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Nordhealth As
3/4/2025
Everyone is doing well. As per usual, this is the Q4 2024 presentation for Nord Health. So as usual, I'd like to start with introductions. I'm Charles McBain. I'm the CEO of Nord Health. And I also want to introduce Alex. Alex, maybe go ahead.
You're muted. Thanks, Charles. Hello, everyone. I'm pleased to be on this call with you today. I'm Alex. I'm the new CFO at Nord Health. I'm British, and my background is in fast-growing technology companies. Most recently, I was CFO of the Norwegian-American creative services company Superside, and before that, I was CFO of the Belgian e-bike maker Cowboy. I joined NordHealth because I think it's an exciting time for practice management software. There's an increasing consolidation of practices, creating more large enterprise clients who require more sophisticated systems. And I think NordHealth has the best team, the best product and the best strategy to be the winner in this space and deliver the best experience for healthcare professionals and ultimately for patients. So I very much look forward to working with Charles and the rest of the team to grow this business. And I'll now hand it back over to Charles for the company update. Thanks, Alex.
So as usual, we will start with the company updates, and then we'll dive into a veterinary BU-specific update, then a therapy BU-specific update, and then I'll hand it over to Alex for a financial update. And as usual, we will do a Q&A at the end. So please hold off your questions to the end, and you'll be able to use the Q&A feature to be able to ask questions. So starting with the company update. In Q4 2024, year over year, we've been able to grow our ARR organically by over 20%. That growth was driven by a net retention rate of 113%. A churn of 5.1, so still quite low churn. And also, we've been able to recruit net new customers with sales and marketing efficiency, as you can see from the CAC to new AR being 0.7. These numbers coincide to get us to 19.6 LTV to CAC. over the last 12 months ending 2024 Q4. So at the end of Q4, we had an implemented AR of 42.3 million and assigned AR of 44.3. What's important to us is the value per share, right? So the AR per share is currently 53 cents per share. Looking back as we do normally, right? So in 2018, when I joined the company and we bought Nord Health, the recurring revenue was 3.4, right? And today it's 44.3, which is a CAGR of 53%. In that 44.3, we do not include vets for pets and the U.S. enterprise chain post-rollout. So only once rollouts and pilots are successful do we actually include those in our signed AR to be conservative. This is a different way of looking at the charts. This shows the change in ARR year over year. As you can see, every year we've actually been able to acquire more or to grow ARR by a larger amount. Now, if we look at how we grew in 2024, We started the year at 33.9. We were able to get 2.6 million in new customers. Also, we were able to upset our current customers by 6.2 million. Important to note here is that this is primarily driven by the CVS implementation, given that they were previously a new customer, but as they were a current customer now, a lot of the growth and expansion as they rolled out new clinics was in NetApp. And then the second primary driver of that is our private cloud, our pre-user growth. Our churn was 5.1% over the last 12 months. And important to note on this one is that churn always goes slightly high when we're migrating and we're sunsetting individual products, as the last few users actually that decide not to migrate are now considered churn. We have, then we ended 2024 with 40.8 of AR. We've got 2.1 million of signed but not implemented AR, which leads us to 42.9 million of AR. And then our other businesses, which are e-training business and also IT operations business, legacy businesses, AR was 1.5 million. And that's how we get to our 44.3. So moving on to the next slide, this is a slide that we brought back in that I want to help investors understand how we spend money and what our targets are. So when I look at the business, I'm always looking at the ROI that we have on our investments. um that's how i figure out how much to invest in uh different initiatives so let me walk through uh this slide with you so as you can see um recurring revenue has grown from around 16.8 in 2021 to 37.4 right and you can see the growth phrase over there Then what we do is we actually look at the contribution margin. So how much cash have we actually generated despite the fact that we've been increasing the revenue? And so the contribution margin is the best proxy for pre-growth investment cash flow, right? So the way we get the contribution margin is we take the recurring revenue. We remove the COGS, customer service, maintenance R&D. This is all the development costs to maintain the legacy products, which we've acquired, but have not yet migrated. And we also take out G&A costs. So the only thing which is not included there relative to EBITDA-CAPEX is investments in acquisitions, CAC, and R&D. And so that's what we call total investments. And so how we make decisions is we look at how much we invest in those three areas, acquisitions, tax, and R&D, relative to the change in contribution margin over the years. And it's really hard to be able to look at this in one year because a lot of times these acquisitions pay back over a multi-year period. The reason why is when we buy a company, immediately when we buy them, we don't migrate them over. It takes... sometimes two, three years to be able to migrate those customers over and see the benefits of that migration in the contribution market. So as you can see, over the last three years, we've invested almost 65 million euros in tech, R&D, and acquisitions. But we've been able to have a change in contribution margin of almost 13 million euros, which is an ROI of 20%. That being said, we can see the ROI trending up in 2024. And we foresee that over time, as we migrate more, we will see that ROI actually increase relative to the 20% average over the last three years. But that's how we look at the business in the long term. The amount that we invest in either of those three growth investments relative to the change contribution margin. Now let's deep dive into veterinary. Veterinary had a spectacular year with almost 30% year over year implemented ARR growth. The particular reason why we grew was one, we successfully recruited new customers for 1.3 million, but also we were successful with the rollout of CVS and other enterprise clients. In addition, our churn, although it was 4.8 for overall for the year, if we exclude the impact that I mentioned previously, which was the impact of profit-win-vet-serve end of life, leading to a one-time churn, the churn rate would have been 2.9%. So it's a very, very, very low churn on ProVet Cloud that we can see in other legacy products that were not end-of-life. Important