Gentlemen, good day and welcome to the Metropolis Healthcare Q2 FY 2025 earnings conference call. As a reminder, all participants' lines will be in listen-only mode, and there will be an opportunity for you to ask questions after the presentation concludes. Should you need assistance during the conference call, please signal an operator by pressing star, then zero on your touch-tone phone. Please note that this conference is being recorded. This conference call may contain forward-looking statements about the company, which are based on the beliefs, opinions, and expectations of the company as on the date of this call. These statements do not guarantee the future performance of the company, and it may involve risks and uncertainties that are difficult to predict. I now hand the conference over to Mr. Tausif Shaikh from BNP Paribas Exane Research. Thank you, and over to you, sir.
Thanks, Akhil, and good morning, everyone. On behalf of BNP Paribas Exane Research, I, Tausif Shaikh, India analyst for Pharma and Healthcare Service, welcome to you all for Metropolis Q2 FY 2025 earnings call. Today, we have the senior management of the company, represented by Ameera Shah, Chairperson and Executive Director, Surendran Chemmenkotil, Chief Executive Officer, and Avadhut Joshi, Chief Business Development Officer. I will now hand the call to Ameera, ma'am, for her opening remarks. Over to you, ma'am.
Hi, good morning, everyone, and thank you for joining us on the Q2 FY 2025 earnings call today. As mentioned, I'm joined by Surendran and Avadhut and Aditya Shinde, who's the Interim CFO, and SGA IR advisors. We've uploaded our updated results documents and annexures on the company's website, and I hope everyone's had an opportunity to go through the same. Let me begin with the industry scenario so we can set the context for today's call. The Indian diagnostics industry continues to be highly fragmented, with over 85% of the market dominated by unorganized and independent diagnostic centers. These centers have succeeded in building a hyper-local customer base with repeat clients, but they struggle to attract new customers and are experiencing a decline in volumes as more organized and trusted diagnostic chains enter these micro-markets.
Independent centers typically offer a limited range of tests, with an average of around 100 tests, compared to over 4,000 varieties of tests that are available at Metropolis. Their limited test offerings, the inability to service specialized doctors, the lack of reach that the local labs have, and the inadequate digital and physical capabilities make it difficult for them to increase volume and scale. We continue to see a larger trend of unorganized moving to organized, especially in metro markets. Recognizing this as a significant opportunity, we have been focusing on selective micro-markets across India, working to establish trust and credibility with doctors through a comprehensive test menu, accurate results, best-in-class experts for test interpretation, and high-touch doctor engagement.
As ongoing customers prioritize quality and experience over price, our brand reputation, in-house expertise on every test leading to huge trust, and our physical and digital infrastructure have made us the preferred choice. In smaller towns, the local lab is still relevant due to strong local relationships, and large teams like Metropolis create relevance for ourselves through specialized testing, which the local labs cannot do. Speaking of competition from organized players and tech-enabled e-health companies, we have not observed any significant changes compared to the previous quarters. The new-age companies continue to face challenges in generating illness-driven volumes, and due to competitive pressures and low conversion rates from wellness to illness services, they have been compelled to raise prices to improve their unit economics.
Additionally, we have witnessed that they have been forced to enter the traditional physical brick-and-mortar model, a process that is both long and challenging, especially when it comes to scaling and achieving profitable sales. There has also been talk about competition from hospital players, but we believe this remains confined to a few geographies like Delhi and Hyderabad, where major hospital chains have had a presence for decades. Pricing for these hospital chains remains a real challenge, as their walk-in price for patients outside the hospital is one-third of what they charge inside the hospital, leading to huge conflicts with their customer and cannibalization of their own business. This is one of the reasons we believe it will be challenging for hospitals to truly scale the pathology ventures in a profitable manner. Let me provide some insights on regional competition.
A strong regional lab in one city with B2C business would try and expand into other markets close by via the B2B route, as they would not have a brand in another city. While capital is available to expand, the ability to build brand, attract talent, and management expertise to provide quality and quick results across regions consistently and build the complex test menu that are needed to scale a business are actually the moats of our industry when we're building a chain. This is why most city-focused businesses have not been able to scale and definitely not scale profitably. We have been leaders in the west and south regions and continue to experience consistent growth in our core geographies, often exceeding the company's average growth rate.
For instance, in Mumbai, our B2C revenues have increased by 17%-20% over the past eight quarters, and we remain the fastest-growing player in these regions, well-positioned to capture market share even if we see further competition. This is largely due to the market's composition, with a significant portion still unorganized, providing ample room for growth if you have execution excellence. We are confident that we will outperform industry growth, gain more market share on the back of the trust and credibility that has been built over the years with doctors and consumers. In warm core geographies like North and East, where our consumer brand is relatively less established, which often we call them feeding cities, we have been strengthening our presence through our B2B business. We have built a strong medical reputation amongst recognized grade A hospitals and labs.
We choose our services due to our testing capabilities and high-quality offerings, with specialized and quality testing at the core of our value proposition. We are also seeing significant growth opportunities beyond the core geographies, especially in tier three and tier four cities, which are becoming increasingly important focal points for us. We are deepening our presence in emerging markets like UP, MP, Punjab, and Assam, where the demand for reliable diagnostics is rapidly rising. With a highly fragmented diagnostics industry, we are strategically focusing on micro-markets with minimal organized competition, with standalone centers and unorganized players having the majority of the market share. In tier three and tier four cities, we are experiencing strong growth, and we anticipate continued acceleration as healthcare access and awareness expand.
