Great! I would like to introduce Hamed Shahbazi with WELL Health Technologies. Welcome.
Thank you very much. That was the one of the nicest introductions I've ever had in my life. Such a big smile, so authentic. Wonderful to see. Thank you. It is great to be here with you. I've been coming to LD Micro for a very long time, so some of you may remember me. I used to come for TIO Networks way back in the day, which was sold to PayPal in 2017. Public company investors did very well. I will say many, a lot of, I think, the price appreciation came from a lot of people who invested from LD Micro, so it was actually a really constructive place for us to find investors, so I'm very grateful to Chris and this platform. It's amazing.
There are actually people here that do buy stock, believe it or not. Maybe, maybe, maybe some of you are part of that group, which is incredible. So what does WELL Health do? We are a digital health company based in Vancouver, British Columbia, that tech-enables healthcare providers. I started the company because in 2016, 2017, you know, I had a couple of experiences in healthcare that drew into question whether or not I was living in 1960, or 27 or 2016, because so little had changed. It was such an under-digitized experience, and that really got me thinking. It got me curious. I started to really look into healthcare, and I found that healthcare was lagging behind other sectors in terms of its digitization and modernization.
And it was very interesting for me because, you know, arguably, physicians should be benefiting from technology the most, and I know certainly for, you know, acute purposes in hospitals and, you know, acute interventions and whatnot, they heavily rely on technology and for scientific purposes in terms of, you know, oncology and whatnot, they... But in primary care and regular care delivery, it was lagging pretty substantially. I'll give you a stat. In 2017, before the pandemic, 0.25% of all consults in Canada were attributable to telehealth.
And, you know, if you contrast that with, let's say, Kaiser Permanente in 2015, delivered more than 50% of its patient visits through telehealth. Now, the U.S. was also generally lacking in penetration in telehealth before the pandemic, but that's just one form of digital transformation and tech enablement that we do. Really, you know, I'll give you a quick snapshot. We're approaching CAD 1 billion in revenue. We'll likely cross that threshold this year. 98% of our revenue is either recurring, truly recurring or highly recurring, and we have about 3,400+ providers that work inside WELL, meaning that they provide care, you know, in one of our virtual or physical clinics. You know, and so we're - we are a care provider.
We're a tech-enabled healthcare provider, and we're unique because we also sell and provide our technology. And so over 34,000 physicians, mainly in Canada, are actually paying us for the technology. That's roughly, just over one-third of all practicing physicians in Canada. And so that would be a significant, and probably closer to about half of all physicians in the outpatient market in Canada. Off that, our guidance is about CAD 125 million-CAD 130 million in adjusted EBITDA, which maps to about CAD 100 million in shareholder EBITDA. So you take out the non-controlling interests, about CAD 100 million, and the free cash flow conversion off that is about 50%. So, we are, you know, serving a significant number of patients.
Well, roughly right now, we're around 6.1 million, you know, care interactions. Actually, sorry, that's in the trailing twelve months. Right now, we're probably closer to a couple per quarter right now, a couple million per quarter. So the way to think about WELL, that's really unique, is that we have a digital platform, and that's all the stuff in the green box here. Everything from practice management, where we are one of the top three providers in the country, in Canada, to the largest revenue cycle billing outsource billing company in Canada, to, you know, a big telehealth tools provider, everything from ePharmacy capabilities to a significant number of patient productivity apps, which are very substantial.
We don't just sell these to doctors and clinics; we also have them funded by the government. So for example, recently, the provincial government in British Columbia just recently funded a CAD 38 million dollar—gave us a CAD 30 million dollar PO in order to provide these three of our products to the entire you know doctor base in the province of BC. We have about 10,000. That's for our e-referrals, e-order, and e-consult product, which comes from our OceanMD platform. And so that same platform now has about 10,000 physicians on the platform in Ontario, and it's being used in Nova Scotia as well. We think that it'll likely become the e-referral platform for the country.
So, other thing that's recently been done is you see kinda AI tools at the bottom here. We've launched a significant number of AI tools. I'll talk a little bit about that in the future, in future slides here. But what's unique about WELL is that, aside from this green box, you have the blue box, and the blue box is our care delivery service. So in Canada, we à la carte sell the technology. In the U.S., we don't do that, only in Canada. But in both the U.S. and Canada, we own and operate a significant care delivery business, and this is those 3,400 physicians work at a WELL......
Virtual or physical clinic, and that's a fairly integrated. In Canada, it's a fairly integrated national platform of primary, specialized care, and diagnostic clinics. So back to kind of the two different ways that you can interact with WELL: à la carte services, you can, you know, pay us for our tools, and this year we'll have about a CAD 75 million SaaS and services business. And then the vast majority of our revenues is generated by our fully managed care network. And so, you know, why have we configured it this way? Well, you know, doctors don't love paying for SaaS. Doctors, you know, it's even though doctors are wealthy and they, you know, generate a lot of economic activity, they're not huge SaaS customers.
