Welcome to Carasent Q1 report for 2024. For the first part of the conference call, the participants will be in listen-only mode. During the question-and-answer session, participants are able to ask questions by dialing pound key five on their telephone keypad. Now I will hand the conference over to CEO Daniel Öhman and CFO Svein Martin Bjørnstad. Please go ahead.
Hi and good morning. Welcome to Carasent's Q1 earnings call. My name is Daniel Öhman, I'm the CEO. With me I have Svein Martin Bjørnstad, our CFO. We will start with me giving some highlights and then a company update, and then Svein Martin will give a financial update. Looking at the highlights for the first quarter, I hope that you all have seen that we have released new financial targets yesterday after working hours. The background of that is that we've seen a good increase in new custom contracts. We have had more efficiency gains than we had planned for. We have sold Confrere and we have continued very low churn. That gives us very good visibility on this year and the next year. I will come back to that and give more details later in this presentation.
Other highlights is that we have a new agreement with Västra Götalandsregionen in Sweden regarding Medrave. Medrave is our system to follow up the quality of care mostly in primary care and also to automate reporting to national quality registries. Västra Götalandsregionen, VGR is now changing EHR system for the region. Then they have procured the Medrave functionality for the new EHR system. The ARR from this new contract is NOK 11 million. The ARR from the old contract was around NOK 5 million. There's a NOK 6 million increase. We also have NOK 2 million of consultancy fees connected to this that we'll have this year. In most respect, this is basically a price increase we're doing. It might sound like a lot, but the background is also that Medrave has had a lot of new functionality since VGR procured Medrave the last time.
So we are actually increasing price to catch up on that. And in general, I think we have quite good pricing power that we need to use, especially in that product. So it's mostly a price increase when they update to a new system in Västra Götaland. We have also released our e-referral solution in Stockholm for Webdoc. So e-referrals is that if you use the region's EHR system in Stockholm, you can send referrals directly to the clinic using Webdoc. It used to be before this that if you had used Webdoc in Stockholm, you had to transfer the referrals by hand from the public system to your own system. And that's quite cumbersome and really makes it more difficult to sell Webdoc when you have to transfer all those by hand. The first pilot says that he can add one more patient per day thanks to this solution.
I think that's a bit optimistic. He's an optimistic guy. But I think it's an important point he's making, and that is that if you look at users of our systems, we cost around 2% of the turnover if they use a lot of our systems and solutions. So we take roughly 2% of the turnover for our customer. But for the customer, we also set a lot of how it is to work within that clinic or hospital. So our systems are extremely important when it comes to driving your processes internally, driving profitability, all these parts. So if we're really good at that, in selling those kind of solutions and really developing them to fit our customers, if we charge 2% or 2.5% of their revenue, it doesn't matter that much. They have mostly fixed costs.
So to make sure that our systems are always up and running, never down, that we keep improving, making sure that they can do as much as they can and help as many patients as possible each day, we sit in a really good position. When it comes to growth, signed not implemented ARR is now up to NOK 40 million. It was NOK 2 million at the same time last year. And this will propel our growth next year, of course. And gives us this visibility of where we're heading in a really good way. And if you look at signed ARR at this point in time compared to the same time last year, we have an organic growth of 20%. And I think this is the most important number for us to look at. This is what says what will drive our growth going forward.
ARR is by far the most important type of revenue for us. We are more and more moving from consultancy fees to ARR. In any agreement we do, we make sure to really focus on the ARR. So for example, the new agreement with Volvat, we have focused on getting well paid for our ARR. We have low churn. This contract will last for a long time. The implementation and the consultancy work connected to that, and that's quite big in that contract, we sell at roughly half what we usually charge. It's enough to pay for our costs, but it's not where we make our profit. It's not from the consultancy fee. It's the same in VGR. We only charge NOK 2 million to get Medrave into the new EHR system. But it's the ARR we're focusing on.
In the long term, that will really help us because it adds every year. Looking at profitability, we have done additional cost savings. I think this is also an important point. Last spring, we did a big cost savings program. We changed the entire structure of the company. We put a lot of new people into new roles. Then, of course, if you do those kind of changes and so much changes, not everything is perfect day one. A big part of running a business is to every day become a little bit better. Over time, that creates a lot of improvement. We continue to get every day a bit better. What we've done since then is looking at different roles. Are they needed? Are they not needed? Did we get that right? And so on.
So we can get more and more efficient and keep getting more efficient going forward, which I really look forward to. Every role when someone leaves, we take a hard look at it and think, can we find another way of not having to hire a new person? Can we move from consultants to employees? Can we lower our COGS? And so on. And this has led to quite significant year-over-year improvements when it comes to EBITDA. And EBITDA, excluding Webdoc X, and I think Webdoc X should always be excluded when looking at this measurement on how we're doing because Webdoc X is using our position, our knowledge to create value in a completely new market for us. So it has nothing to do with the present business. But the EBITDA excluding Webdoc X goes from -NOK 11 million to +NOK 1 million. So that's a big improvement.