By tailoring our approach to meet the unique needs of these communities, we are ensuring that our reach extends beyond the traditional urban centers, establishing a robust network that serves diverse populations. In Q2 FY 2025, revenue from these towns accounted for over 25% of our contribution, with a year-over-year growth rate of 23%. Currently, the revenue for Metropolis from India's top 10 most popular cities comprises nearly half of our revenues, while the top 100 cities contribute close to around 75%. The balanced revenues are contributed by smaller towns and cities, which are growing at a fast pace. This increase in revenue growth is driven by our aggressive network strategy, adding new locations across smaller cities, and finally being able to earn the trust of doctors to get patients to walk into these centers.
Today, we are present in over 700 towns with plans to expand to at least 1,000 in the next 12-18 months. These cities not only offer promising growth but also opportunities to build enduring relationships and trust within these communities. Moving forward, we will prioritize increasing our leadership in our core B2C markets, where we have consistently outperformed industry growth. Additionally, we will focus on expanding our presence in tier three and tier four towns, which have limited diagnostic providers and services. By implementing targeted marketing and sales strategies, we aim to enhance our market penetration and establish a strong foothold in these regions, driving overall growth in the coming years. Let me quickly share some insights into our inorganic expansion strategy. We've been actively pursuing inorganic growth with two main objectives.
First, to acquire capabilities in advanced specialty testing areas such as genomics, oncology, histopathology, and molecular diagnostics. The biggest growth is going to be in these areas in the next 10 years, and therefore, we definitely want to go deeper into these testing capabilities. Second, to extend our reach in non-core geographies, particularly in North India, where Metropolis has a relatively lower brand presence. These acquisitions will serve as entry points into these specific micro-markets, allowing us to then build a business organically after acquisition by implementing Metropolis standards in testing, service, and delivery, along with specialized testing and extensive test menu and scientific marketing through doctors. We are in advanced stages of evaluating potential targets, and we'll keep you updated at the appropriate time.
Aligned with the government's focus on workforce development and skill enhancement, we have launched the Metropolis Institute of Laboratory Education and Skilling, or what we abbreviatedly call MiLES, in partnership with Datta Meghe University and Maharashtra State Skills University to offer specialized fellowship and certificate programs for post-MD and DM students. Covering fields like advanced clinical chemistry and molecular pathology, these programs blend theoretical learning with hands-on training on advanced diagnostic technologies. MiLES reaffirms our commitment to bridging the healthcare skills gap and preparing professionals to meet the sector's evolving demands.
Before I hand over to Surendran to take you through the quarterly highlights, I would like to reiterate the key growth strategies for Metropolis. We will continue to focus on it. Number one, expanding lab and collection center networks in new cities, largely in tier three and tier four cities in India to expand our addressable market.
Number two, focus on being the pioneer in new test advancements and amplify our engagement with specialty doctors to grow our specialty volumes. Number three, focus on our Tru Health Packages with curated packages and increase our contribution, which is currently 16% of revenue, to keep increasing this as we go further. Fourth, fostering the inorganic growth and foray into adjacencies. And fifth, heighten our service standards and digital marketing initiatives to improve productivity and customer experience. That's all for now, and I'll be happy to chat with you guys more over the question and answers. Surendran, over to you.
Thank you, Ameera, and good morning, everyone on the call. We have been consistently able to deliver industry-leading growth over the last eight-plus quarters now. Our revenue for quarter two of financial year 2025 grew by 13.4% on a year-over-year basis, well within our guided range of 13 to 15 percentage points. Our EBITDA for quarter two grew by 22%, with an EBITDA margin inching up to 26.2%, an increase of 190 basis points year-over-year. Our PAT for the quarter stood at INR 46.7 crores, an increase of 31% year-over-year. PAT margin also witnessed a growth of 180 basis points year-over-year. On the broader KPIs, our patient volume growth for quarter two stood at 7%, and our test volume growth stood at 8% on a year-over-year basis, which stands to be one of the highest in the industry. Our patient and test volume growth for H1 stood at 7% and 9%, respectively.
Increase in volumes are on account of increase in market share among the core geographies and expansion and deepening of presence in newer geographies, especially in tier three and smaller towns across the country. Now, moving to a few of the operational KPIs, our B2C revenue for quarter two grew by 21% year-over-year. Patient volumes in B2C segment have grown by 12%, signaling an increased market share driven by extensive test menu, trust, and credibility Metropolis brand holds with both doctors and consumers. We have achieved faster revenue growth in our core geographies within the B2C segment. B2B revenue for quarter two grew by 13% year-over-year. Our focused efforts and enhanced engagement programs with the key B2B clients have enabled us to increase our value share in this segment.
As we have managed to keep discounts at bay and enhance our productivity per client, we believe our graded approach to customers can help us grow well and profitably as they look for quality and good services with Metropolis. The B2C and B2B revenue make up to almost 90% of our business, and the combined growth of this segment is around 17% year-over-year. As shared in earlier occasions, we have strategically chosen to disengage with government and institutional clients, resulting in a revenue decline in this segment and impacting overall growth in the last two quarters, which may continue for another couple of quarters more. This decision aligns with our focus on quality over price-sensitive business. Excluding this segment, our combined B2C and B2B patient volume have grown by 8% year-over-year.
As a part of our larger strategy, we have been prioritizing the specialty and bundle product segment as dual growth drivers. Our Tru Health portfolio achieved strong year-over-year growth of 23% in quarter two. Carefully curated wellness and illness packages and focused marketing efforts have driven the growth in this segment. Tru Health now contributes to around 16% of our total revenue, and we would like to move this towards 20% in the coming few quarters. By upselling to our existing customer base, we have increased the number of tests per patient, leading to higher revenue. This approach also boosts our margins as customer acquisition and servicing costs remain steady. Metropolis has been a pioneer in the specialized diagnostic services, driving a 16% year-over-year growth in our specialty revenues, and this portfolio growth is bettering quarter after quarter.
