I'm Jeff Meuler, I cover information and education solutions for Baird. Pleased to introduce Adtalem as the next presenting company. Adtalem is the leading provider of healthcare degrees, including in nursing, MDs, vets, several other degree categories throughout a portfolio of like-kind universities. With me on the stage, CEO Steve Beard. He's been CEO since 2021, been at the company since 2018, previously COO and GC. Also with us at the conference, Jay and Chandrika from the IR team. I'm going to hand it over to Steve. He's gonna do a run-through or an overview of the company, and then we're gonna have plenty of time for Q&A. I'll lead it. If you have questions, you can raise your hand, or you can send them to session1@rwbaird.com. But with that, over to you, Steve.
Thank you. Appreciate the opportunity to be with you and introduce you to the company. As Jeff said, we are the country's largest healthcare educator, based in Chicago. About 10,000 employees, 75,000 students, and about $1.7 billion in revenue. It's been quite a journey for us. We're really excited about what we do. We're a purpose-driven organization. We've got a commitment to creating long-term shareholder value, and just as importantly, we believe we're now positioned in a way that makes us systemically important to healthcare. As Jeff also mentioned, five like-kind institutions, all post-secondary higher education, and all of which are rooted largely in healthcare, which, as you know, is an industry that struggles with severe workforce shortages. We go to market through three separate segments.
The first is Chamberlain University, which is the country's largest nursing school. Delivers nursing and other health sciences programs, both on a campus-based model, online and through hybrid programs. Walden University, which is one of the country's largest comprehensive online universities, a pioneer in distance learning. Really, a strong nursing program there as well, the number three nursing school in the United States, all post-licensure. And then we have our medical and veterinary segment, which consists of two medical schools and one veterinary medical school. Taken together, we're the number one provider of MD residents to the United States, as well as the number one provider of doctors of veterinary medicine to the United States.
It's a great, diverse mix of programs, both undergraduate, graduate. Nursing, obviously, is our largest franchise, but we've got a sizable behavioral health component, which is obviously in high demand given the mental health crisis that we're dealing with here in the United States. And we're just really proud to be a scaled solution that is delivering at a time when the healthcare system needs it most. We're a national platform. You just can see here our physical footprint, which consists largely of Chamberlain campuses, but we also deliver online in over 40 states. And so we're singular in the sense that from a healthcare perspective, we're the only scaled player able to engage with providers and other healthcare delivery networks on a national basis.
When we think about the opportunity, from an investment perspective, we believe we play in a highly attractive market, healthcare. We've got scale that's market-leading and difficult to replicate. It's difficult to stand up nursing schools and medical schools because of the regulatory and accreditation hurdles that are necessary to do that. That adds to our competitive moat. We use the Walden acquisition as a catalyst to really take what had been a diversified group of assets and integrate them in a way that brings a couple of really important advantages to us. We get some incredible cost and revenue synergies, but also, we get a chance to scale best practices across all of our institutions, and we also get to face off to healthcare providers with an integrated solution.
How we think about taking the business going forward into its next phase of growth is through a strategy we refer to as Growth with Purpose. It's an operational excellence strategy, really focused on accelerating our performance across the five levers of value creation in the business: marketing, enrollment, persistence or retention, pricing, and programs. And we are working to be best in class across all of those dimensions, all while serving a community of learners that is typically overlooked by mainstream higher education. So our economic imperative and our social impact imperative are mutually reinforcing.
We launched this strategy on the heels of what we think was a strong fiscal 2023, where we grew revenue by 5% year-over-year, maintained what we think are really healthy profit margins, and grew EPS significantly. We've got a strong balance sheet. We think we've been good stewards of capital, and we look forward to realizing real operating leverage as we grow the top-line revenue through gains in total enrollment across our institutions. So if I were to fall back and just sort of restate the investment thesis for you, we are systemically important to one of the most important industries in the country, and that is healthcare. We're the only scaled provider of clinicians to that industry.
