingale. One blood sample, multiple disease risks at the same time. The required clinical data to run all of these diseases: blood sample, the Nightingale Blood Test, sex, and age, with equal or better performance. I'm of course a bit biased to say this, but this is groundbreaking.

This is, like, this changes the way how the health risks can be detected, and this is the core for the future of primary care in every health system in the world. I think it's quite exciting, and it's available today. We can scale this to national use. We have the capabilities in multiple locations around the world, and now we are scaling this to be adopted in different healthcare systems, and here is just an example, like, how this happens in reality. There is a picture of the risk assessment report. You can look at this in more detail in our web page.

And then in addition to the risks, many times healthcare professionals are asking like, "Okay, but I want to see the LDL cholesterol. I want to see HDL cholesterol. I want to look at the different biomarkers," that are being used to run diagnostics in healthcare. Now, we also deliver this, so you don't need to run your clinical chemistry. We also deliver the biomarkers aligned with the gold standard, so again, you use the Nightingale, they are not like Nightingale biomarkers. They are the same biomarkers that are being used in medicine all the time, so in addition to the risk detection capability, you also get the biomarkers. This is why this is a tool that can be adopted to healthcare use, like, immediately. It doesn't take anything away.

It keeps the same things on the table that are being used by healthcare worldwide all the time. But then it brings a layer with the risk detection that is like. It's way more efficient than anything else in clinical use. We can also do this. Of course, the majority of the business is with the venous samples, because that's the standard in healthcare, but I think there are quite exciting applications with self-collected samples, so a person can give the sample by themselves from a finger prick. I believe when we look healthcare, like the, in the next five years, I think these self-collected samples becomes more and more of a standard. It's just we can create a more distributed health system and create more efficiencies, and it's also nicer for people.

You don't have to go anywhere. You just give the sample at home, and then you get the results, and then when you meet with your GP or the clinician, you already have the risk report on the table. It's just better for everyone. All right, so that was the recap of the Nightingale and the core value we are delivering. Now let's have a review of the business targets that we had in the previous fiscal year. So we had three targets. Target number one, to win an international commercial contract with healthcare industry partner. Target number two, win a white label deal. Here we mean the B2B2C business that we have based on these, like, self-collected samples.

And then target number three is with our research. There's a lot of scientists around the world using the Nightingale's technology for medical science. So then we had there a contract value target. Just as a brief summary, we reached all of the targets. I think especially with the first target, the adoption of Nightingale's technology, we made several important announcements, several important deals in the United States. The adoption of the Nightingale's technology is moving forward very strongly. I will talk more about this. I will go in more details in that area. We also had a target regarding the FDA approval in the United States. There is a significant change in the FDA ruling, so in the rules, how...

What are the requirements in the United States? We will be talking about that in more detail soon. But I think the changes that has now taken place in the new ruling, I think, puts us in a position that, the international standards that we have approvals already, I think they are very applicable for the, for the new, for the new FDA ruling. So I think we are in a very good position now to pursue the approvals also in the United States. And then the new ruling also takes a lot of... The previous model has been a bit of, like, a lot of interpretation has been in the way, how the rules are being interpreted.

The new ruling makes the rules very, very clear, and we believe we think it's a very, very, very good, good thing, but I will come back to that. We will come back to that later. All right, so let's go into the key achievements in the past fiscal year. Here we have our international locations. I think what I'm very proud about is that if you think about Nightingale as a company, we are a company with around 90 employees, and we run this business in 5 different geographical regions. We have from all of the regions, we have very strong results. Of course, this is, like, the company journey is still in the early, early...

It's in the early stage in many ways. This takes time. That should be no surprise. It takes time, but I think, like, now if you look all of the five location, and you look at the progress that we are making, it's pretty unbelievable that a team of 90 people can do this. So I think the Nightingale team is, like, one of the most efficient teams in the world. If you look at the results, if you look at the team size, I think it's quite unbelievable. So huge, huge thanks to the Nightingale team once again to reaching all of these achievements. So in Finland, we have the partnership with Terveystalo. This is where we have the technology in a nationwide use.