By introducing new tests and strengthening our relationship with specialized doctors nationwide through education and engagement on the latest testing capabilities, we continue to expand our specialty business. We have launched, for example, in the last six months, NextGen Pre-implantation Genetic Testing for pre-IVF, NextGen Panels for oncology to guide targeted therapies and optimize cancer treatment, and the Fecal Immunochemical Test, which is a very important test for early screening of issues in the gastrointestinal system.
We have also introduced comprehensive panels for testing in transplant patients and advanced profiles that provide an in-depth analysis of multiple steroid hormones in a single test, enhancing diagnostic accuracy. See, these advancements reflect our commitment to precision and progress across critical healthcare specialties. Our scientific approach to selling, combined with omnichannel strategy, has enabled us to reach a larger audience and drive significant traffic for specialized testing.
In terms of network expansion, we added seven labs in quarter two and 17 labs in H1, with the goal of reaching 25 new labs by the close of financial year 2025. We have also closed down a few labs, which is affecting a smaller net addition number for this period. This has been done to optimize cost synergies in certain regions. We also added a net of 186 collection centers in H1, bringing our total centers to 4,336, and we are targeting about 500 additional centers by the end of this year. This growth strategy is driven by the increasing presence in tertiary care outside metro cities, extending into smaller cities and towns nationwide. In line with this trend, we have entered over 400-plus new towns in tier one and tier two regions over the past 24 months, focusing on these areas as key growth opportunities.
Our reach has now expanded to nearly 700 towns, and we aim to reach 1,000 towns over the next 12 to 18 months, like Ameera mentioned. This expansion lays a strong foundation for Metropolis' next growth phase. We have made significant progress in boosting our operational efficiency and elevating customer service by heavily investing in our digital and IT infrastructure.
Our focus has been on developing a seamless, intuitive platform where customers can easily explore and select tests, schedule appointments, make payments through integrated gateways, and receive their reports digitally, enhancing convenience and accessibility at every touchpoint. In parallel, we have fostered and consolidated strategic partnerships to establish a center of enablement dedicated to optimizing our mission-critical IT applications. This collaborative effort enhances efficiency across the organization and positions us for long-term sustainable growth.
This end-to-end transformation not only enhances operational efficiency but also strengthens customer loyalty as we provide a faster, more reliable, and customer-centric experience. Lastly, if I speak of our outlook for full year, financial year 2025 and beyond, we are maintaining our revenue growth guidance in the range of 13%-15%, driven by high single-digit patient volume growth. We expect margins to improve as we move forward, benefiting from operating leverage within the business. As our new labs reach maturity, we expect margin to further enhance through increased throughput and reduce lab expansion-related expenditures. With this, I'll hand over to Aditya Shinde for financial updates.
Thank you, Surendran. Good morning, everyone. I am Aditya Shinde, and let me share some of the key financial performance for the quarter. Revenue for quarter two FY 2025 stood at INR 349.8 crores, a growth of 13.4% YoY, with 7% patient volume growth. Our test volume growth stood at 8% for this quarter. Revenue per test has increased by 5% on a YoY basis. Our B2C revenue stood at INR 194 crores as compared to INR 161 crores in the quarter two of last year, which is an increase of 21%. Our B2C for wellness and specialty grew by 26% and 24%, respectively, on a YoY basis.
Patient volume growth for B2C business stood at 12% YoY. Our B2B grew by 12.6% for this quarter compared to the same period last year, with B2B wellness and specialty growing by 21% and 10%, respectively. B2B patient volume grew by 4% on a YoY basis. Revenue share of Tru Health segment stands at 16%, indicating a growth of 23% YoY. Our specialty segment revenue stood at INR 129 crores, which is a growth of 16% YoY.
Reported EBITDA for the quarter stood at INR 91.5 crores as compared to INR 74.9 crores, a growth of 22.2%. Reported EBITDA margins for this quarter stood at 26.2%, which is a delta of 190 basis points. PAT for the quarter stood at INR 46.7 crores, a growth of 31%. PAT margins for this quarter stood at 13.4%, up from 11.6% for the same period last year, which is a delta of 180 basis points. Moving on to the balance sheet, we have a net cash surplus of INR 185 crores as of 30 September 2024. That's all from my side. With this, I open the floor for questions and answers. Thank you.
Thank you very much. We will now begin the question- and- answer session. Anyone who wishes to ask a question may press star and one on their touch-tone telephone. If you wish to remove yourself from the question queue, you may press star and two. Participants are requested to use handsets while asking a question. Ladies and gentlemen, we will wait for a moment while the question queue assembles. The first question is from the line of Shaleen Kumar from UBS Securities India. Please go ahead.
Yeah, hi. Thanks for the opportunity, and congrats on a good set of numbers. Sorry, it's a bit of a long question. So there was a time when your margins were a little higher than the industry-leading peer, but obviously, you got into investment modes and expansion mode, which is great, and we could see the results coming in. But your margins are now tad lower, in fact, visibly lower than the peer, while your revenue per test or revenue per patient are still higher.
So what I want to understand is you're still in a kind of this expansion mode where you called out your tier three strategy. But how should we think about the margin and the growth balancing effect? Because your growth in tier one, tier two cities is not that great. A large part of growth is coming from tier three cities, where you need to invest and expand. But at the same time, we look forward for a margin expansion because you still have a reasonable critical mass. So any thoughts on that?
So I have a couple of thoughts on Surendran to add to it as well. The two areas we are seeing good growth is actually in our tier one cities, metros, where we are continuing to, like, you gave the example of Mumbai and Pune and other markets, Bengaluru, where we are continuing to see a very positive revenue growth, especially on the B2C side. So we are finding the growth is very high in the top markets where we have a brand, and the growth is high in the tier three, tier four markets just because there is that much opportunity, right? And we believe that these two areas, geographies, will continue giving us a good revenue growth as we go forward. To your question around margins, see, if you look at pre-COVID, the margins actually for the industry hovered around 26% approximately. And it was during COVID that, obviously, they went up closer to 28%, 29%.