We've positioned ourselves in a way that gives us what we think is a strong competitive moat. We are launching a strategy of organic revenue growth that we think brings long-term shareholder value to our owners. We're focused on operational excellence, which we think, if we get right, is durable and can persist. And again, as I mentioned, we do it on the heels of on the basis of a strong financial balance sheet and platform that we've managed over the last couple of cycles. With respect to capital allocation, we are first and foremost focused on strengthening the business. How can we ensure that our programs and institutions can outpace the competition?
And how can we ensure that we're providing our students, the return on their investment that they deserve through programs that are tailored, with a real focus on student centricity and persistence, and matriculation to graduation? We are a high cash flow producing business, and we believe, there are accretive opportunities to return capital to shareholders, primarily through share repurchase, but also, through managing, the debt side thoughtfully. We just feel like we are good stewards of capital. We're not in an acquisitive posture at the moment. We like the portfolio we take to market today.
We think we have the right assets, but obviously, we are opportunistically looking at things that may allow us to get into markets that we're not in currently or may allow us to take capabilities to market that we don't have currently. So that's the, that's the pitch, if you will, the high-level overview. I'll leave you with a visual of Adtalem by the numbers. It's a really compelling set of metrics for our institution, and we don't think there's anything quite like it in the marketplace today. And with that, yeah, Jeff, over to you.
Thank you. Excellent overview. So just, you know, I'm sure many in the audience have been hearing about the healthcare provider shortages for quite some time. I guess, and this goes into what you said with some barriers to entry for your business, but why have we not seen the higher academic system at large, including not-for-profit universities, expand supply of healthcare education to a greater degree?
Yeah, I think there's a couple of reasons for that. I think lots of what we consider mainstream higher ed today goes to market on the basis of selectivity and historical prestige, so it would be off-brand to expand scale. In addition to that, it's difficult to do. Standing up nursing programs, expanding nursing programs requires the approval of state boards of nursing and accreditors. It also requires you to take a risk on students that aren't the very best students, which you don't have to do at selected universities. But we're in the business of expanding access, and those students that would otherwise be overlooked by mainstream universities are the audience that we actually market to. On the medical side of things, I think physicians like scarcity quite frankly.
And so, at most U.S. medical schools, classes are small by design. But we understand that the physician shortage, particularly in internal medicine and family practice, is a dire need. And so we're pleased to be able to offer those opportunities to students at scale. So I think it's a question of where folks choose to play, and what their mission is, and our mission is one of access.
Where have you seen more supply expansion or more competition? I think about things like a DO degree or online nursing. Just where have you seen it or any other areas where you've seen it, maybe capacity come out of the system?
Yeah, I think the one place where we've seen capacity grow incrementally is in medicine, through the creation of new DO schools, through incremental expansion of MD programs, and also through new entrants into the Caribbean medical school market. That having been said, that additional capacity hasn't really moved the needle on the supply-demand imbalance. There's still about two and a half applicants per seat in medical school nationally. So we still think despite the additional capacity that's been brought on board and the competitive dynamics that presents, there's plenty of opportunity for us, and we've got what we think are some attractive competitive advantages in that, in that competition.
When you talk about, you know, "Hey, it hasn't even been a needle mover on the supply-demand imbalance, these are really important industries and jobs," I guess what have the constraints been on Adtalem's growth historically? Like, considering those dynamics, why haven't you grown faster than you have?
Yeah, well, the most obvious one would have been the pandemic, which had a huge impact on both the medical schools with folks being uncomfortable traveling overseas to go to school. And given that post-licensure nursing makes up a big piece of the franchise, working nurses during the pandemic had no time to go to school. So those were barriers to growth over that three-year period. Those headwinds had dissipated by and large. We spent that time really investing in the student support model, driving up persistence rates across our programs. Now that the pandemic headwinds have dissipated, we've got the benefit of high persistence with improving trends in new enrollments, and we're excited about what that means going forward.
You talked about 5% growth in 2023 for revenue, but there was a contribution from an acquisition in that figure.
Sure.
Maybe talk about what you're assuming in terms of the guidance for 2024, as well as you've given us some multi-year targets. So just help us understand, like, how much acceleration you're expecting.
