Q3 2023 Afya Ltd Earnings Call

Participants

Luis Andre Carpintero Blanco; CFO; Afya Limited

Renata Couto; IR Executive Manager; Afya Limited

Virgilio Deloy Capobianco Gibbon; CEO; Afya Limited

Lucas Dai Nagano; Research Associate; Morgan Stanley, Research Division

Lucca Generali Marquezini; Analyst; Itaú Corretora de Valores S.A., Research Division

Marcelo Peev dos Santos; Senior Analyst; JPMorgan Chase & Co, Research Division

Unidentified Analyst

Presentation

Renata Couto

Thank you for joining us for Afya's Third Quarter 2023 Conference Call. Today, I'm here with Afya's CEO Virgilio Gibbon; and Luis Andre Blanco, our CFO. During this presentation, our executives will make forward-looking statements. Forward-looking statements could be related to future events, future financial operating performance, known and unknown risks, uncertainties and other factors that may cause actual results to differ materially from those contemplated by these forward-looking statements.
Forward-looking statements in this presentation include, but are not limited to, statements related to the business and financial performance, expectations and guidance for future periods or expectations regarding the company's strategic product initiatives, its related benefits and our expectations regarding the market. These risks include those more fully described in our filings with the Securities and Exchange Commission. The forward-looking statements in this presentation are based on the information available to us as the date hereof. You should not rely on that as predictions of future events, and we disclaim any obligation to update any forward-looking statements, except as required by law.
In addition, management may reference non-IFRS measures on this call. These measures are not intended to be considered in insolation or as a substitute of the results prepared in accordance with IFRS. This presentation has reconciled these non-IFRS financial measures to the most directly comparable IFRS financial measures. Let me now turn the call over to Virgilio Gibbon, Afya's CEO.

Virgilio Deloy Capobianco Gibbon

Thank you, Renata, and thanks, everyone, for joining us today. As we approach to the end of the year, we can see Afya maintaining the strong pace. So moving on to Page #3. Let's start with our quarter highlights.
Adjusted net revenue grew almost 25% year-over-year, reaching BRL 723 million, followed by an adjusted EBITDA growth of nearly 22% year-over-year, reaching BRL 278 million with a margin of 39%. We also reported a record cash flow from operating activities generated, ending the 9 months period with BRL 934 million, 26% higher than last year, with a cash conversion of 109%, and we were able to reduce our net debt to BRL 418 million when compared to December 2022, even with UNIT and FITS acquisition in January, as we will see on the Slide 14.
Adjusted net income followed the same positive trend of last quarter and reached BRL 128 million, a growth of 7% year-over-year with an adjusted EPS of BRL 1.38, 7% higher than last year, even considering a higher net debt level and a higher interest rate. This result reflects Afya's great capital allocation discipline on buybacks, M&A and an efficient capital structure.
In this quarter, we have reached 3,113 operating seats with the acquisition of UNIT and FITS, the beginning of Mais Medicos operations, along with (inaudible), representing an increase of 15% year-over-year. Our number of undergrad medical students has reached more than 21,000, representing a 20% growth compared to the same period last year.
In the Continuing Education segment, we continue to see great results, presenting a net revenue growth of 35% year-over-year. Once again, after reporting great results on the Digital Health Services revenue, which ended the quarter with an increase of more than 19% year-over-year, reaching more than BRL 53 million in the 3 months period. This result reinforces the great opportunity ahead in the Digital Services and is explained by the strong ramp-up on B2B engagements with new contracts with pharmaceutical industries companies and the continuous ramp-up on B2B contracts.
Last but not least, our ecosystem reached 280,005 active users, what represents around 34% of the Brazilian physicians and medical students market. Moving now to Slide #4. We will talk about our solid business execution within our three business units, starting with the Undergrad segment.
We saw important movements throughout the quarter, such as higher tickets in medicine courses with 9% increase in medicine tuition for the 9-month period and the maturation of medical seats. We are delighted to present that the most significant growth in terms of revenue came from the Continuing Education segment with 35% growth year-over-year due to a robust intake process, new campuses and course maturation.
On our Digital Services segment, we ended the quarter with a revenue increase of 19% compared to last year. This result reinforces the opportunity ahead in Digital Services and is explained by the ramp-up in B2B engagements that boosted net revenues and grew more than 75% with new contracts with the pharma industry and the continuous ramp-up on B2B contracts.
In the next slide, we are reaffirming our guidance for 2023, which considers the successful concluded acceptance of new medical students, ensuring 100% of occupancy in all its medical schools. Considering the above factors, the guidance for 2023 is defined as shown in the charts.
Adjusted net revenue is expected to be between BRL 2.750 billion and BRL 2.850 billion, and the adjusted EBITDA is expected to be between BRL 1.1 billion and BRL 1.2 billion, excluding any acquisitions that may be concluded after the issuance of this guidance. And also, considering the increase of (inaudible) contribution rate.
In other words, after 2023, net revenues and adjusted EBITDA will be almost 4x higher than 2019, the year of our IPO. Furthermore, the cash conversion rate will continue to perform above 90%, which shows our capacity to deliver strong growth, expanding our profitability and cash generation. Once again, we are guiding another strong (inaudible) the top of the year guidance, improving Afya's resiliencies and abilities to keep delivering solid results with a high predictability.
And now moving to Slide #6. On October 4, The Ministry of Education announced the rules for the Mais Medicos 3, which defined the criteria for medical seats expansion throughout Brazil, aiming to achieve OECD average of 3.3 physicians per 1,000 inhabitants in 10 years. The new program will allow the opening of nearly 10,000 new undergrad seats, of which 5,700 seats will be distributed through 25 health regions across 95 cities, considering 66 per entity.
In addition, approximately 2,000 will be allocated to existing private institutions and another 2,000 allocated to the public system. As separating the notice from Mais Medicos 3, each organization is eligible to compete for two health regions. Afya has 18 entities with 17 of them offering high-quality medical courses. Mais Medicos 3 presents a significant opportunity to expand Afya's medical courses in Brazil and address the pressing need for more health care professionals in underserved areas. Afya is committed to engage in the program with high-quality proposals and enhancing the standards of medicine courses throughout the country. Now I'll turn the call over to Luis Blanco, Afya's CFO, to give more color on the financial and operational metrics. Thank you.