We all knew that was not sustainable. The choice we had post-COVID was, as some of the peers have done, is not really invest in lab expansion or other areas, but to actually let the operating leverage flow through to the profit, but that very clearly then reflects in a much smaller growth in volume, patient volume, test volume, as well as in revenue growth. The choice that we chose to make is that, considering the large opportunity in India at hand, we felt that rather than maximizing margins, that we believe that the opportunity really stood in continuing to increase access and to continue to grow across the country and really stabilize and build the brand even further, and therefore, we continued our process from FY 2021 to FY 2025 of adding approximately 90 labs, which was increasing our lab capacity by 50% plus, and obviously adding centers.
Now, everybody knows that when you add a new lab, it doesn't become mature in one, two, or three years. It takes longer than that. And as we've been busy in building labs, while we have built collection centers, we have not built collection centers to feed these labs at the pace that we will be doing going forward. Now, we have to remember the collection center model is an asset-like model. We have, obviously, we are building some centers at our own fixed rent, etc., which are patient service centers, but the majority, 90% of our centers are through the franchise route, which is an asset-like model. So from FY 2026, you will actually see the lab addition come down to four to five a year, probably, and you will see actually the center expansion move up further, which is on the asset-like model.
We believe that as this continues to mature and our network of the last few years matures, we will continue to see operating leverage, which is why we indicated that we will see margin expansion happening. Finally, business is all about choices, and we believe that margin expansion, frankly, 100-200 basis points can be done pretty much within our control at any point if we decide to stop expanding, and therefore we made the call to really focus on the revenue expansion. I think the next three, four years, we will hopefully continue to see revenue expansion still be at a targeted number, but see the margins expand as well. I hope that answers your question.
Yes, yes, yes. I mean, mostly. I agree with you, right? That's the way I also look at it, that a lot of margin is in your hand because you can take a call of how much you want to invest and claw back in the growth. So is there a thumb rule which you play by? Certain amount, certain growth you need to target, and beyond that, anything, whatever you make, that will spill through the margin, and if that's the case, any long-term aspiration on both growth and margin, where you're seeing that's the steady state?
I mean, I think we would like to, I mean, we can't comment, honestly, beyond two, three years for any industry because things change, but at least I can comment for the next two, three years, we are continuing to, like we said, target the 13%-15% revenue growth and margins at about between 26%-27%. And hopefully, we'll see if there is an ability to be able to see further margin expansion, we'll obviously do that. But at this point of time, we believe that today we are already between 26%-27% if I remove the dilution of the lab addition that we have done just for that. And going forward, we also have obviously potential to expand it further. So I don't want to give anybody specific numbers because then that keeps it too tight, but we certainly see an opportunity.
All right. Can I ask one last question? Let me go ahead.
Yeah, please go ahead.
Any size in mind when you're thinking about the acquisition and the payback?
Look, I think acquisitions, we have seen lots of assets available across the country, but as we've always maintained, we find 90% of them, 95% of them not investments that we would like to do because of poor governance or poor models, etc. So we will be continuing to be very selective. And the ones we will do will be high-quality businesses, which we believe can make fair profits in time. I think sizes can be both on acquisitions, which are smaller, but leaders in their cities. They could also be larger regional players, or they could be pan-India players. But I think our goal will be to, one, to make sure that we are pricing the acquisition very fairly and correctly from a rate perspective.
And like I said, second, high-quality businesses, if they are built on, then they have to have majority business coming from B2C, which is high margins. If they are B2B businesses, then they have to be non-commoditized B2B businesses, high-specialty B2B businesses, which can bring some very tangible quality of customer to the table and specialty volume. So I don't have any specific numbers for you, but we will certainly keep you guys updated as we move forward.
Got it. Got it. Thank you so much, and best of luck. Thank you so much.
Thank you. Ladies and gentlemen, you may press star and one to ask a question. The next question is from the line of Anshul Agrawal from Emkay Global. Please go ahead.
Hi, morning. Thank you for the opportunity. My first question is on the B2B portfolio that seems to be lagging our B2C portfolio over, let's say, last four, five quarters, predominantly in terms of volumes. While you have alluded in your opening remarks, the reasons for the same. Do you expect this divergence to continue as online players sort of target this portfolio?
All right. Good morning, Anshul. And see, B2B portfolio, if you look at it, the overall growth in the last two quarters, we are growing at 13% each now. I mean, so in the past quarters, if you look at beyond that, we were at single-digit numbers on B2B. And B2B growth has come on the back of a very, very focused approach towards improving the client experience and our relationship with them, etc., getting strengthened. And also by controlling the discount.
That's sort of a long tail that we have in terms of which were giving us a little bit of volumes, but were not giving us enough margins and revenues. So in this transition phase where we are actually trying to get focused in the head part of the B2B client and also hold the discounts and increase revenues, there could be a small phase of time where you will not find volumes going up because those volumes which are coming were not really good margin volume. So otherwise, if you look at the overall portfolio, it looks good. The revenue of patients is looking good. The overall revenue is looking good. And as we go forward, I think you'll get to see the volumes also stabilizing.
Okay. So are you saying that B2B volume growth would be lagging B2C volume growth for the next, say, couple of quarters or longer than that?
Well, I mean, we may take a couple of more quarters to get over with the long tail that story that I was talking about it. We can't equate or I can't make a comment about whether B2B and B2C volume will be going in the same trajectory or not. But I think we are aiming for an overall volume growth of coming close to two-digit numbers. That's a high single-digit number as we go forward, and we can clearly see that's happening.