Yeah, so we put out obviously guidance for fiscal 2024 multi-year growth targets at our Investor Day. We expect modest revenue growth in fiscal 2024, flat margins relative to the prior year. But over the longer term, we're looking at 4%-6% growth on the revenue line, and 1%-2% growth on the bottom line. So, we expect to even compound that a bit more when we get into fiscal 2025. So we are definitely, I think, in a position where an attractive growth trajectory is well within our control.
The environment has normalized, and the advantages we have, both from a student outcome perspective, from a scale perspective, are ones that we can really make the most of.
I guess how much of the acceleration is it. I guess it's hard to quantify, but is it this post-pandemic recovery that is still unfolding? Because you need to have several periods or intakes with good new enrollment to fully see the benefit. How much of it is about some of the self-help components, with the growth, with a purpose strategy?
Yeah, look, I think a normalized demand environment is helpful for everyone in the sector. But to the extent we can outpace the competition, which is what we intend to do, that is really gonna be a reflection of execution against our strategy. The ability, again, to enroll, to persist, and to get students through our programs at a pace that is really a step change better than we've done historically. And we're really excited about that.
And as you said, you're systematically important to a really important industry. There's social impact. You're important to DE&I initiatives at, for the healthcare system, but you're also a regulated entity. So how do you think about regulatory or legislative risks? Maybe if you could hit on gainful employment as a part of it.
Sure. So we've restructured the portfolio in a way that we think it can thrive in any political regulatory environment. Most of our programs are programs where the return on investment for the student and the taxpayer is clear. We've got programs, by and large, that require licensure, whether it's the NCLEX in nursing or NAVLE for our veterinarians, or Step 1 MLE for doctors. And those metrics compare favorably to other universities, for-profit and not-for-profit. So when we engage with regulators and policymakers, we've got a set of data that we think proves out the value of the programs that we bring to market. Now, that having been said, in a Democratic administration, the regulatory agenda is a bit more activist. That and so you mentioned gainful employment.
We're keeping a close eye on that. We think Gainful Employment 4.0, as some refer to it, is one that's particularly susceptible to challenge, given just how draconian some of the rules are. We also think that the department is thinking constructively about some of the comments it received, unprecedented public comment on the GE rule, because of how punitive it was for some institutions, and we've gotten some, what we think are constructive questions, particularly about the veterinary program and how salaries ramp up over time. So we're hopeful that the administration produces a rule that doesn't look at a wonderful program like veterinary medicine and decide that it isn't Gainful Employment.
But if the rule as currently drafted is actually promulgated, I expect it to be the subject of quite a bit of litigation.
Okay. And, I know that you've addressed this topic at Investor Day, but I feel like I'd do a disservice-
Of course
... to the audience if I didn't flag it. So you sold an institution, DeVry. You retained some potential indemnification liability related to that sale. It's a relatively big potential number relative to your current market cap, so... But I think that you can provide some perspective on-
Happy to
... how likely it is you think you'd actually have a meaningful liability there or not?
Sure. So when we sold DeVry University in 2018, as part of that agreement, there was a trailing indemnification agreement, where we agreed to indemnify DeVry for certain liabilities up to a defined cap of $340 million. About half of that cap has been consumed at this point, Jeff, and it's a definable absolute cap at $340 million. So I don't envision a scenario where we actually hit the cap, but were we to hit the cap, we know what it is. And given the amount of cash we produce as a business each year, if you just do the math on half of the cap being consumed already, it doesn't represent a material risk to our business.
Got it. Thank you. So just wanna get into some of the institutions. Chamberlain, it's had some pandemic challenges. The new enrollment trends are getting better. Persistence is getting better. If I go back quite a few years, there was a lot of years in a row where Chamberlain was growing 20% plus. So it's been a while now. Some in the audience may not remember it.
Yeah.
Take us back to that period. Like, what was driving the growth, and is there a lesson for what is possible in the future?