And we're also actually cash flow positive in the first quarter. Looking at our financial development, in the quarter, we only have organic growth. But the previous numbers actually include Confrere when you compare the revenue and all the other measurements, of course. And you can see here that the EBITDA is improving quite rapidly from back. And you can also see how we continue to invest a larger share than we used to in maintenance. And this is, I think, the most important part to win new customers is that all of our solutions really help them every day, that there are no bugs. It's always up and running. And then maintenance is really important to give us pricing power and also to drive sales. This is a more important part to drive sales than new functionality. The systems are stable. They work really well. There are no bugs.
they are always up and running because all of our solutions are mission critical. You cannot run a healthcare clinic or hospital without the EHR system up and running. So when there are bugs, when it's downtime, it really hurts the production of our customers. On this slide, you can really see how we are scaling into our cost base. So revenue has increased by NOK 7 million. And a combination of growth and cost savings lead to a larger improvement in EBITDA of NOK 30 million. What's also worth mentioning is that at the same time, we are investing in compliance and marketing and other functions. So we're not just saving money. We're trying to become a much better company to also spend more money on new things than we didn't spend on before. So it's a combination. But in total, of course, we're saving money.
Going forward, growth in ARR drives very limited costs. So that's really what I like compared to my previous business of running clinics. That here, a new revenue does not at all drive costs, especially when it comes to ARR. The consultancy is a bit different. As I hope you know, within WebDoc and most of our products, we do not have any development for a specific customer. The consultancy then is just implementation projects and helping customers with education and so on. But some of our products have some development specific customers also. And if we continue to focus, and as we do continue to focus on efficiency, we will see excellent effects on the bottom line from our growth. Looking at what we have done to drive sales, I would say the first three points are the ones where we have gotten traction.
The last two, we're not really there yet. The focus on customers is going from kind of an internal focus that we used to have to an external focus where we really discuss and meet our customers, look at what makes us more attractive in their eyes. That's the most important point. And that lead us to choose what to develop, how to improve our products, how to improve our delivery, and to always, of course, then become also more efficient in doing those things. We have invested a lot in marketing. We have new web pages for almost all products now. I think there's one or two lacking still, but almost all of them have new stories around them, new web pages, new marketing material. We are also running a lot of ads in different forums.
Most importantly, we're trying to generate a lot of leads with different types of efforts and built a marketing department based on really generating leads for our sales team to work with. We have started with outbound sales efforts. We're not really there yet. It's supported by the change in how our salespeople are paid. They now have a much larger share of the payment being dependent on how much them as individuals sell. It used to be mostly fixed salary. So I think that will also help. But it's an ongoing effort to move in that and also to learn how do we best approach a customer which is semi-warm. I would say that most of our potential customers, they are using an EHR system which they are not very happy with. I think that most of them feel that they would be better off in using Webdoc.
But you have to convince them to really take the leap, take all the work in changing the system. And as all of our customers mostly have fixed costs, it's really expensive to have some downtime also when changing EHR systems. So we're a bit reluctant to do that. And it also creates a lot of turmoil within a clinic or hospital, typically to change the EHR system. And that's why our delivery team is so important, and they do a great job. And what we're trying to market at the moment more and more is that it's quite easy to change to Webdoc. You can import all your old medical records. The customers that we do move, they are really happy with the change. When we ask them a month after to change to Webdoc, are you happy? We get really good responses.
I think to do more marketing around that will really help us because I think that's a major obstacle to changing systems. We're also doing new development to open up new markets. There I especially look forward to surgery. This has given effect. If we look now, as I mentioned previously, we have NOK 40 million of signed not implemented ARR. That's up from NOK 2 million before. If we would add that, it equals 6% growth on top of the growth we already have. The major new contracts in Norway, it's Metodika and Volvat. In Sweden for Webdoc, it's Capio and Joint Academy. For Medrave, it's Västra Götalandsregionen. So we're winning customers from many of our competitors at the moment. I think we also have quite a strong potential pipeline of new contracts, larger ones.
It's connected both to surgery, which I think will really help drive Webdoc growth even further. Also in Norway, we need new contracts at QRIS and AdOpus. That's extremely important. We are not close to where we need to be at the moment within those products. It's really needed, but it's also ongoing. I have strong beliefs in us getting further contracts. Looking at new functionality to drive growth, I've already mentioned surgery e-referrals. I really look forward to our work on the patient journey within Webdoc. Today in healthcare, you still send a lot of snail mail. You have a lot of phone calls. It's really cumbersome to be a patient. It's also cumbersome to be the caregiver because you have to send all these posts. Then people don't like what they see and read in the posts.
They call you and so on. This takes really a lot of time and effort from the clinic and makes it difficult to plan your days. Within Webdoc, we have a lot of functions that really can help the caregiver be much more efficient and just get rid of all the snail mail, the phone calls, and so on. But we need to make sure that it's a really good experience all through. We need to sell it as an experience and a process, not sell it as different functions. Me as a customer, I would have loved what we can do within Webdoc in a way that almost, yeah, no other system I've seen can do. So it's really something we can work with. HBI, we've been talking about their new functionality before and that it's not growing as fast as we wanted.