30% of the Finnish workforce in the country is being tested with this technology, and it is in occupational health, but importantly, in Finland, occupational healthcare is part of the primary care system. In Japan, we made progress by acquiring a company that puts us commercially in a new position. I think we are now in Japan in a very good position to pursue growth. In Singapore, we made a partnership with Innoquest Diagnostics. It's part of Pathology Asia, which is the largest diagnostic provider in Southeast Asia, covering a population of 500 million people. So I think that's also very strong progress. In the U.K., we have the new laboratory started there.

We completed the analysis of the UK Biobank with Nightingale's technology, the largest health data repository in the world. This is the kind of because the scale is so immense, the results that we kind of when we do the data analysis with Nightingale's technology, the scale that we are operating in, it's massive, it's unprecedented. So that gives a lot of confidence then when we also do the healthcare implementation. And then we had some progress in with the self-collected samples in the UK. In the US, there was a lot of new deals announced, so we had the partnerships with and deals with major healthcare organizations. So we are working with Mass General Brigham, Weill Cornell Medicine, Kaiser Permanente, the Boston Heart Diagnostics, and 23andMe.

If you look this up, they are some of the most important healthcare customers in the world. Not only in the United States, I think many of these organizations are also leading the way in medicine and healthcare. We are very proud that they want to partner with us, they want to adopt the Nightingale's technology. I think it demonstrates that what we have is something that is hugely important in answering the question: how do we build the future healthcare systems? I will go a bit more detail in all of these. We also have this in top part of the slide, we have this progress bar. With the progress bar, we want to indicate what is the...

What is the status like? Where are we in the journey? And as I said earlier, the Nightingale journey, these kind of companies, it takes easily 10 years to build the validation, build the technology, to get everything running, and then you start step by step going into adoption of the technology. In the healthcare cases, it takes time. So that's why we wanted to give a bit of understanding about how we see the progress in different markets. So in Finland, I think we are. This is the most advanced use case of Nightingale's technology. We are in large-scale healthcare use.

The nice thing about this collaboration is that here we directly replaced the kind of old way or the previous way of doing the risk assessment. So we directly replaced that with Nightingale solution, and that of course also brings quite significant sample numbers right away, because these are workflows and processes that are taking place already, and now when you just switch to Nightingale's technology, there are quite a lot of like samples involved. But I think it's a very strong achievement, and this is a very important reference also when we look at our business in other countries.

And it's after a very long time in building this technology and developing the company, it's great to see that there are hundreds of healthcare professionals using this technology on a daily basis. I think it's something to... It's a major achievement. Then in Japan, we are, the progress bar is that we are in the implementation phase. We acquired the Welltus Inc. to strengthen our business position. Now what we are, this acquisition enables us to kind of work with the partnerships, provide the technology more broadly to different use cases in Japan. And it's already available in more than two hundred hospitals.

So now the next step to get into the large-scale healthcare use is, of course, that we need to position the technology to the use cases where the scale is like, where it can scale fast. But I think this Terveystalo collaboration in Finland is a great reference also to Japan, because in the Japanese system, occupational healthcare has a huge role in how the whole healthcare system has been built. In Singapore, as I mentioned, we made the deal with Innoquest, and Innoquest is the leading clinical diagnostic service provider. So the reason why we built a partnership like this is that it helps us to get our technology where the samples are already being shipped.

You know, in this kind of a business, collecting the samples and managing the logistics is quite a big thing to solve. In Finland, we have solved it ourselves, but now in the international locations, we prefer the models where we built the Nightingale capability, like lab in lab, and now we are building the laboratory, and the ramp up is proceeding as planned. Commercially, we estimate the launch will happen in the last calendar quarter of this year, so we are making good progress. Regulatory-wise, I think the HSA, the Health Sciences Authority in Singapore, we just announced a third approval in this, and well, I think it's pretty much aligned with our results from other regions.

But I think it further demonstrates that Nightingale's technology basically is aligned with the gold standard in clinical medicine, and the technology can be used in healthcare. I think it's very important step also to get these approvals and now we are. I think we are very well positioned also in Singapore. In the UK, so the laboratory is there. We have staffed it. The samples are already being analyzed. And now I think what we are looking to do next in there, now we have the local capability in the UK. Now there is a lot of commercial actions that we can do in there.