Yeah. So, it was a much smaller university once upon a time, and it grew at a rapid rate on the basis of two dynamics. One was it was an early mover on RN-to-BSN, and the need for hospitals to get their nurses' bachelor's degrees to get magnet status. They were way ahead of the competition on that and were the leader in RN-to-BSN for a long, long time.... They also used that rapid growth in RN-to-BSN to expand campuses nationally. And that took time as well, but that contributed to the aggressive growth over that period of time. As we think about today's Chamberlain, the good news is that it's a model that's very difficult to replicate.
It would take someone a long time to build a franchise of that size and scale. But where we see the growth coming from going forward is really in defending our position to RN-to-BSN, because there's still a tail on that demand, but also BSN. And our goal is to own the BSN program in any way that meets the needs of the students: campus-based, online, hybrid. And there's a huge demand for that credential because for this generation of nurses, they often entered the profession through the BSN as opposed to the registered nurse credential. So, BSN online, since we launched it, has been growing at a rapid rate.
We expect that to continue, and we expect that to be the driver of growth, along with some incremental campus expansion going forward. In addition, there are the new programs that we brought online, like physician assistant programs, which are growing rapidly. And then there's all the things we're doing around specialty-focused tracks for nursing that are innovative and unique to Chamberlain. So, we just announced a partnership with DaVita on a nephrology specialty track. We've got a home healthcare track that we partner with BrightStar Health, which is the largest home healthcare provider in the country. We've got others in the pipeline.
So, while we may never get back to the 20% growth per year that Chamberlain enjoyed in its early days, we definitely can get back to rates of growth that are high single digits at a minimum. So we're excited about that.
Online BSN, I believe you're not authorized. I don't know if that's the right word for all states currently.
Mm-hmm.
There are some very large population center states that you're not currently doing online BSN. What do you have to do to expand online BSN into the, into those states?
You need to get the approval of state boards of nursing. And then once you do that, you start a program. Your program has a capped enrollment until you can demonstrate that the academic outcomes of the program are satisfactory to the state board of nursing. Then they lift the caps, and then you continue to grow the program from there. What I will tell you is there's probably no one better at standing up a new nursing program in a new market than Chamberlain. So there are markets we'd love to be in that we're not in today. And there are markets that we're in today where we think there's more demand. So we just announced a new campus in the Atlanta metro area in Stockbridge.
We've had a central Atlanta campus for a long time, but the demand there is sufficiently large that we convinced the State Board of Nursing in Georgia to let us open a second campus, and we're excited about that, and we think we can replicate that in other markets across the country.
Okay. And, your NCLEX for Chamberlain, first time passing rate on the nursing licensing exam took a step back in 2022. What drove that, and what are you doing to get it back up to your prior high rates?
Yeah. So, the decline in NCLEX scores wasn't a Chamberlain-specific issue. NCLEX scores were down nationally, which was part of the sort of learning atrophy coming out of the pandemic. We immediately jumped in to remediate that, and our most recent set of NCLEX scores are back up in the 88% range. So, we feel good about that. And even as we bring the NCLEX scores back up to the levels they had been historically, we're getting ready for the new NCLEX to ensure that we can maintain those pass rates when the new exam comes online.
So I picked up at Investor Day that Walden was getting a lot better. When you reported two months after that, it was much better than even I was expecting. So talk about what's driving the improvement at Walden.
So, as you know, Jeff, we've always been bullish on the Walden investment. Our timing was a bit unfortunate when we made the acquisition 'cause we ran right into the pandemic. That having been said, we think it is an incredible asset that was underloved in prior ownership. We brought in a new leader for the institution. We immediately got to work on what we thought were the key levers to pull to drive growth there. And we're seeing really good trends in new enrollment, record persistence at Chamberlain... I'm sorry, at Walden. The best persistence rates it's ever enjoyed in its history.
And we're seeing it in the areas that were key to the thesis for the purchase, which is nursing, health sciences, and behavioral sciences. So, we, we are excited about that trajectory. We're excited about what Walden can do, and just as importantly, it was the catalyst for the integration of the legacy Adtalem assets as well.