Here you see the number of tests in that new functionality from August 2022 to March 2024. You have this really exponential growth. This is how it typically looks with software, especially in healthcare. You need to have some first users. Then they talk to some other users. Then more and more users get to know about the product. It's difficult to sell a product that you don't to get someone to buy a product that they have no references on because you're quite careful within healthcare. You really don't want to take risks as a healthcare provider. It's also in the mentality of a healthcare provider. So here you can really see the growth. We hope it continues this way. You never know, of course. But it's a good sign.
In total, we have new customer growth of 5% and net retention rate of 110%. Svein Martin will talk more about it. All this leads us to our new targets. With the backlog and cost control, we have this high visibility of our results going forward. If you look here at 2023 compared to 2024, 2023, of course, includes Confrere. But the difference between 2023 and 2024 is a combination of the savings we already have done and growth and continued cost control. We feel it's quite a lot in our hands to make sure this happen and that this is very doable. Looking at 2024, 2025, more of the improvements come from higher growth and continued cost control, of course. But growth is a larger part of the improved results.
But the growth in here is the increased growth from 2024 to 2025 is roughly NOK 15 million. That's what we have in the backlog for next year. We basically know that we have that extra revenue. Of course, we have to continue to sell well in all of our products and have the underlying growth that we already have that needs to continue. We need to improve it a little bit. But most of the difference between these two years, we already have in the backlog. We feel quite good about this. Looking at the financial performance in the first quarter, we have shown you this structure before to give you a good view on how the different parts of Carasent are doing. We have the major part, which we call operations, which are the parts of Carasent that is quite healthy.
It's 86% of our revenue, so almost all of it. There we have 16% growth. EBITDA continues to improve, and especially EBITDA improves from NOK 0 to NOK 8 million in the quarter. So quite good improvement there. When it comes to the parts where we have a little bit more challenges, there we have HBI and AdOpus. We used to have Confrere also, but it's been sold. It's just 30% of our revenue. There we have a lower growth. So it's important to keep going. The signs are very positive when it comes to HBI, as you saw in the previous graph. AdOpus, we still have some work to do when it comes to growth. But costs are under control within these two products now, which feels really good, as you can see from the EBITDA going from -NOK 4 million to -NOK 1 million.
We expect to continue to improve there during the year. In Webdoc X, we have improved somewhat. We keep going from consultants to employees in that project. So that will also help us save money. HQ has improved a bit. So looking ahead, we aim to continue with strong organic growth. A lot of it is already in the backlog. I look forward to having new functionality that will drive sales even better. Efficient use of resources is, of course, extremely important when it comes to driving profitability. In this quarter, we did have additional cost savings. Those are the only one-offs that we have adjusted the EBITDA with is the cost related to layoffs of NOK 1.7 million. It's a bit all over the organization where we've seen that here we can become a bit more efficient.
But it also comes from, yeah, every time someone leaves, we look at do we need to replace this role or not, and can we replace it with someone internal and always become more efficient? And finally, which is an extremely important part in the little bit more long term, is the launch of Webdoc X. The development there is focusing on certifying the system for Germany so that someone working for a public system in Germany can start using Webdoc X. We hope to do that within the coming six months. And we're also working with acquisitions, as you know from before. I think it's an important part of rolling out Webdoc X in Germany is that it cannot be a complete greenfield. Then it will take too long and be too expensive.
So we are looking for an acquisition there to support them, to have a customer base to work with. But we have to make sure that we buy the right target and that the system of that target is ready to be replaced and it doesn't have too much functionality because then it will be too difficult. But I think we have good dialogues and look forward to continuing that work. But nothing I can go into more details now. Having said that, I will hand over to Svein Martin.
Thank you, Daniel. Although we don't see all the effects of the recent operational advancements in the figures yet, we are starting to see that our financial metrics are also improving rapidly. Revenues in Q1 were NOK 67 million, up 12% from last year. And we now have a signed ARR base of NOK 260 million, which grew organically by 20%. Our net retention rate was 110% in Q1, which shows our very solid basis for growth. If we hadn't succeeded at all on the new sales side, we would still have grown 10% the last year. Our margin is also improving. We had the 12% adjusted EBITDA margin in Q1 and the -7% EBITDA minus CapEx. That's including all the investments in Webdoc X. Quite some details on this slide. In summary, we are seeing major improvements on several levels.
As you see on the top here, Webdoc grew 25% year-over-year. Adjusting for currency, 21%, which is still a major uptick compared to the level we saw last year, which was around 15%. That shows that Webdoc is gaining momentum on both the new sales and also upsell to existing customers. Our other EHRs are growing at a steady pace. Here you see that the platform products, which is HBI and Medrave, declined. But that was due to the divestment of Confrere. And adjusting for this, we had 10% organic growth in this category as well. And our consulting revenues are down. And this is because we prioritize recurring revenues in basically all levels of the organization, as Daniel mentioned. Our gross profit increased quite significantly from 80% last year to 84% this year.