The UK Biobank analysis was also very important milestone for us, and if you look at the publication, publications done with Nightingale's technology, I think it has, like, the number of published sciences going through the roof because many research scientists can access the data from the UK Biobank, and then they can also get the benefits of Nightingale's technology in the medical science they are doing, and with this, we are actually step by step, helping to build also better tools in healthcare use. In the United States, five important, very important deals, maybe to mention a bit of the nature of the deals.

With 23andMe, we are of course, they are one of the, or they are maybe the biggest company in this, like, a consumer health area in genetics and Nightingale's technology is a great addition to the genetic data. With genetic data, you can look what you have inherited, things that you cannot change, basically, and then with Nightingale, you get an understanding what the lifestyle is, how your lifestyle is, how your body is reacting to your lifestyle. And then when you put these data modalities together, you get, like, even better risk assessment. Of course, with the chronic diseases, the lifestyle side has a kind of. That has the most important role to kind of impact the risks.

Then another example, like Mass General Brigham, Kaiser Permanente, they are huge health systems in the United States, some of the biggest. They are also, I would say, like global references in many ways. So working together with them, I think it's a great step also forward to advance the adoption of Nightingale's technology in the United States. All of these deals, it will take time to bring these projects into production, but we are making great progress with them, pilot running with the Boston Heart Diagnostics, for example. So we are also moving to that direction, but we need to take it step by step.

I think the important point is to look to kind of see the customers and kind of how they are operating in the what is their role in the healthcare system in the United States? And then we are building the laboratory in the United States. I think that's a very important step with these new customers also, to be able to serve them also locally. And then finally, we announced that we acquired all the intellectual property assets of Velvet Blood Collection Device. So earlier, the change here was that earlier we were holding a license to use and manufacture the device.

As I said earlier, I believe that when we look ahead, like five years, these self-collected samples will become more and more important to make the healthcare system even more efficient. This blood collection device, so far, has been the only one that yields very good results. In other words, it has very good sample stability over a long time period. We can keep the sample good, like up to three weeks after collection. This helps with the logistics. Then we also wanted to acquire the technology because now we can fit it better. We also do the analysis. We are the only company in this field that has the collection device and the analysis capability. You can get from Nightingale all the components from a single company.

I think that's that will be also a strong competitive advantage when we look forward. All right, so that's progress, and I think there are quite a lot of things that we have achieved. I could have used even more time to go through all of them, but I think it just describes the great progress that we have managed to do over the past fiscal year, and I think we are like we have, like, excellent position to continue the rapid progress with these cases we have already announced, and then also with the new deals that are brewing in our pipeline.

So now let's go to the numbers, and I would like to ask Tuukka Paavola, our CFO, to join me on stage, and let's have the numbers review.

Tuukka Paavola
CFO, Nightingale Health

Yes. Thank you, Teemu. Great to be here, presenting the numbers from our last financial year. So, let's actually start with the cost side of things, because I think it is actually quite amazing that we have managed to achieve all the great things Teemu was talking about, while actually keeping the same cost level as we've had for the last couple of years. So it, of course, means that we are running a tight ship. We are really doing things in a focused manner, in a really efficient way, and also in an effective way, really making things happen.

The change in our liquid funds, meaning cash and certain short-term investments we are doing for liquidity management purposes, was -EUR 14.6 million in the previous financial year, which is actually almost the same as in the earlier financial year. Which means that at the end of the financial year, we had around EUR 66 million liquid funds available, which means that we have a really strong financial position to continue executing our strategy and growing our business globally, and giving us multiple years of runway. Definitely enough for us to really scale the business globally.

Then on the revenue, the revenue for the second half of last financial year was in the same two million bracket as where it has been for the last couple of half year periods. Landing at 2.6 million EUR, which is at the same time also the highest half year revenue for half year period ever. It's good to notice that still the largest part of the revenue comes from the research business, which is rather volatile in nature, so you should expect to see some volatility also in revenue going forward. But at the same time, we are building this other revenue bucket, if you will, a foundation from the healthcare revenue side, which is then more stable in nature.