Can you just kind of maybe frame up Walden? It used to be owned by Laureate. Laureate does not have a lot of U.S. focus. I guess, was it run as a cash cow? What kind of investment does it need? What kind of operational change or optimization opportunity is there?
Yeah, you know, Laureate, as you'll recall, over time, shifted its focus ex-U.S.. Used its U.S.-based assets, Walden and University of St. Augustine, as really cash generation machines to fund that international expansion. There's a lot that had atrophied at Walden. The brand hadn't had a lot of attention in a while. The morale was a bit low. And you know, there had been some things that were hurting it. There was some pricing creep where they were not competitively priced. There were some programs that quite frankly just weren't as market responsive as they ought to have been. And so we've just sort of taken a fresh look at the opportunity at Walden.
We've cut down the number of starts that the university has to ensure we can maximize each of them. We've focused on persistence rather than on new starts, which had been the frame of reference previously. And we've emphasized the healthcare elements of that business in a way that hadn't been the case under prior ownership. So, we thought it was a diamond in the rough, and we were excited to prove that out.
So your two largest segments by far are Chamberlain and Walden.
Mm-hmm.
Chamberlain, new enrollment back-- or total enrollment back to growth, Walden trends getting a lot better. There was a step back in Med/Vet, which was in med. Can you just address what happened, and what are you doing to fix it?
Sure. So just to be clear, three institutions in the Med/Vet segment, two medical schools, one veterinary medical school. Vet school is doing fantastic, operating at or near capacity. It's the one institution where we actually have a wait list, and the demand in veterinary medicine is so high that we've decided to launch a DVM program at Chamberlain to try to address some of that demand. With respect to the medical schools, we had a really tough May enrollment cycle, which was largely driven by poor execution at the bottom of the funnel. We were failing to convert what was otherwise a high-demand environment. We immediately launched an effort to sort of identify the root causes of that stumble.
We made some changes in process, made some investments in training, and also made changes in leadership. So we, we feel like we have that issue well in hand. We think we'll see sequential improvement in the total enrollment trend over the next several enrollment cycles, September, and then January. And then we expect, as we come out of fiscal 2024, that we'll get back to positive comps on total enrollment in the med schools.
So you just referenced the leadership changes, but subsequent to you reporting the results, there was an 8-K about the president of Med/Vet departing Adtalem. Just... We got some questions on, like, why now? Does this mean that the issue was greater than you recognized at the time? Or if you can just address the why now.
Well, I think we have an opportunity with the medical schools and an opportunity that we haven't had in a while. You know, there've been the hurricanes and the relocations and the pandemic, and quite frankly, the demand environment for medical education is attractive, and we want to ensure that we are maximizing that. So, looking beyond just the stumble in the May enrollment cycle, we wanted to ensure that we had a team in that segment that was prepared to operate that segment at maximum performance, and so that's really what drove the change. It was an opportunity, you know, given the stumble, to take a fresh look at the team.
I'm encouraged by the interim leader that's running that business, and we've got a search going to find a permanent leader for that business, and that person will obviously be one that's as bullish on the medical schools as I am.
Okay, and then you talked about long-term operating leverage and margin expansion potential, but margins are expected to be flattish this year. Why is that?
Largely because of some of the investments we're making in the Growth with Purpose strategy. They're heavily weighted toward the first half of the year, but we expect to begin to see the return on some of those investments towards the back half of the year. Both new enrollment and total enrollment trends grow steadily during the year, and the drag of the investments tail off. So we expect to end the year in a way that allows us to have that flat margin year-over-year, despite the pressure on margins in Q1 and Q2.
And then just last, you showed us the guidance, but EPS guidance for this year, $4.20-$4.40. Stock's around $44. You talked about investing in the business, opportunistically looking at acquisitions. How do you think about buybacks and leverage?
So I think we've been pretty active in share repurchase, and I think given the current valuation of the stock and the fact that we've got a fair amount of room on our existing authorization, we'll continue to be active where it makes sense to do so because that's accretive move for our investors. So we're committed to more share repurchase, absolutely.
Excellent. That's all the time we have for questions in this room. Please join me in thanking Steve for his insights.