So this is the patient volume, not the sample volume that you're alluding to, correct?
Exactly. We are talking about the patient volume growth, yes.
Great. Just one clarification on the number of labs that were added in H1. Our presentation says a net lab addition of three, and if I heard you correctly, you said they added 17 labs in H1. So is there a rationalization of almost 14-odd labs on the Hitech portfolio?
Yeah. Actually, that is where you want to mention in your speech as well. We have just, wherever there are synergies possible between Metropolis and Hitech, we just combine those labs, and with the numbers, we'll lessen the total count, and there are also a few other geographies where we could find an opportunity of lab consolidation or the lab was not making sense to us, so some of those, in these last six months, we just took a call to consolidate that without really impacting either the revenues or customer experience at all.
All right, so will you just add about eight labs in H2?
Well, I mean, that's the plan. 25 is the number for the year, and I think we are on course.
Okay. Great. Just one last question now. Our top line, while it has grown because of volume level, but because of RPT improvements, which would be on the back of price hikes that we have taken probably at the start of this year, which would sort of be in the base by, say, Q4. Do you see volume growth to sort of expand materially to keep our top line growing by these 14%-15% number, say, after FY 2025 as well? Just broad understanding would be useful over here.
Yeah, that's right. I think our top line growth, as we mentioned in the speech, it's growing in the range of 13%-15%. Maybe a couple of quarters later, the impact of the price increase that we took last year may have a little bit faded away. But then I think the volumes should start substituting for that.
Just want to add one thing to that. Let's see, the ARPP growth is, I think, 5%-6%. Of that, the price increase is only the net price benefit is only about 2.3%-2.4%. So all of it is not coming from price increase. It is actually coming from product mix largely.
And obviously, considering that we are trying to enhance and seek higher contribution from specialty wellness portfolio, RPT should continue to increase some of the price hike numbers.
That's right. So the product mix changes will continue to drive the revenue per patient increases as they always have. Obviously, the volume growth, we would like to continue to see it to move on an upswing. And a combination of these two is where we believe that the targeted guidance should land between 13 to 15.
Got it. Many thanks. Just one small follow-up on this. Our sample per patient number is hovering around 2.07, 2.06 since three, four quarters. Would this significantly improve now that we are focusing more on wellness portfolio?
In fact, this was in the range of 2.2, 2.3 three to four quarters back. As we keep progressing on the Tru Health and the specialty getting better, now we have come closer to 2.7, 2.8. As we keep focusing on this portfolio mix of Tru Health and Wellness, this should start getting better. And we're anyway driving the bundle products in the last two, three quarters.
Okay. Thank you. That's it for mine.
Thank you. The next question is from the line of Nikhil Mathur from HDFC Mutual Fund. Please go ahead.
Yeah. Hi, all. Good morning. So my first question is around the geographic mix of revenues. So I'm on slide number 13 of the investor presentation. We would say that tier one and tier two growth was around 8% and 7% this particular quarter. So just wanted to understand what's happening on the tier one and tier two side. I don't know if you have talked about this on the opening remarks, but the growth seems to be lagging in these important clusters for the company. Is it because of B2B defocus or competitive pressure? Can you just elaborate a bit more on tier one and tier two? Yeah.
Yeah. In fact, if you remember, I just mentioned that we just a little bit defocused on the institutional business and government business, which were normally giving us the lower margins. And these businesses were largely coming from tier one cities, right? So I mean, that's one of the reasons you will find a temporary drop in the tier one revenue growth. And then also the tier three growth is definitely fueled by the increase in number of labs and centers that tier two, tier three towns. So I think maybe, like I said, one or two more quarters, we will have a little bit of a very focused view on the corporate and institutional business. And post that, I think you will see that the tier one cities are also coming to a double-digit kind of a growth.
So I'm just a bit curious to understand. Sorry. Yeah.
Nikhil, if you even in this quarter adjust for the institutional growth, for example, we had this government contract in Delhi, which was the Mohalla Clinics contract, right, which we sort of have been which has come down, etc., and we are exiting. But for example, these businesses like this, there are two, three contracts which are all part of the government institutional. So if you adjust for those and you actually look at the B2C and B2B, the tier one cities are actually doing really well. But on the reported revenue side, it will not show up because, like we said, of the degrowth on the institutional, which happened to be in these tier one cities. Let that clarify.
Yeah. Sure. Also, just curious to understand, your B2B customers predominantly would be hospitals, right, if I'm not wrong, and hospitals today are in the pink of health. I mean, if you look at how hospitals are reporting their numbers, they are at the top end of the margins that the industry has ever reported. So is the B2B non-government private market now getting more lucrative for diagnostic tests for you, or because they are so doing well, they would rather invest themselves and move their own diagnostic requirements rather than outsourcing to a company like Metropolis?
Okay. If I see, I mean, just to clarify on the B2B segments split, and if you look at this B2B segment split, a large part of B2B, Nikhil, is on the B2B smaller labs. The hospital of the B2B portfolio is relatively much smaller, right? And we keep engaging with the bigger hospitals as well as smaller labs, which is across the country, the wider geographies.
So our dependence on the big hospitals is not as high that tomorrow, if they start insourcing the tests, that will have a huge impact on our performance. So I mean, at the same time, we keep building volumes from the hospitals where we are already doing business with, and we also start keep getting more and more B2B hospitals at the same time. But our focus on B2B clients, which is basically the doctor-run pathology labs or the technician-run pathology labs, that's on the larger in terms of size. And we keep engaging with them and keep giving them better services, as I said. Yeah, please.