Now, for instance, we are seeing the first revenue coming into that bucket from this Terveystalo occupational health deal that commenced in early H2. Many of the deals Teemu was describing have a chance to actually start contributing to that more stable healthcare revenue bucket, and that is, of course, something we really want to grow going forward. Just to summarize the numbers for the financial year. The revenue for the full year landed at EUR 4.358 million, which is a slight 4% increase year over year, but also actually, at the same time, it is the best full year revenue-wise to date.

We also managed to improve our profitability slightly with EBITDA landing at -EUR 10.4 million and net income at -EUR 17.46 million. We are practically debtless. So yeah, virtually no debt in our balance sheet. Our net debt to equity ratio is minus 76%, which is fantastic. We have a solid financial position with net cash at EUR 63 million. The difference now between the liquid funds I described two slides ago and net cash is that net cash is actually liquid funds, where we take away then the interest-bearing debt and leasing liabilities. So I think to summarize our financial position in three: First of all, it's really solid, strong position to continue executing our strategy and multiple years of runway remaining.

Secondly, virtually, we have no debt in our balance sheet, which gives us possibilities in the future to leverage our balance sheet, if needed, for certain, you know, projects to scale up the business. And we are also on the path to improve our profitability, where both the increased top line, but also efficiencies across the board are contributing, too. So, we are on a good path towards our midterm target of becoming EBITDA positive in the future. I think that's a short summary from the numbers. Then back to you, Teemu.

Teemu Suna
CEO, Nightingale Health

Thank you. So I kind of now when looking at the numbers, when looking at the progress, I think the Nightingale journey is moving forward as planned. We are managing the financial position, the financial side, the way how we've been planning to manage it. We have solid runway. We very strongly believe that it's enough to reach the positive EBITDA. We are winning deals that are very significant in promoting the adoption of the technology to healthcare use. In our plan, we know it takes time, but I think the speed of the progress is very strong.

So, we are quite comfortable about the position where we are, and I think it's a great situation to accelerate forward and reach towards the international ambitions that we have for this company. With that, let's go to the business targets for the ongoing financial year. We continue with the primary focus with target one in winning new large international deals, particularly in healthcare and aiming to these flagship quality deals. The journey, the Nightingale journey is still in the phase where we need to kind of win the flagship deals. We need to win new deals, because it's the new deals that are moving the adoption forward.

I actually believe that once we get Nightingale's technology implemented in couple of more large scale, healthcare use cases, there is a strong possibility that this technology becomes something that... It gives such a competitive advantage that if you are without it, how can you compete in risk assessment? Which puts us in a rather nice position. That's why we try to win large deals. That's why that is the primary focus. Because what we are trying to do, we believe this, we can build this a significant player in international healthcare, and to go there, the target one, that's where we want to deliver, and that's why it's our primary target. Target number two, we are now bringing also more of the numerical side on the table. It's not still the core priority.

As I said, core priority is to win new deals. That is driving, that is moving the company forward the best possible way. But also increasing revenue is our target, so we also want to do deals that are helping us to bring the revenue up. As Tuukka was saying, some of the deals that we have announced can also help to build up the revenue. And then when we move forward, the more we win the deals, the more we will give also priority to the revenue side of things. But this is a journey. It takes some time, and we are evaluating all the time when where should our core focus be. And then target number three: improve efficiency.

So we continue keeping the strong cost control and then aiming to improve the EBITDA. Same story with the EBITDA. So when moving forward, we will give more focus and priority to this, but now it's still the time to win the deals. That moves the story forward the best possible way. And then no changes to midterm business targets, long-term business targets. In midterm, we aim to achieve positive EBITDA, and as I said, the runway that we have, we strongly believe that we have a solid roadmap towards that. And then in the longer term, what we try to do here, we try to build an international scale healthcare technology company. Here you can see the financial calendar and the date for the annual general meeting.

And then we go to Q&A, and I would like to ask Satu Saxman from our management team to join on stage, and let's have a look at the questions.

Satu Saksman
Head of Investor Relations, Nightingale Health

Yes. Thank you, Teemu, Tuukka. You guys talked so much that we have, like, five minutes for the questions.