to note is that Indy's numbers fed for pets and the U.S. Enterprise post-pilot rollout AR are not included. Looking at profitability, we have been able to improve profitability year over year, where in 2022, the veterinary BU lost almost 3 million euros in Q4 2022 as we were investing into the product very aggressively. We reduced that to negative 1.1 million in 2023. And you can see that we have a 1.5 million improvement in 2024, Q4 relative to the previous year. The drivers of that have been, one, we've been able to grow recurring revenue. The second is that we've been more efficient with professional services. So the profitability of those professional services have increased. But we're still investing more and more in product development, which tampers this improvement. But we've also been more efficient in other costs, as we're seeing product developments yield more efficiency through automation. And there's a small restructuring costs, which are all submitted from here, which you can see are around a hundred K as in euros in Q4, 2024 and similar amounts in 2023. Now, I want to break up the growth of veterinary a little bit more to show you what the drivers of growth are. So in 2021, at the end of that year, which is the year of our IPO, we had roughly a 10.8 million of implemented AR. The majority of that came from the Nordics. So 94% of our AR came from the Nordics. The Nordics has been growing fine over the last few years. However, the majority of our growth has been boosted by our success in international markets. So in 2024, 46% of AR at the end of the year came from outside the Nordics. And that contrasts to the 6% that we had in 2021. Interestingly, 32% of the AR came from what we call our growth markets, which is the UK, US, and Southern Europe. And you can see some quite nice figures here which display our success of organically conquering new markets. You can see the UK is now at 4.3 million of AR. The US grew very well in 2024 and is now at 1.5 million. And we are continuing to grow as well in Southern Europe, which is now at 1.8 million. Interesting as well is that this is implemented AR. However, we do have 2.1 million signed AR that's not yet implemented. And 90% of that actually comes from growth markets. So if we look at signed AR, this would be even more acute. The second is driver growth in veterinary has been our success with enterprise. So ProBitCloud is a very good solution for enterprise. And we are very well positioned to capture the enterprise opportunity as we call it, which is the opportunity to acquire or to provide the PMS for companies which are currently doing a consolidation in countries. If we look at in 2021, we were the number one provider of PMS enterprise in the Nordics. Now in 2024, we are now the number one provider of PMS to enterprise in Europe. And we can see that our share, the enterprise share of Total AR has grown from 21% in 2021 to 41%. So enterprise is a bigger and bigger part of our business. And we can also see, just like in the previous slide, international was driving our growth, that enterprise is also driving our growth, where 57% of our growth in the last three years has come from enterprise clients. But what's also important to note in an enterprise strategy is the customer concentration, in that despite our focus on enterprise, our customer concentration remains low and that our top three customers together compose less than 21% of our AR. Then our next project is obviously we grow organically, but we also grow via acquisition. And so the key to making sure that acquisitions are successful is the migration. So our cloud, so basically the percentage of AR which was on cloud products, private clouds, was 37% in 2021. Now it's 74%. In 2024 specifically, 1 million euros of AR was migrated from legacy to private cloud. The churn rate for non-clad products was 9% in 2024, which is a good result relative to the previous migrations. We were successfully able to sunset that certain probit win. And now we're working on migrating probit net in Finland, Stana Malus in Norway, and VegVision in Denmark. Now onto the therapy updates. Therapy, the focus of therapy has been to build a unified platform based on the easy practice software that we can migrate all Aspect customers to. Despite our focus on migration, we were still able to grow our AR around 9.2%. As you can see, our net retention rates, including price increases, was one on one. The reason why is that our churn was 5.4, which was quite good churn for therapy, given that we've got easy practice and we're doing migration. And that was a lower churn than in 2023, which is 7.8%. So we can see our improvements in product are yielding less churn on easy practice. And also we don't have the one-off effect of physios churn for the iron. Looking at profitability, our adjusted therapy BU EBITDA minus CAPEX remained positive in 2024. We slightly grew our profitability and the drivers of that was one recurring revenue growth, 0.4 million, but that was offset by an increase in product development of 0.4 million. that product development increases mostly targeted at additional recruitment of engineers and product managers and designers for the unified platform. We're also slightly more efficient with a decrease in other costs of around 100,000. And we emitted around 400,000 in restructuring costs in 2022, none in 2023, none in 2024. Similar to the country breakdown for veterinary, we can see the country breakdown for therapy, where we have been able to grow in therapy by going international. In the therapy case though, we have grown mostly through acquisitions in those markets. We have not gone into a net new market organically with the exception of Finland and other markets. You can see here on the graph that the 7.6 is mostly Aspit, which was acquired in 2021. We can see then the addition of Denmark and other in 2022, the acquisition of EasyPractice. And as mentioned on my first slide from therapy, the current focus is migration. And so that's why we've been seeing slower growth in 2024 and we should foresee slower growth as well in 2025 due to migration. Once migration is completed, we will resume work on add-ons and potentially new country expansion as well. Now let's take a look at the therapy migration. So in 2021, 30% of our AR was on our cloud products. And today it's 45. We have only begun the migration of OSPIT with 100,000 of AR migrated in 2024. But what's very impressive is that churn for a non-cloud products was actually quite low at 2.5%. So the approach we're taking is to make sure that we keep that churn as low as possible by having a wonderful migration experience and to make sure there's good feature overlap between the legacy platform and the new platform. In 2025, we'll be focused on this migration. We'll see significant strides towards migration being progress. Now I'll hand it over to Alex for the financial update.
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