Yeah. I just wanted to give you a little larger context just to see the hospital business as well. If you remember that 85%-90% of it continues to be smaller hospitals. The guys you see on these listed platforms or listed exchanges are only in the top five or 10% of organized players, right, which are a handful. 85-90% of the market is unorganized, smaller hospitals like it is in diagnostics. And really, like to Sareen's point, the larger customers come from that 85-90%, not from the top 10%, which are the organized listed companies.
So the organized listed companies will obviously do their best effort to try and do more and more testing in-house. And especially teams will try to consolidate their own volumes. Now, despite all their efforts, still a fair amount gets outsourced from their hospitals because doctors sometimes don't want the hospital or pathology. They want another expert pathology player like us or somebody else. And therefore, still some amount of revenue will get outsourced. Testing will get outsourced. But that is not our key focus anyway. Our key focus is 85%-90% of the hospitals and other labs that will outsource the specialized test work who do not have the capability to do this themselves.
Understood. And one final question on the tier three market. I mean, the growth is phenomenally strong in that market. The strategy of venturing and expanding in these cities is clearly playing out, as we can see in numbers. Just wanted to understand, we are also seeing on the wider healthcare penetration side in tier two and tier three, especially when I look at hospitals, not just the top 10, but beyond that as well. They are also generating decent ROCs now in these markets, which was the biggest pain point for the overall sector till now. Do you see a correlation between more hospitals being set up in tier two, tier three, that driving your pickup as well in these markets as you are venturing in many of these cities? Any case studies, any correlation that you are able to track or understand in these markets?
I guess comment on the broader pattern, and Surendran can comment on the specifics. Just on the broader pattern that we've seen for the last five, seven years, or maybe a little bit more than that, actually, eight, nine years, is that doctors who used to come to metro markets to come and study, let's say, oncology or gastroenterology and would stay back in metros and jobs in the corporate hospitals started actually migrating back to their hometowns and setting up their own hospitals or their own practices in specialty care in their small cities.
And we started seeing this sort of reverse movement, which is why Metropolis then proceeded to say, "Look, we need to expand our labs into these cities because especially if doctors are going back into small towns, it's only a matter of time that those diagnostics will be required there." And that's the reason we went on an aggressive last four-year-old lab expansion spree in these markets, which, like you're saying, is paying off for us. We are now seeing hospitals coming up in these smaller markets as well.
And that is increasing volume because the minute you have treatment and therapy to be done in a local place, automatically the diagnostics for that will increase because more of those diseases and symptoms are getting diagnosed and then treated. We believe this trend will continue for the next at least two decades where we'll continue to see sort of strong access to healthcare in tier three, tier four markets. And that will bring about good volume for diagnostics.
Mr. Nikhil, does that answer your question?
Yes. Can I just chime in one last piece?
Sure, sir. Please go ahead.
Yeah. So the bundled testing, TruHealth, and tier three markets, at a very broad level, now quite a few quarters have passed since we have been seeing traction in both these segments. Now, if things have stabilized, what is the impact of these two segments on gross margin and EBITDA margin for the company? Are they accretive at both these line items, accretive or dilutive at gross margin, accretive at EBITDA margin? Any broad thought you can share on this?
See, largely the Tru Health Packages, the wellness packages, largely align with the company's margins, right? It's not any dilutive at all, right? And if you're able to add more tests per patient, then it will be good in terms of revenue. I mean, it will be improving because you don't have to go back and take the samples one more time, and you don't have to service it one more time. So we'll keep focus on increasing the number of tests per patient. That will really help us in terms of improving the margins. But otherwise, neither specialty nor the Tru Health Packages are diluting the margins. So in a steady state, it will only go to help us with overall margin for the company. And the tier three market is like that?
Yeah. I just want to make one comment on the tier three market. See, frankly, if you look at Metropolis's strategy currently and in the past, we focused a lot on the tier one markets, and then we started expanding our labs, like we said, in the last four years in tier three, tier four. And while that is giving us revenues, actually, it's giving us revenues, but without having a very robust sort of franchise network partnership, which operates very well. And that continues to be an opportunity for us, which I see will play out in the next few years. So I think the kind of franchise model structure that we are building now, the kind of engagement, the kind of marketing support, all of that, we believe will start boosting the revenues from the franchise network.
So not only will the productivity of the existing franchise network increase, but the numbers of the network should also increase quite significantly in the time to come. And all of this will add benefit at the bottom line. So if we're able to get that model really running very well, streamlined and tight like we're intending to do, we believe that it should be over.
Got it. Thank you so much. All these answers are very helpful.
Thank you. Before we take the next question, a reminder to all the participants, you may press star and one to ask a question. The next question is from the line of Rishi Mody from Marcellus Investment Managers. Please go ahead.
Yeah, guys. Good morning. Can you hear me?
Yes, sir.
All right. So Ameera, my first question is on the three out of the five initiatives that you mentioned that you're going to focus on. First is the wellness package. Second is the foray into adjacencies . And third is the digital initiatives to drive productivity and customer engagement. So if you could just give some more details on what exactly are you all doing for each of these initiatives, that would be helpful.
Sorry, could you repeat which three? You said one was the customer engagement.
The wellness one, the adjacencies one, and then the digital initiatives one.
Okay. I'll ask Surendran to take the one around the wellness and the digital, and I'll come in for the adjacencies.
Yeah. So, see, what we're doing is on the wellness side. We have actually curated all the packages, which is going to give good benefits in terms of the science as well as commercial for all the consumers. Bringing it to the last three quarters, all the wellness packages have been absolutely upgraded, and it becomes very, very specific to the consumer segments. Now we are also driving it through multiple channels, omni channel. One is, of course, on all the centers. All the centers that we have, we are actually trained all our phlebotomists in the center to provide good advice to the consumer who walks in about the best package if that's suited.