And this is driven by two main factors. Firstly, we have done a procurement process in Norway for a new hosting supplier. And that cut our cost by close to 50% on a run rate basis, around NOK 2-3 million per year. And also, the divestment of Confrere had a positive effect on the margins, given that it was very dilutive on gross margins the same period last year. Personnel expenses increased NOK 5 million.
However, this was driven by a decrease in capitalized development of more than NOK 10 million. So this is what we have talked about, that we prioritize our core products in our core markets, and then we capitalize less costs. Also, we had the one-off on the personnel expenses of NOK 1.7 million related to the layoffs in the quarter. That will drive cost savings going forward. So in total, EBITDA increased from NOK 2.3 million to NOK 6.3 million. And adjusting for the layoffs, we had adjusted EBITDA of NOK 8 million in Q1 and EBITDA minus CapEx of NOK 4.9 million. And we had a positive EBITDA minus CapEx, excluding the German expansion project. Our recurring revenues grew organically by 15% in the quarter, which is also a step up compared to the level we have seen the last few years.
It was driven by a strong net upsell of 12%, where approximately a bit less than half is related to price increases. The other half is that we continue to sell more services to our customers and that they continue to grow. Churn is very low at 2%. The new customer growth in the quarter was 5%, which is quite in line with what it has been the last few years. However, we now see that all the initiatives on the sales side are starting to pay off. We see that the ARR, including the signed not implemented ARR, is increasing quite rapidly, mainly as a result of the large new contract we have won. Looking at the signed ARR last year, it was NOK 211 million. With constant currency, we had the organic growth of 20%.
You can see that it is driven by the strong growth in the revenue backlog that increases from NOK 2 million-NOK 14 million, combined with the strong underlying basis we have, with a net retention of around 110% and the bread-and-butter new sales of around NOK 5 million. In addition, churn is very low, 1.7% for the group. That's even lower if we exclude AdOpus, which has higher churn. It's closer to 1%. That clearly shows that our system is really critical to our customers. In addition, as Daniel mentioned, we are a quite small fraction of their cost. So that combination is very powerful in terms of our churn and also our pricing power in the long term, I would say. Another highlight in Q1 is that we had a positive cash flow. Our operating cash flow was around NOK 13 million.
The increase was partly driven by the improvements in profitability. But also in Q1, we have quite strong working capital effects, as some of our products do annual invoicing for their customers. This, of course, will vary a lot from quarter to quarter. But in general, our working capital profile is very attractive and supportive to our cash flow, given that we invoice our customers in advance. That could be like three months in advance or 12 months or one month. And then we pay our invoices in arrears. So it's a positive effect that we will have in the long term as well. Investments or CapEx is significantly down from NOK 25 million to NOK 13 million. And in total, we are cash flow positive slightly, but it is a milestone for us. And our profitability is also improving rapidly.
On the left-hand side, you see that our cash profitability, excluding Webdoc X in Q1, is positive, improvement of NOK 12 million year-over-year. In Q2, we will be close to breakeven, even including Webdoc X. The main uncertainty in our business and profitability development is basically how fast we can grow our revenues, given that the cost side is very much in our own control. Combining the large contracts we have won with the underlying net retention and the bread-and-butter sales that we have delivered the last few years means that we now have much of the growth for 2024 and 2025 already secured. This gives us very strong visibility that the margins will improve rapidly as well.
This was faster than we anticipated and also at a lower cost, given that we expected that the new ARR we would generate would require more resources than the one contracts we have signed. In general, all our businesses are highly scalable. If we manage to continue to grow our revenues, our margins will expand rapidly also in the long term. With that, we can open up for questions.
If you wish to ask a question, please dial pound key five on your telephone keypad to enter the queue. If you wish to withdraw your question, please dial pound key 6 on your telephone keypad. There are no more questions at this time, so I hand the conference back to the speakers for any written questions or closing comments.
Okay. So we have gotten quite a few questions here. First one is from Rasmus Persson. Can you talk about the tender for Region Stockholm and Gotland, and any risk you see if they move to a closed system?
So I would say that today, Stockholm is basically a closed system, which we just opened up, because in Stockholm, in theory, you can choose any system you want. But if you choose another than the region system, then you have to transfer all referrals by hand, or the one sending referrals have to send you a letter in the post. And no one referring a patient will send a letter in the post. That's just a lot of work that they don't want to do. So everyone has to transfer patients by hand, or as we now can do with the help of an RPA solution, a robo-solution, we can transfer patients between the systems. And I see us doing similar things with all other systems in the regions so that our customers are free to choose systems, even if the region wants it or not. That's our aim.
So, I think they basically closed today. What they say is that the private providers will be allowed to use a public system. That's what they say so far, but there's not a demand. Stockholm has generally been there. I think that they will continue to be there. So, I feel very positive about Stockholm. That's a couple of years in the future. So now we talk about the system that will be deployed in 2029, 2030 somewhere. So it's quite far in the future. But at that point in time, I think it will be very positive for us because the major obstacle for us is that everyone needs to get people to change systems. They know that they will be more happy with WebDoc than with what they have. But it's a lot of work to change systems.