Luis Andre Carpintero Blanco

Thank you, Virgilio, and good evening, everyone. Starting with Slide #8 to discuss the financial highlights of the third quarter. It is with much satisfaction that I present another strong quarter results for Afya.
Adjusted net revenue for the quarter was up almost 25% year-over-year to BRL 723 million. For the 9-month period, adjusted net revenue was BRL 2.145 million, an increase of 24% over the same period of the last year, reflecting the maturation of medical seats, higher tickets in medicine courses and the ramp-up of Continuing Education, boosted by the growth in the number of students. Once again, the Digital Services segment has also contributed to the revenue growth this quarter with the increase of the B2B engagements and active payers expansions in B2P.
Adjusted EBITDA for this quarter increased almost 22% to BRL 278 million, while the adjusted EBITDA margin decreased 90 basis points to 38.5%. For the 9-month period, adjusted EBITDA was BRL 877 million, an increase of around 22% over the same period of the prior year with adjusted EBITDA margin decrease of 80 basis points in the same period. The adjusted EBITDA margin reduction is mainly due to mix of net revenues with higher participations of the Continuing Education segment and the consolidation of 4 Mais Medicos campuses that started operation on the third quarter 2022 and UNIT Alagoas and FITS Jaboatao, which are performing better than expected, but still present lower margins when compared to the integrated companies.
Moving to the next slide. Cash flow from operating activities for the 9-month period was 26% higher year-over-year, totaling BRL 934 million, resulting in a strong cash conversion ratio of over 109%. Adjusted net income for the third quarter of 2023 was BRL 128 million, an increase of 7% over the same period of the prior year, mainly due to the increase in operational results, which was partially offset by higher financial expenses.
Adjusted net income for the 9 months of 2023 was BRL 427 million, an increase of 5% year-over-year. Even with higher interest rates year-over-year and an increase in debt with acquisitions of UNIT Alagoas and FITS Jaboatao, our adjusted EPS keep increasing due to operational leverage reaching BRL 1.38 and BRL 4.58 per share in the third quarter and 9-month periods, respectively.
Moving to Slide #10 for a discussion of key operational metrics by business unit. Starting with the Undergrad progress. Our number of medical students grew 20% year-over-year, reaching more than 21,000 students with operating medical seats increasing 15% year-over-year. With our net average ticket for the 9 months of medical school increasing 9% year-over-year, we've reached BRL 2,446 million in combined tuition fees, up from BRL 1,978 million from the prior year, an increase of 24%. Regarding the revenue mix, 79% was derivative from medical school students and 91% from health-related courses.
On the next page, I will present our Continuing Education metrics. As said before, we saw another quarter with great recovery in our Continuing Education segment, with an increase of nearly 23% in the number of students compared to the last year, reaching 4,954 students. In this quarter, net revenues for the segment grew 35% compared to the same period of the prior year. And for the 9-month period, we saw an increase of 43%, reaching a net revenue of BRL 108 million.
Moving to Slide #12, I will discuss the Digital Services operational metrics. On the first graph, you can see our total active payers, which are those ones that generate revenues in B2B. With a continuous growth trend in this quarter, we've reached 217,000 paying users, a 12% growth compared to the last year. As you can see in the second graph, our ecosystem reached 285,000 monthly active users, representing around 34% of all medical students and physicians in Brazil, as Virgilio said before.