So if you wanna be really relevant and really valuable to them, the best way of getting access to their economic output is to partner with them. Fortunately, they need a lot more of that. You know, increasingly, they do not wanna run a business and provide care at the same time. This is a global trend. Previously, the practice of running a doctor's office was fairly simple. You had your wall of folders, you know, you had your assistant, you know, walk into a consult room, you'd get handed the folder, you'd sit there, you would talk to the patient, you'd scribble a few notes, hand the folder back, and away you go. Then electronic medical records got introduced.
This started to become a requirement, you know, that's pushed by a lot of governments. And now, as a physician, you had to transcribe your notes, you had to have your head buried in the laptop and transcribe a bunch of notes, and then you had a bunch of requirements to ensure that there were medically relevant documentation that were being pulled together. And then you would be pulling in a bunch of other notes from and artifacts from hospitals, from X-ray centers, from labs. And so this practice management software or electronic medical or EHR software started to build dramatic amounts of data. I would argue that actually all that data is not doing much for doctors today.
It's actually made their lives more difficult. Until now, where our digital platform is able to with these AI tools... And, let's see, do we have an AI slide here? Oh, there we go. Yeah. So AI product suite. So, these are the three AI recent AI products that we've launched. One is called-- One's an ambient scribe. So it's an AI scribe that listens to the conversation with patient and provider consent, and not only transcribes the information, but uses generative AI to construct a note that's medically relevant. This, what we found, we now have the majority of our primary care providers in our own network using this, and we're selling this, and it's Canada's leading AI scribe now. That's the best-selling AI scribe.
It's returning 3.5 minutes per patient consultation, which a normal primary care physician is doing 30-40 consults a day. So giving them back 2 hours of their day. So think about how important that is. And this is just, you know, version 1. This is V1 of an ambient scribe. In the future, instead of just producing a note, it'll also pick off, you know, different elements that occurred within that consultation, let's say a referral, and it would automatically create the referral pathways and orchestrate those next events. So it's an enormously consequential piece of technology. And again, we are, you know, one of the market leaders in developing this. The second is WELL AI Decision Support. This is clinical decision support software.
Think of a, you know, physician copilot that leverages AI technology that is now able to take advantage of all that data sitting in the patient summaries, sitting in the EHR. We have launched this. The early aspect of this is a rare disease copilot. We've partnered with our affiliate, HEALWELL AI. They presented here today. In fact, the CEO is sitting right there, Alex Dobranowski. You may have seen him. If you have any questions, you can ask him. But they have built some phenomenal technology. They have very deep AI technology. They started with a rare disease copilot, but they have significant patient identification capabilities, where they can take EHR data and query it to very low levels.
Last week, they had a pretty significant announcement involving precision oncology, where they were able to use a large language model to, you know, prosecute the data, EHR data. It was funded by J&J, Johnson & Johnson, and identify a bunch of lung cancer patients with a rare form of lung cancer. Why this is really important to us is that we've partnered our data into HEALWELL, and we are the biggest shareholders, and we have a path to control with HEALWELL. So if we take advantage of all of our options, we would have 90% of the vote and just over 40% of the stock.
Within a year, you know, actually, not even a year, HEALWELL's gone from, you know, less than CAD 10 million market cap to, probably now well over CAD 200 million market cap on a fully diluted basis. So it's been really, a tremendous run. So I urge you to take a, you know, take a look at HEALWELL. The third AI product that we've launched is WELL AI Inbox Administration... this is a workflow manager that basically helps orchestrate workflow. So, you know, in healthcare, believe it or not, there's still significant numbers of faxes that occur.
Instead of, you know, you know, manually processing these faxes, our technology is able to digitize the faxes, actually cut out aspects of them, and automatically orchestrate them into the patient record, and orchestrate other aspects of the experience. So basically makes clinicians' lives easier. This is just the early product suite, but already it is by far the most compelling AI product suite in Canadian healthcare. So coming back up here, you know, really a big part of why WELL is successful in its care delivery business is this slide. So if you forget every other thing that I said, don't forget this slide. So we're gonna talk about this slide. I love saying that 'cause everyone's like: "Oh, shit, I better listen now," 'cause I've been listening at all.
No, but seriously, physicians have a return on time business model, right? So they-- they're fee for service. They don't get paid on a per, you know, return on equity basis. You know, the vast majority of the business is I make a consult, I spend time, I get paid for my time. The problem is when they're running a practice, they're spending time on things that they're not getting paid for. They're doing a lot of paperwork, they're doing a lot of administration, they're doing a ton of appointment management, you know, they're managing queues, and even if they're not doing that themselves, they're hiring and firing people that are doing that.