As you have seen in the press problems from time to time, people within healthcare are typically not very happy about changing systems. So if you own a private practice or a hospital group or something like this, you're very reluctant to do those changes unless you feel really, really confident that it's good. So that's our major obstacle. Region Stockholm will fix that for us because everyone will have to change systems. Also, I think everything points to Cambio winning that process. And those are the ones we're winning customers from in Sweden at the moment. So I think you saw that I had a Capio on a picture showing that we won from them. So we signed, I think it was eight clinics that moved from Cambio to Webdoc now. So I think that's all in all a very positive thing for us.
I think they are in a closed system. I think it will be less closed going forward. And also, what the government is initiating in this area is to increase interoperability between systems. There is also new EU regulation on the same thing. So I think in the longer term, we're moving to a more open environment and not a closed environment. But it's something we have to always look at. We have to be there. We have to push for it. And we have to discuss with different parties. Yeah.
Next one. You had a workshop with Cambio a few years ago where you talked about sharing information between your EHRs. Any update on the progress here?
Yeah. I don't know that specific workshop. But as I mentioned just now, there is a push from both the government and the EU on increasing interoperability between systems. There is even a government utredning, what do you say in English?
Investigation.
Investigation into new legislation where they are looking at interoperability between the systems. You have a lot of new things coming out, for example, NLL, which means that new medication list. That means that any user of any EHR system should be able to see all medication given by any other healthcare provider in Sweden. So that will really help and lessen the demand for interoperability between the systems themselves. We also have NPÖ that is part of 1177, where you can really also look at the medical records from other institutions, even if they use the same EHR or not. So I don't think the solution is really to have a one-on-one integration with Cambio. It is moving in the direction that society is moving with more and more interoperability between systems. Yeah.
Great. There is talk about Nationella Taxan, how large part of revenue within WebDoc is from doctors and physicians within Nationella Taxan.
So I think Nationella Taxan here, I think, is talking about etableringar, what you should call them in Sweden. So that is that the doctor or physiotherapist or psychologist, they have an agreement where they can by themselves just take on patients without the region having any say in it in general. It's a bit mixed. And there is always discussion on should that continue or not. I think that it was introduced in the 1990s with the right-wing government at that time said that we need to increase competition. And then you were allowed to leave the hospital. And then you didn't have to win a tender. You got this agreement with the government that you can charge the region for any care you provide within certain limits. Then it was about to be closed down back in, was it around 2000, a little bit later.
Social Democrats didn't like this at all. Then when we got the Reinfeldt government, they started allowing those contracts to be sold. So there were no new contracts awarded. But then they started selling them between themselves. So doctor to doctor, nurse to nurse, physiotherapist to physiotherapist, and so on. And ever since then, it's been really difficult for the regions to close this down because individual doctors and physiotherapists have paid a lot to get those contracts. So that's been discussed since the '90s. If that will happen or not, I don't know. The reason why the regions want to close this down is that they don't really have control of these doctors and physiotherapists, and they want to have control. They want to tender those agreements instead. I don't think we're very dependent on those agreements. But I also don't think they will disappear.
It's been an ongoing discussion for quite some time. But I would say that it's not a major problem for the regions. So it's not really a big push, but we'll see.
Next question. Can you please provide a split on net retention? I mentioned it briefly in the presentation, but if you look at our net retention, it's composed of 12% net upsell and 2% churn, basically. And on the net upsell side, price is close to half of it, so 5%-6%. And the remaining is that we have seen quite a strong momentum for several add-ons, for example, Vårdrummet recently. So that's one part, the upsell. And then the other part is that the volume growth. So that's the remaining 6%-7% in addition to price. Next question from Philip. Can you elaborate on the momentum in the sales from smaller contracts?
Yeah. So as we talk about them, it's mostly WebDoc that's winning a lot of small contracts all the time. We have good pace in small contracts. What really drives growth to get extra growth, we need also larger contracts. So in Q1, we had Joint Academy, which was quite a bit larger. We had a couple of Capio clinics going over from Cambio. So we need those larger clinics also. And that's why I look forward to surgery when we have that module up and running because typically, if you have surgery, then you have a much larger clinic. So there we have large customers waiting, and we have great discussions with them and big interest from potential customers. So we have many potential customers in that project working with us, setting all those structures. But small customers, they continue to add.
they are important because they drive net retention going forward. I mean, most start small and then they grow. So we need to continue with them. But to drive growth in more short term, we also need large clinics and private hospitals moving to our systems.
I would say also that the 21% growth for Webdoc currency adjusted is a good signal on this point that the momentum is very strong in Webdoc compared to what we have seen the last few years. Next question from Niklas. While your primary focus for acquisition is to make one in Germany, what opportunities do you see across your ecosystem in Sweden and Norway for add-ons?
Yeah. So there are a lot of interesting opportunities out there. I think there are a couple of different points here. The first one is that we cannot try to do too much at once. So even if we have a list of acquisitions that we would like in this region, we're not actively pursuing it. I think also in the private market in general, especially in the Nordics, I feel, is that if you are profitable and you have good cash flow, and you don't need to sell your business, then prices haven't gone down. They were all offered really good sums a couple of years ago, and they are not prepared to sell for less, typically. So the price has not really changed to reflect the valuations that you see in, for example, a public company.