Finally, our last graph shows our digital service net revenues for the quarter, which increased more than 19% year-over-year and regarding the 9-month period increased by almost 22% year-over-year. The organic growth is the combination of the start of the B2B engagements with pharmaceutical companies and the expansion of active payers in the B2P.
In addition, since 2022, we started to break down our Digital Services net revenue within B2P and B2B segments. So from the BRL 164 million of Digital Services net revenues during the 9-month period, more than BRL 134 million came from the B2P and almost BRL 30 million came from B2B. B2B strategy holds a huge potential (inaudible).
And now moving to my 3 last slides, I will discuss our cash and net debt positions, also giving more color on our cost of debt. Cash and cash equivalents at the end of the quarter were BRL 822 million, an increase of 15% over the third quarter 2022, and an increase of 11% over the second quarter 2023. Net debt, excluding IFRS 16, totaled BRL 1.788 billion compared to the net debt of BRL 1.348 billion in the same period of 2022. The increases when compared to the third quarter of 2022 is mainly due to the BRL 825 million of UNIT Alagoas and FITS Jaboatao acquisitions, closed on January 2, 2023, which was partially offset by the free cash flow generation in the first 9-month period of 2023, as we can look closely on the next page.
In this slide, I presented the net debt reconciliations for 2023. The cash flow from operating activities was allocated to income tax and lease payments. CapEx activities for the service of the financial debt and our churn buyback program. We were able to generate BRL 418 million as free cash and reduced our net debt in the 9-month period.
On the next slide, you can see a table with the breakdown of our gross debt and our total cost of debt, considering our main debt, the Softbank transaction, other loans and finance, account payables to selling shareholders plus other financial obligations. Our capital structure remains solid with a conservative leverage position and the low cost of debt.
This ends our prepared remarks. As we approach the end of the year, even considering the challenging economic and political scenario, we can gladly see Afya delivering strong results. With a quarter marked by significant increases in net revenues in our 3 segments, positive EBITDA, cash generations and EPS growth and the consistent business expansion. I will now open the conference for the Q&A session. Thank you.

Question and Answer Session

Renata Couto

(Operator Instructions) We are going to start our Q&A with Lucas Nagano from Morgan Stanley.

Lucas Dai Nagano

We have two questions. First one is related to Mais Medicos 3. Is it possible to provide us some color on your plans for the program in terms of how many proposals you plan to submit, how many seats does it represent, and which regions you're targeting?
And the second question is related to tuition readjustment for the next year. So how much you're increasing prices for 2024? And if it -- there is between schools, so -- if you could give us some color on the range of tuition readjustment in all of Afya's schools?

Virgilio Deloy Capobianco Gibbon

Hi Lucas, Virgilio, thanks for your question. So regarding the Mais Medicos 3, we have 18 institutions that all of them is going to propose for additional two medical schools. So we will be allowed to send the proposal for 36 new additional schools. So the number of medical seats will be 36x60 per school. So this is the number that we are going to participate on this entire process. So regarding the tuition adjustment, I'll pass to Blanco here to give you more color.