We've also recently launched something called a recommendation engine, which is when the patient walks into a center with a proper algorithm that's been used on the back end, the phlebotomist will be able to recommend to the patient about what are the next best tests that he or she can actually do. So one on the center, the physical centers that we have. And second one is on all the digital platform, whether it's an app or website, everywhere. When the consumer goes, he will be able to really navigate himself and figure out what is the best solution that he'd be able to get in. But we have actually powered all these digital engines, which is a website and an app, etc., in the last few quarters. So we are able to see much better traction.
And the third one is about the customer data platform that we have, the consumer base that we have. So we are able to engage with our existing customer in a much more programmed way, using much better science. And we're able to tell them and remind them at the appropriate time about what kind of a next action that they will be wanting to take. So the omni channel presence, which is helping us to engage with the consumer, and we are able to see a very good traction on the customer lifecycle management. So these are the initiatives we have taken to get the wellness portfolio right. I mean, what was the next point you said? One is on the wellness and
the digital initiatives to drive productivity and
digital, the website, and our app, and also our customer data platform. All this is part of the digital initiative that we have. And we also very recently launched something called the recommendation engine, which will be able to advise the customer about the next best action that he can take. So a combination of all this with a good execution focus, we are able to get the traction to the tier of 23%-25% on this portfolio.
Sure. That's helpful on the front-end piece. On the back-end, anything for cost optimization where digital is helping you all?
Yeah. See, today, 20% of the revenues are coming from the digital channels that we have. And digital channels, of course, doesn't carry any, what do you call, franchisee margins or anything other than the overall IT operational cost. So definitely, we are getting a much better margin on the digital. As the digital portfolio grows, we'll get much better margins. And also, the consumer experience gets that much more superior.
Okay. All right. Got it. And where do you think your wellness as a contribution will settle in?
So I said that wellness, I will put it as TruHealth together, which is illness and wellness bundles together. Today, it's at 16% of my total revenue. So we are driving this towards the first milestone we are wanting to cross is 20% in the next few quarters.
Okay. Got it. Ameera, if you could just give us the adjacencies.
See, out of probably all the diagnostic chains that are in India, there's something very unique about Metropolis, which is that the majority of the other guys are running all their operations through franchise networks. Metropolis also does that in terms of collection centers, but we have about 500-odd collection centers that we actually own and operate ourselves.
One of the goals we've been thinking about is how do you make yourself more and more relevant to the patient? Pathology is one part of their entire care paradigm, but they also need other services. In line with that, we are saying, how can we make these 500-odd centers more and more holistic in the experience they provide? Initially, we added basic radiology, talking about the adjacencies in all of these and in so many of these centers. Second of all, we're also experimenting with consultations and other models that we can provide to consumers as well. I think our idea will be how holistic care we can provide in these 500 centers.
At this point, we're just piloting, trying different models that could work. As these work, if they work well for us, then obviously we'll continue to expand them. So the inorganic growth will obviously be very focused on pathology and acquiring pathology. And organically, we will then continue to foray into these adjacencies in our own centers, which are owned and operated by us.
All right. Second, Ameera, are you guided for 26%-27% EBITDA margin over the next two, three quarters? Is this pre-Ind AS 116 or post-Ind AS 116? Does it include lease cost or does it exclude lease cost?
Yeah, I'll take that.
Yeah, go ahead.
Yeah, sorry. So this is lengthy. This is after the Ind AS 116 lease liability has been pushed below the EBITDA margin. So that's what the guidance is. Whatever you're telling is after the Ind AS 116, the proper reported audited EBITDA margin guidance.
Okay. So Ameera, if I just look at the Ind AS 116 impact, right, it's typically about 250 basis points difference that gets flown into the post-EBITDA line items. And if I look at your numbers pre-COVID, right, you all were doing about 27-28% EBITDA margins, which included the rental expense. So ideally, if you all revert back to that, you all should be 30% plus reported EBITDA margins. So I'm just trying to understand, is there something which has changed which is not allowing us to go to those levels, or if you could just do some understanding there?
Yeah. So firstly, pre-COVID, the numbers were more 27-28% for the 26%. So that's the first thing. The second thing is that we have to remember that while Ind AS changes happen, there are also many other changes that have happened. For example, GST came in. Now, while we are GST-exempt as an industry, which means we cannot collect GST from the customer, we don't get any of the reverse benefit, which means on all our costs, we have a GST impact. So finally, if you look at the GST cost as a percentage revenue, it's actually closer to 4%.
That's number one. Number two, you have to remember that our materials and all the chemicals that we use for testing are largely imported, which are usually from the U.S., Europe, Japan. And there has been a tremendous rapid appreciation in the last seven, eight years in the country. And that is the other aspect to it. But still, if you look overall, our margins have remained despite the GST impact, despite the dollar fluctuation. Despite that, the margins have actually remained stable and will continue to expand, primarily because of two things.
People talk a lot about economies of scale in our industry, but what they forget is that it's not only about economies of scale, but it's about the right quality of business. It's about making sure your discounts are—it's about making sure you're actually getting some good quality customers who are willing to pay. And I think the metrics of our business have been very strong from that angle, and which is why we believe the unit economics are strong and at least should grow.
Okay. Okay. I'm just trying to understand you, right? So all these dollar depreciation issues used to be there pre-FY 2019. I understand the volatility is higher and all of that. But over the longer term, right, do you think we'll be able to get to those levels of, say, 28-29% reported EBITDA margins?
See, I mean, honestly, it's always a question of strategy for every business, right? I mean, if you're asking me inherently, does the business have the capability to keep expanding margins, the answer is yes. Does Metropolis have the ability to keep moving towards 20%-29%? Yes. But the question is about choices and what you're wanting to do. I mean, do we want really as shareholders to keep maximizing margins or should we keep reinvesting back into businesses' growth? So I think there's a time that we believe that, look, margins are there and we can keep expanding, but we want to keep reinvesting in the business. I think it will be safer to say that the margins will continue around 26%-27%. They will be there inherently anytime we want to pull, turn a knob and release further margin we can.