When it comes to the ones not making a profit, and there's quite a lot of that after that boom we had those couple of years, they have come down a lot in price. But those are not the ones we want to buy. Typically, they have business models which are not really working. I think what many have made as mistakes is that they come from the outside and try to change how healthcare is provided too much. Healthcare is a slow-moving business when it comes to change. You cannot come in and try to disrupt it, especially not from the outside. That will not work. So I think that makes it also, it's not the right time, maybe, to chase opportunities when it comes to acquisitions in the Nordics.
Great. We have a few questions from Richard. Have you seen any effects with customers from product improvements, NRR, MPS, etc., potential going forward?
Yeah. I think, I mean, that Webdoc now is growing at more than 20% is what you really see there, and the net retention rate where we can increase prices a little bit more than a year ago. So I think it was in January last year. I mean, I was a customer before, and all of us customers, we felt that Webdoc was a great product, but it felt like they didn't really care about us anymore as customers. They were focused on other things. So that was a general feeling, actually, and we spoke about it between the competitors. And so one of the first things I did was to invite the Chief Digital Officer of our largest customer, Capio, here. And he said that, "I don't need a lot of new functionality.
I just need this system to really work and work well." And they were quite upset at that point in time that it did not work better, that we didn't fix things that needed to be fixed. Software, if you don't do anything, there will be more and more problems. You have to have maintenance just to make sure that it works as well as it did yesterday, basically. And now, a year later, they are really happy with the product. So we have completely different discussions with them and other customers. So that's why I feel we're in a really strong position. Yeah.
Yeah. Next question. What is your view of the long-term sustainable level of consulting revenue and its effect on EBITDA? So in Q1 now, we had consulting revenues of around 8% of the total, where recurring revenues was 92%. Given how we focus now, we expect recurring revenues to grow faster than consulting revenues. But we will always have some consulting revenues related to implementation. There could be specific projects for Metodika, etc. But the most important focus is on the recurring revenues without being too specific. Next question. What is your view on the efficiency of resources deployed into Webdoc X with only one live customer?
Yeah. So we're not trying to get more live customers in general into Webdoc X at the moment. What we're really trying to do is to make sure that it's allowed and certified for the German market. And then we want to have live customers in that market. I think it's extremely important that we develop the system for a specific customer base and not try to build a too wide system. Then you typically have issues with the customers not really liking the product you have developed. And that's what you see quite often, I would say, and part of the reason why we win customers from other systems at the moment. But you can always discuss efficiency. We're trying to become more and more efficient. The team is now smaller than it was a year ago. And I think it's also working better.
We've changed the entire structure around the team. We have a new management in place. And I feel that the team really knows what needs to be done. We now have good how to put it? When it comes to software development, it's very important to make sure that you have a good pace in demands and that the developers can meet that demand so you don't have any lags and that you have no one sitting idle at any point in time. That's kind of the factory going on here. Now within Webdoc X, we start to get that hum really going well, I think. We had a lot of changes in the personnel there to make sure to get there.
That team was employed in maybe a bit too short time with the focus on just employing the entire team in a very short period of time, which created, yeah, maybe we were not at that point in time as careful enough as we should with employment, as you always need to be. That's what we had to fix quite a lot there. I feel now it's a much better team with good internal pace and with more harmony than before.
Next one. What effects can be expected on the communicated targets for EBITDA with the potential German market entry in 2024 and 2025?
Yeah. So that includes investment in those targets include investments in Germany and Webdoc X with NOK 20 million per year, roughly. And we feel that we do not include the acquisition in that. So that's why it's just negative, that part of the case. Aiming for acquisition, we don't have it yet, so we cannot put it into the numbers. But we're aiming to buy a profitable company, which will help us scale up faster. So that should be a positive for those targets when we have that and if we have that acquisition. But this is the base case where we do not have it, and it's being rolled out quite slowly.
Yeah. And the targets now, I would say, on the revenue side is very limited effect from Webdoc X, but we have the NOK 20 million in cost. But we, of course, aim to do an acquisition that will make it potentially look quite different. Now we have quite a few questions from Market Red Eye. First one. Could you comment on what you see in Region Stockholm, given the political landscape? Your churn is low, but has this impacted your customers yet? And has it impacted new sales in the region?
Yeah. Yeah. So, Region Stockholm, now, so private healthcare in Sweden is always quite political. It's always been. I've been active here since 2006 in this landscape. Typically, there has been a lot of talk but very little action. So the private part has always grown because the private providers are cheaper than the public ones. It's easier for the region to deal with, and it just gives more care for the taxpayers. Now in Region Stockholm, I would say for the first time, you see the Social Democrats actually trying to turn the tide. Never seen that before. And they are actually trying to take some of the care into the public hospitals again from the private providers. It will be much more expensive than the care they get at the moment.