Teemu Suna
CEO, Nightingale Health

I'm sorry. It's not because of that, it's because we have so many things that we need to tell.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, agreed. So, a lot of questions, obviously for obvious reasons, related to our ongoing projects around the world, especially here in Finland with Terveystalo. A lot of these things has been discussed over the presentation, but maybe some highlights and clarifications. So let's start with Terveystalo. According to the public information, as well as our internal resources, the Terveystalo collaboration has started well. So how is this... What is the role of Terveystalo? Tuukka also shared something about the revenue coming from Terveystalo project, but what is it? I mean, there's a big role in Nightingale strategy and also the revenue. Can you kind of clarify that one more time?

Teemu Suna
CEO, Nightingale Health

Yeah. So you said two words: revenue and reference, and now the priority here is reference. So this is of course, when moving the Nightingale story forward, we need to win cases where the adoption of the technology goes to large scale. And for us, working together with Terveystalo has been like great opportunity, in one hand to get the technology to be used in large scale healthcare. But then also in the other hand, there's a lot of like collaboration and development together with them, and it's been something that a lot of learning has been exchanged in that partnership. And of course, there is the revenue component.

But now, we play the long game here, and in the long game, the meaning of this partnership is to have the reference, to have the possibility to build something great together with a great customer who is kind of really forward-thinking how we build a better healthcare in the future.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, let's continue on that strategic angle then. So internationally, how do you believe the Terveystalo type of health check or this use case can be adapted to the other markets and then other geographical areas that we've been talking here?

Teemu Suna
CEO, Nightingale Health

Mm

Satu Saksman
Head of Investor Relations, Nightingale Health

... today?

Teemu Suna
CEO, Nightingale Health

Yeah, well, I think the short answer is very well, but maybe to give a bit of like, idea, like beyond a single case. So with Nightingale, we have basically like three kinds of, like, use cases. So we have the first one is that where we detect the early risk, early risk detection, screening. It's all about, like, how do we find the risks as early as possible? This is the part of the preventative healthcare system. This is part of the health insurance system. So there are a lot of use cases for this. So that's the first one. Then the second one is that actually this technology can be used... We have not announced significant deals around this, but this technology can be used also to help treating people who already has the disease.

So this is more of like specialized healthcare application. I think there are good use cases in that segment, too. And then we have the third segment, which is using the Nightingale's technology as a KPI. So now we talk a lot about if you look, if you write to Google: "value-based healthcare," this is what is happening in the United States. So there is like a strong movement towards like paying and focusing in the healthcare outcome. So what is the performance of the things that healthcare is doing? So how they are creating value. But there is one problem that is quite a big problem: How do you measure the progress? If you do something, how do you know that these actions have been impactful?

Actually, Nightingale's technology can be used as a KPI. Because what would be a better KPI for the healthcare progress than the change in risk? So if you do something that reduces the risk, you are doing better, kind of, you are doing better healthcare. So I think these kind of a KPI use cases are also emerging. Not that we have deals in that area right now, but I think it's good to think about the technology like this. So risk screening, then helping to take care of the sick, and then the KPI use cases.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, thank you. Then, very frequently asked question about Singapore. Probability of getting the Singapore commercially available by the end of this year, yes, no?

Teemu Suna
CEO, Nightingale Health

Yes, it will be available commercially by the end of this year.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, let's see then about that. Then maybe, I mean, I think we are pretty much out of the time.

Teemu Suna
CEO, Nightingale Health

Let's have a couple more.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, let's have a couple of more. So, this came maybe also Tuukka could share something related to that. So there was this focus areas, different market areas. So now question: How much more laboratories and employees you need to grow bigger worldwide, let's say, short midterm? And how do you then see the burn rate developing related to this?

Tuukka Paavola
CFO, Nightingale Health

But if you then start from the number of laboratories we need?

Teemu Suna
CEO, Nightingale Health

Yeah, yeah.

Tuukka Paavola
CFO, Nightingale Health

Yeah. Mm.