So they're running a business and providing care, and that is becoming very difficult for them because the administrative requirements and now the technology requirements, as technology started to disrupt healthcare, is becoming very challenging for them. And for this reason, you know, you know, over 50% of physicians attribute burnout to manual tasks like charting and paperwork, and basically administrative time is really hurting them. So what we do is we take the same revenue share relationship that they already have. So a doctor working in a small clinic has typically a 70-30 rev share relationship with their clinic.
So they keep 70% of all the consult revenue that comes from all the different reimbursement sources, which in Canada is typically the government, and 30% of that goes to pay for the OpEx of the clinic. If there was a small clinic of two or three doctors or 10 doctors, that's how it usually works. But remember, they still have to run a business on top of that. When they come to WELL, they get their 70-30, but they don't have to do anything but see patients. So they get a whole bunch of time back. So guess what? They see more patients, they make more money, they're happier. And this is something that we see again and again, and again.
In the last couple of years, instead of, you know, acquiring clinics, we've now been having clinics come to us and say: "I don't know if you would acquire my clinic, but even if you don't, let me give you the keys. Please run my clinic for me, because I am finding it so hard to run a clinic and provide care at the same time." We call this our absorption program. We recently, for example, absorbed the largest clinic in the province of Manitoba that does CAD 24 million in revenue, over 50 physicians, for CAD 375,000. In our third month, we had an ROI on this business, and then we just found out that the reimbursement in Manitoba is increased by 15%-20%.
So we'll likely have 5%-10% operating EBITDA margins on that CAD 24 million this year. In fact, we think we can grow the CAD 24 million to probably CAD 34 million over the next few years because a bunch of physicians had left the practice before we, we bought it. That's just one example of what we're seeing in Canada. The Canadian ecosystem, you have to think about it a little bit different than in the United States. We don't have the same complexity in our healthcare ecosystem, we don't have health insurance payers. We have, you know, we have different payers arranged on a provincial basis. So we have every province is a payer, and those payers pay on time. There's no, there's no rigmarole in getting paid.
That's a really important part of how to think about how the two countries differ. The only difference is that Canadian reimbursement is on the rise. For the longest time, Canada did not pay doctors, you know, give them enough raises to stay in balance with the CPI growth, you know, inflation, and this has now become a bit of a big issue in Canada, and physicians have been very unhappy, and some of them have been leaving the practice. So reimbursement trends are dramatically moving up in Canada. So that should really benefit WELL's organic growth. That's something to be aware of.
But, this slide really exemplifies what happens when our platform is used, especially when it's used in a fully managed environment, as I mentioned earlier. So how are we doing on time?
You have 3 minutes, and then 5 minutes for questions.
Okay. Are we done? Let's see.
Yeah.
Okay, yeah. So we got two more minutes left. Okay, great. So yeah. So there's essentially three lines of business: WELL Canada, WELL USA, and our platform solutions, which is Canada as well. So you'll actually notice that the majority of WELL's revenue comes from the United States and the majority of our EBITDA, but we're growing faster in Canada. In fact, last quarter, we generated more shareholder EBITDA in Canada than we did in the United States. So we're, and our 2023 EBITDA in Canada grew by 39% year-over-year to CAD 42.5 million. So our Canadian business is on fire, and we are the largest market share owner in care delivery.
We own just shy of 1% of all physician spending in the entire country, and we're larger than the next five competitors combined after that. So you've got this huge, fragmented industry. We're a very small share owner, and we're the largest by far. We think we can get from roughly 1%-10% over the next few years. So just think about what that means, and there's no one, no one in front of us, and public sector really likes us and starting to giving us more, you know, the software contracts. So we're very, very pleased with that. The thing you should remember about this is that, again, you have 33,000, one-third of all Canadian physicians using the à la carte service. By the end of this year, it'll be 40%.
Within two years, we think it'll be closer to 50% of all physicians touching WELL's platform. But this isn't the big revenue generator, the care delivery side is, right? As I mentioned before, that's where you acquire more of the physician's economic output. But so many physicians know about WELL, so when they're ready to not run a clinic anymore, guess who they're going to? They're going to WELL, and that's really. So you can see this big flywheel, you know, 'cause you could say, "well, why be in this à la carte business if it's a small part of the revenue?" Because it generates enormous opportunities for our care delivery business. So that's pretty much it. You know, these are all the categories where we are number one in Canada.
No. 1 owned and operated clinics, No. 1 in omni-channel patient visits, No. 1 in RCM, digital patient management, e-referral volume, and we have the No. 1 app ecosystem for integrated EMR apps. So, I will see if there's any questions.