But it's the first time I actually see that the number of private providers actually will decrease and are maybe decreasing in Stockholm. But at the moment, we have quite few customers in Stockholm. So it makes it a bit more difficult to sell. It's been like that for maybe a year now. So it's a bit more challenging environment to sell in. If we wouldn't have that situation, we would be able to sell more. And most of the providers today, at least, that are working towards the public are now aiming to get insurance patients. Then WebDoc is an even better system for them. And they are also hoping, I think, to win tenders because the public hospital will not be able to manage this. The public hospitals, every year, they get a little bit less efficient. And the care need increases all the time.
So we might have some short-term headwinds there, or we have. But in the longer term, I think it's not an issue, and they will move back to the usual pace. But at the moment, it is a bit more difficult to sell. And it's been like that for like a year, I would say.
How has the response to the e-referral been so far?
Yeah. So the pilots are up and running now. As I mentioned earlier, they are very positive, maybe a bit too positive. It really saves a lot of time for them and decreases the risk for patient risks. When you process this by hand, you might miss patients. I know there was a patient, for example, where they had missed giving a response in a cancer case because this was missed in the by hand work. It went okay for the patient, but it's not acceptable that those things happen. So now we automate it. It decreases risk. So that's quite good. And it will help us sell in Stockholm. It's a key part of it. It's not a standalone thing that makes you buy the system, but it's part of the whole thing that will help us and helps us drive sales.
Have the new Capio clinics signed due to the expected surgical module, or is it tied to other underlying things such as improved downtime e-referrals, etc.?
Yeah. So it has nothing to do with the surgical module. I think it has more to do with the product improving and that they feel that we want to have customers in Sweden, that they feel that we're going after that and that we are improving the system all the time. So those clinics, they will not use the surgical module. We had to do some other development to automate reporting into the cataract register because it was eye clinics. We didn't have that before. We can sell it to also some of the existing clinics, that module. So that's a good thing. But we had to do some small, small development that we can then sell to all other customers also.
Next one. Webdoc is selling strongly. Could you talk more specifically about the upsell? What do you see here?
So what I really look forward to is this patient journey I spoke about earlier. We have a product which we call Vårdrummet, which is for the interaction with patients between the clinic and patients. And there you can have a chat with the patient. You can have video calls with the patient. You can have the patient rebooking their appointment. You can send out forms. You can do a lot of things. And what's really key between Vårdrummet and other similar solutions out there is that it's completely connected to the EHR system, WebDoc that is. So anything you do there connects directly into WebDoc. So when you change the appointment, it changes within WebDoc. If you chat with the patients, you can press a button and it goes into the medical records. Otherwise, you have to transfer it by hand in different ways.
And many systems, a good EHR system, doesn't allow you to use Control C, Control V for safety reasons. So it's really a very efficient system. But we've been selling it as singular functions, and caregivers are not the most inventive. So if you're trying to sell, you should sell a chat. It doesn't really help them very much. But if we sell a complete customer experience and how that can drive efficiency in their world and really show that, and we set it up for them, then I really believe in that product and that we can relaunch it. And there are some smaller things we have to do to make sure that that is a seamless experience. So that's the aim now. And I think that could really drive upsales. So will the surgical module.
We're also adding new partners in the network that will help us drive upsales.
And I think another part that has driven it is that upsell has been quite strong for a period. But we also last year had quite big drawdowns in volume after the pandemic. So that volume growth is now more stable than it was last year as well. Next one. Do you see a chance of a larger contract for Medrave in Skåne as well, given that the region has also procured the same public EHR system as Västra Götaland?
No. Skåne has a different type of contract. So it will not be a completely new contract with them to give Medrave to Millennium in Skåne. So no, it will not be the case. They will have Medrave also in Skåne, and they will continue to have Medrave. We are setting it up for them at the moment. But in general, and including Skåne, I think we need to look over the pricing of Medrave everywhere. We have improved the system a lot, and we haven't really charged our customers for it fully, I think. And it's creating a lot of value for our customers. So we will not have a new large contract with Skåne, but I see the opportunity in general to increase prices within Medrave. But we're analyzing it at the moment. We also have many different types of contracts in that product.
I mean, more than 90% of all primary care in Sweden use Medrave. So it will be stepwise and will be at different times, different contracts, and so on. But in general, I see a good opportunity to increase prices within Medrave.
Next one. Any update on the process of finding an acquisition in Germany?
Yeah. We have, I think, good discussions. I think every time we're there, we feel more and more strongly about this opportunity. We're very positive about that it's the right time to enter Germany. We have good discussions. This is the challenge with M&A. It's black and white. You never partially do it. You do it or don't do it. It's always important that we are ready to back off if we find something or see something that we don't like or if the negotiation doesn't go well enough. It will be very difficult to give a proper update until it's done or not done.
Do you see good acquisition targets in the Nordic region too?
I think I responded to that earlier.
Could you comment more on Ad Curis and AdOpus and their sales progress?