Teemu Suna
CEO, Nightingale Health

So now when you saw in the presentation, you saw there, like, we have now five locations, where we have put the Nightingale's technology or putting Nightingale's technology available. That is kind of the core, because if you look those markets, there is a lot we can do with these laboratories. Of course, if there is a customer case in some other region where the deal size is just big enough, we go there and we implement the laboratory. We can do it. We have quite a lot of experience about this. But maybe to say as kind of a more general strategy, so we have believed from the very beginning there's a lot of power with small teams.

We are now like 90 people, and what we try to do is that the point is not to let's hire another hundred people. That creates also a lot of inefficiencies. Now, with the team size that we have, we can be like super efficient. And how do we manage? How we manage that we also make progress? One word: Focus. Focus, focus, focus. So we don't go to the United States and say like "Oh, call to top hundred customers." You'll just make a mess. Choose out of these top hundred customers the 10 most important and the most viable cases. Windows.

Tuukka Paavola
CFO, Nightingale Health

Mm.

Teemu Suna
CEO, Nightingale Health

And then you kind of manage also the cost side.

Tuukka Paavola
CFO, Nightingale Health

And maybe then fully agree with you with what you said, and then maybe commenting on the actual cost side. So naturally, we need some CapEx and OpEx investments when we set up new laboratories. But of course, we do them only when we have solid business cases in the pipeline. And the revenue from those business cases should then, you know, offset the increased costs by far, which means that we should continuously be able to improve our EBITDA and achieve the positive EBITDA. Of course, there will be some time, but it's, you know, not gonna be that long. But our solid financial position and the fact that we are debt-free gives us the possibility to scale up.

Teemu Suna
CEO, Nightingale Health

If we would need to invest in this, if we have a commercial deal and we would need to invest CapEx in those deals, we have the debt card, which we have-

Tuukka Paavola
CFO, Nightingale Health

Mm

Teemu Suna
CEO, Nightingale Health

... not used at all.

Tuukka Paavola
CFO, Nightingale Health

Exactly.

Teemu Suna
CEO, Nightingale Health

I think there's a lot of, like, flexibility then how we build up the growth. I would say about the number of employees, the day will come when we need to hire a lot more people if we are successful, but then that's, then we build the company. There's a lot of changes that we then need to do. We do the changes when the time comes, but the time is not now.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, so then maybe something that has raised a lot of questions. I mean, this regulatory field raises a lot of questions in the U.S., but also elsewhere. Can you somehow summarize, like, how have the regulatory projects in... What was your experience of, about the regulatory project already now taking in other markets? What is the... Based on those, what is the expectations for new markets to come, like, when rolling out to the new geographical areas and all that, so?

Teemu Suna
CEO, Nightingale Health

Yeah. Yeah, so I think the, to summarize the situation briefly, so in the markets where there is the, kind of the rule book is very clear how you need to do it, and there is not a lot of, like, room for, interpretation, the process typically, like, it's not something that it takes, like, years to build up. We have been very successful. I think, recent, achievements in Singapore demonstrate very well. I mean, the requirement level in Singapore is very strict. It's very strict.

When the rule book is clear, we have made very good progress with the regulatory approvals, and I think now in the United States, with the new FDA ruling, I think that's why we think it's a very good change in the ruling because it makes the rules more clear than before, and we have certain elements in our current quality management system that are compatible out of the box with this new ruling, but this can go to very detailed very quickly, so we will tell more about this soon.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay, maybe wrapping up the whole presentation and this question and answer session, so the last one: priorities, how Nightingale's priorities look like for this ongoing fiscal year, and what's there to follow from our press releases and company releases from in the future for next nine months?

Teemu Suna
CEO, Nightingale Health

So look at the deals we do. Look at the progress we do in the deals that are now in the pilot phases. That's it. That describes how we are moving forward. And of course, we take. We have a lot of priority and focus to take good care of the numbers. That's what we always have been doing. It of course kind of takes investments, and it takes time to build these kind of things up. There is no shortcut in this kind of a business and with these technologies. But I think, like, if you really want to follow the story and to see where we are going, deals and the progress we are making in those deals.

Satu Saksman
Head of Investor Relations, Nightingale Health

Okay. Thank you. I think that was pretty much capturing the questions, and we are-

Teemu Suna
CEO, Nightingale Health

All right, so thank you, everyone, for the questions. That's it. We'll meet again. Have a nice day!

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