How do you contrast your business from competitors, in either Canada or the U.S.? I would think if you have a software platform, you'd stick to that business. Can you just compare a business model to what's out there and how people do things?
Yeah. So in terms of competitors, I would say very few people do both of these things. So you see a lot of either software companies or you see care delivery companies that are kind of consolidating clinics, maybe rolling clinics up and trying to cost optimize and things of that nature. What's different about us, we put this in a press release a few weeks ago, but if you look at all of our clinics that we bought and you don't cherry-pick, you take, like, a vintage analysis of any clinic that we bought, this is a six-year-old company. You know, I found this company six years ago. So all the clinics up until, you know, 2022, we didn't choose at 2023 because it was so recent.
The average clinic's profits grew by 31% after we acquired it, and so, and so, you know, that's because of the digital transformation. That's because when we started this business, less than 5% of all clinics had any kind of online patient booking. So in order to even secure an appointment at a clinic, you had to call someone. Someone had to take your call, someone had to, you know, do something manually. So when we come into a clinic, we start adding workflow and software and, you know, online patient booking and waiting room automation and, and so, and so there are different vendors.
The thing that I would say is, there's different vendors and different competitors that we have on a per line of business basis, or even in that green box, we may have competitors in that, but no one has as comprehensive a platform as we do in the country. Yeah. The thing that I will say, that's really important too, is in the U.S., we have a couple of assets, Circle and Wisp, that are significant-sized telehealth businesses. You know, Circle will do about $100 million in revenue this year, and Wisp will do about CAD 100 million this year. Both operating this year, probably at 4% or 5% EBITDA margins. We are majority owners of these businesses.
We have call options and processes that end this year, so we either have to take them public, buy the balance of them, or sell them. We are in the process of figuring that out right now. We will likely sell these assets 'cause they don't contribute a lot to our EBITDA, and so that is a major catalyst. You know, TD Bank just did an analysis that shows that, you know, just by selling, you know, getting sort of mediocre rates for both of these, we're likely a minimum CAD 5 stock. We're currently about CAD 3.75. So that just gives you a sense of, you know, some hidden value and some sum of parts. We're trading at a major discount to sum of parts right now.
So if you're looking for catalysts, I think they're tremendous catalysts. We started buying stock back, a couple of weeks ago. They're small amounts every day, but it just shows a very different way of thinking that we now have as a business. We're dramatically going to be reducing any kind of dilution because we believe that we've now built the network. And now that we've built the network, the cash flow is there. We're gonna be using the cash flow. We just had a very successful cost optimization program, so we're gonna be likely buying a lot of stock and reducing the float size over time now. So hopefully, Yeah, go ahead.
How do you finance the purchase of the clinics?
How do we finance-
The purchase of the clinics?
So for the longest time, we would do cash, stock, and earn-outs. Now, increasingly, we're not issuing any more shares. We're basically using cash, or we're just recruiting full-blown clinics, and we're not paying. We're paying nominal fees for them, like we did with that Alberta, Manitoba clinic.
What's the same- clinic sales growth of the company versus?
Yeah, it's a great question. So we recently had a press release about that a couple of weeks ago. It was in the same release where we talked about reimbursement growth in Canada, and we had our organic growth rates, our total organic growth rates at double digit, and the same clinic growth rates overall were in primary care, also low double digits, and in other aspect, like our specialized care, was high single digits. Which is really hard to do in healthcare, by the way, to have same clinic growth in low double digits or high single digits. These are typically businesses that don't grow, right? But that's actually. You know, we're actually causing these things to grow truly organically, and then we're adding more into our network. Great. Did you wanna ask your last question?
We have one-
No, I'm not allowed.
No, well, our next presentation is in 5 minutes, so if it's very quick.
Yeah, go for it.
I'm just curious: So the U.S., you know, is a market that's dominated by, you know, Epic. I heard you stress the word community at one point. And does that mean in the U.S., you're essentially thinking about you go after this, but you leave Epic, you know, Epic, still Epic in the big hospitals, but you guys are gonna focus on this kind of, you know, smaller-
Yeah
... regional community style?
Yeah. We don't even sell the software in the United States. We only use it ourselves. In Canada, we'll sell it, but only in the outpatient model. To your point, there's no point in going after the big hospitals. That's Epic, Cerner. They've got all that sewn up.
So you're thinking more like a One Medical kind of approach?
Yeah, yeah. I mean, that's a highly integrated hybrid offering-
Yeah
... that Amazon bought. It was losing a ton of money.
Yeah, yeah.
but yeah, so our Circle Medical, which will do about $100 million this year at 4%-5% EBITDA margins, that's similar to One Medical, but it's a lot more virtual than it is physical.
Okay. All right, thank you.
Thank you.