Yeah. So those products need more customers. I think we have good discussions and good likelihood of at least one a bit larger contract for one of those products within the coming months. Then we would have ability also in one of those products under control, which would feel really good, and we need it. Otherwise, we need to do other things. AdOpus, we've lowered costs quite a lot and rolling out AdOpus Web. We have some parts which are not really developed enough to give that customer experience that we need to give, especially when it comes to logging in and logging out of the system. It's not stable enough. But we should be there within short. We just had a customer survey, and AdOpus Web users are quite happy that they don't like, but in other circumstances, they are really happy with the system.
I'm optimistic still, but we are a bit behind schedule on AdOpus.
Next one from Philip. What gives you confidence in the 15% growth during 2024? As I understand it, most larger contracts will contribute with start in 2025. So for 2024, we, of course, have quite good visibility at the moment. And the growth we target is quite close to the run rate we are at, at NOK 67 million in Q1. And we expect some growth during the year as well. But it's correct that the larger contracts for VGR and Volvat will have the main impact in 2025, although the Medrave contract will start generating revenues in Q4 already. You are saying from Emilia , you are saying that most of the growth included in your updated targets are already secured. But can you say something about how much of the growth with new contracts will contribute in 2024 and 2025?
Yeah. So the new contract is basically why we target a higher growth in 2025 of 20%. In 2024, we expect to grow around NOK 35 million nominally, if we adjust for Confrere last year. And then if we take the same growth, which is basically how we have been growing the last few years, and add the new contracts, then we come to the 2025 figure. So we have to continue to succeed in the same pace that we have done historically and then add the new large contracts on top of that, basically.
Next one. What is your best guess on the timing on new system in Stockholm, and when do you expect to see effects from this process on your sales?
Yeah. So I mentioned this briefly before, but it's being tendered at the moment. It's to be implemented around 2029 somewhere. The plan is these two projects are typically delayed by two, three years. I think Stockholm is a bit more difficult than it usually than it should be at the moment because you have some care that the region is trying to move from the private to the public side. And also you have that the caregivers don't know really what will happen with the new system. They don't know what their options will be. So I mean, they are comparing WebDoc with something they don't know what it is yet. So I think that as we get closer to that point in time, it will be easier and easier to sell.
I mean, we're selling quite okay anyway, but it is actually quite a difficult environment to sell in at the moment. But that will take some time because 2029 is some way off. And this is the third time I think they tried to tender this system. So I think that clarity and that things get clear are always good. When our customers don't really know what the options are and what's happening, they tend to wait with big decisions like this, with changing systems, that is. So I think it is affecting us negatively. I think we just need to realize that that's how the market is and just make sure that our system is even better so that you anyway choose to change systems. And we are taking customers in Stockholm. We'll continue to take customers in Stockholm.
I think we can increase when it comes to surgery. A lot of that is in Stockholm because surgery are the big care. That's what you typically don't pay out of pocket for. If you look at a smaller region that doesn't put as much care on the private providers, then you will typically have a lot of outpatient and less surgery. In Stockholm, you have a lot of surgery within the private setting. The surgery model will be important in Stockholm, especially.
Next one, another on the potential German acquisition. How many targets would you say are ticking all the boxes of the requirements you mentioned? And would you expect that several of the legacy systems are complex, given that you typically see that systems grow in complexity over the years?
Yeah. Yeah. That's partly true. So the German market for EHR system is extremely fragmented. You have CGM owning 30% of the market, but that's not one system. That's so many different systems that they acquired and not really invested in, and not kind of pushing them together, what we can see in any major extent. So they own a lot of systems. And then there are a lot of small systems out there. So the potential target list is really long. And as you mentioned in the question, you're completely right there. It's important to make sure that what we buy does not have too much complexity. And that's something we really have to look carefully at when buying systems.
Next one. I think we have talked a little bit about, but on your ecosystem of third-party add-ons and developments here, new interesting applications or any existing applications that are gaining traction?
Yeah. So I think Vårdrummet is gaining traction. I think we can do much more to make it gain traction more. We have a new partner we're working with, which is using some AI in the speech recognition, which is maybe a bit more popular than the ones we used to sell. So that's improving. The check-in kiosks we're selling are actually we're losing some customers at, and we're moving them to Vårdrummet, which we're trying to move them to instead. So I think that's a positive. It gives us a bit less revenue but more profitability because Vårdrummet, you don't have a physical kiosk, and you don't need to have that anymore. So it hurts revenue a bit, but it's good for profitability, that move. And yeah, we add new partners all the time. But I think those are the most important changes.
Then the final question from Peder. You are not making any changes to your long-term guidance, correct?
No, that's not correct. We used to have a goal three years in the future, kind of, with the average for each year. Now, with increased visibility, we can give a much more precise guidance, but we're giving it for this year, next year. This means that we do not have a goal for the year after that yet. We see this be a very positive and optimistic as you can hear. But we don't have the same visibility on three years in the future as we have in two years in the future. We're replacing the old targets fully and now have much more granular targets for the coming two years.
Okay. That was the final question. You want to wrap up?
No. Thank you all for listening. If you have any questions or comments, just reach out. I look forward to hearing from you. Have a good day. Thank you.
Thank you.