But I believe that the next few years we'll continue to need investments from the company more than anything because we want to be also one of the fastest growing players from a revenue growth perspective with good quality business. So I think it's about choices, and I think it'll be a good balance for us to maximize revenue growth and still maintain good margins.
All right. So 26%-27% EBITDA margin and mid-teens growth is what I think we are comfortable with.
Yeah. That's fine. All right. Thank you.
Thank you. Reminder to all the participants, you may press star and one to ask a question. The next question is from the line of Pranav Chawla from Antique Stock Broking. Please go ahead.
Good morning, ma'am. Congratulations on a good set of results. Ma'am, what would be our regional spread between north, south, east, west for the quarter?
Sorry, what is the regional
mix between north, south, east, west for the quarter.
Okay. So exact numbers on regional split, I think we will come back to you on the exact split of the region-wide, but the trends are in line with the post, just a minute. I think I can get some number.
Sure. And have we added a focus city in this current quarter? Because I think that number has increased up significantly.
Okay. Let me come to your first question. I think our west is around half of our total business, and then about 25-26% is coming from the south, and the remaining is from the north and east. That's the contribution from the region-wide, if you ask me. And what is it? Focus cities, you're not saying the focus cities. Focus cities remain the same: Pune, Bangalore, Mumbai, Chennai, and Surat, the five focus cities. And we're growing 10% on the focus cities in the last quarter year-on-year basis.
Okay. So, sir, in the south region, I think our growth has been pretty muted. If I see our base numbers, we have broadly seen a flattish sort of a number. Anything particular that you would like to highlight over this muted growth?
So in south also, we have had a couple of institutional businesses which we have to take a call and we have to disengage with. That's one of the reasons. And going forward, we'll keep seeing south also coming and joining the party on terms of overall growth.
So can you highlight what is the quantum of institutional business in the base year-out of quarter so that we get a clearer idea?
I think when we started the year, it was close to around 10%. Then at the end of quarter two, I think we are about 7-8%.
Okay. And lastly, what would be the impact from these new centers on our margins as of now?
So I think we said about 1.2% of EBITDA is what can be rolled as a result of all the new centers and new labs, right? Like we mentioned, our mega lab expansion will largely end this year by the time we end this year. Next year onwards, we'll only have a handful of labs getting added. The center addition will continue to happen. We largely focus on out of the 500 centers get added, roughly 400 centers get added through the franchisee route, about 100 centers get added, our own centers. So not too much of a dilution on the centers specifically, but a little bit, yes. So 1.2% is the total impact of the new labs and the new centers put together. And in the next couple of years' time, this will start settling.
So, sir, if I see correctly, our major lab addition has happened in FY 2022. That is around we have added 20, 25-odd centers in FY 2022, and the next big tranche was in FY 2024. Has the FY 2022 tranche been margin positive as of now?
Yeah. So typically, it takes about two years to be positive. In year one, normally we find a minus 10% kind of an EBITDA in the new labs. And the year two, we normally see it's coming to a little bit positive, single-digit positive. And year three onwards, in the 30th month onwards, we will start seeing coming closer to the company margin. But this also has got different split. Geography-wise, this could be different. And west and south, this could be much lesser time. And north and east could be a little longer time. So on average basis, what I'm telling you. So yes, 2023, we added around 14 labs. And 2024, we added about 24 labs. And this year, so far, we added 17 labs and a little bit of lab consolidation at the same time. So currently, only probably our lab addition in FY 2024 and FY 2025 would be weighing on our profitability, most likely.
So see, two things actually get tied up because we said we want to move from 700 to 1,000 towns.
So we have just created a plan that how many labs we require to service the 1,000 towns, and that by the end of this year, largely we would have met those objectives and maybe left with maybe a few more labs or eight to 10 more labs, which we will take up in the coming year. So by the time we exit this year, our focus on 1,000 towns in terms of expansion and those being serviced by the labs that we have will actually be done with. That's the reason we are confidently saying that our strategy on lab addition and strategy on network expansion are going together.
Okay. Got it. Thank you so much, sir.
Thank you. Ladies and gentlemen, we will take that as the last question. I would now like to hand the conference over to the management for closing comments.
Thank you, everybody, for joining us today. It's been a pleasure to chat with you as always. We obviously feel very positive about the business. We've seen good growth over the last many quarters. We've seen operational efficiency run through as well, and more importantly, the brand of Metropolis is getting broader, wider, not only in the existing markets in which we are strong. We are getting much deeper, but we are also going into many new markets and creating access to patients and healthcare and building our brand amongst new doctors all over. We believe that a lot of the investments that we've made in the last three, four years, whether it was on technology, on labs, on people, on management, will continue to play through for us in the years to come.
We believe not only will Metropolis be able to accomplish good organic growth and operating leverage with it, but our M&A strategy will also play out well for us. And just to remind everyone, we have done a large amount of M&A or 20-odd deals over the last 20 years. And we have been able to very successfully integrate all our acquisitions and get value from them. The key is, like we said, is to make sure that the payment paid is fair. And once we have made the fair payment and valuation for these businesses, then it is really up to our team to execute and to drive a good ROI from it.
So we're excited. We believe there's a long runway for growth from both these levels. And we, as a team, will obviously continue to work very hard and be very focused in our attempt to be able to deliver the right value for the organization and to all the shareholders. Thanks, everyone, and talk to you next quarter.
On behalf of BNP Paribas Exane Research, that concludes this conference. Thank you for joining us, and you may now disconnect your lines.