Luis Andre Carpintero Blanco

It's Blanco speaking. Regarding the second question about readjustments. We have defined the increase in tuition fees for the next year. Specifically from the medicine courses, we are increasing most part of the courses in 4.95% for freshmen and existing students. Most part of our institutions, we're going to have this kind of readjustments.

Renata Couto

The next question comes from Marcelo Santos from JPMorgan.

Marcelo Peev dos Santos

I have two questions. The first is, considering we are already in the middle of the fourth quarter, would you please provide an update on the outlook of the prep business, probably already had a lot of the intake. So it would be interesting to see how do you see this next cycle?
The second question is, if you could comment a bit on digital business. We saw a slight sequential decline in revenues, so isn't this a business where we should be hoping for a little bit higher growth? Could you please comment this change from the second to the third quarter, what are the moving parts here? And how do you see this moving forward?

Virgilio Deloy Capobianco Gibbon

I will get the question about the prep course here. So this is basically regarding the Medcel operations. So the 9 months, we are operating below the trend when you compare to last year, the same period last year. Remember that the seasonality -- we have the new offer for 2024 cohort starting in end of September, October.
So what we are seeing from October and November that the volume intake that we are seeing, it's ahead last year. So it's the first month when you compare to the last 12 months that we are seeing a stronger intake from when you compare to the last year same period intake. So we expect to reduce the gap between last year and for 2024, resumed growth also on prep course offerings. So regarding the Digital, Blanco will give more color for that.

Luis Andre Carpintero Blanco

Medcel (inaudible) to have a pushback on the Digital results as a whole, so it's not our most important business in the Digital. We -- it's lagging with white book, it's lagging with our white book. But as you noticed in our release, the number of students of Medcel decreased more than 50% year-over-year. Now we can have this new intake that started here in the fourth quarter that we can recover and stop this fall from the last year.
So the Digital as a whole, to achieve this BRL 1.2 billion net revenue that we have guided for 2028 has to grow around 35%. And you are right, we delivered 19% in this quarter. But this drop on the net revenues come mostly from Medcel. If you take the main important part of the (inaudible) business, we are growing around 30%, okay? The numbers of the active base users are growing 16% and the number of the B2B business is growing 75%. So we have this specific pushback because of Medcel. We took all the actions on that and for the first numbers of the fourth quarter, as Virgilio mentioned, we saw a recovery year-over-year.

Virgilio Deloy Capobianco Gibbon

Just summarizing that, Marcelo, the way that I like to see that is that separating on Digital, the Pillar 1 that is basically medical education, medical education, most of that comes from Medcel operations. And even combining Medcel operations, there is a business to physician type of business with other programs that we have on Pillar 2 and also Pillar 3. We are growing on B2B more than 14%, even considering the downturn coming from Medcel. But if you see the B2B business that we started ramping up last year, we are moving above 75%, at least where we put our efforts here to leverage our Digital operations. So this is basically (inaudible). So on Digital, (inaudible) is growing faster than expected. But when we have the Pillar 1 that's more regarded to medical education impacted by Medcel operations, it is just expanding 14% year-over-year.

Renata Couto

If I may complement, Marcelo, other thing that's important to remember is that when we look for the future of the company, especially in the Digital, what comes mostly of the money comes from the B2B part of the Digital Services, right? And to accomplish that, we don't need the Pillar 1. Let me -- I don't want to make you guys think that that's not important or that. But to complement a strategy here, we need to have the contact with the physicians, right? And the products that most matter here is the products that are Pillars 2, 3, 4, 5 and 6. So Medcel, it's really important (inaudible) we want to keep up with the physicians, but what we are seeing with Medcel, it doesn't make us believe that we cannot achieve the BRL 1.2 billion or anything like that, okay? Our B2B segment is going great.
So the next question comes from (inaudible).

Unidentified Analyst

I have two questions as well. If I can just go back to Mais Medicos program, just trying to get your understanding, do you think that eventually, as it looks like the restrictions of the request per institution, they are more restricted than previous programs. Do you think that eventually this could bring an opportunity for you in terms of M&A as I don't know, maybe smaller companies gaining some of these seats and eventually, they don't have the CapEx to do the investment and then you could eventually buy in the Mais Medicos more seats than you can request? That will be my first question. And then the second one, more like a perspective. If you have any idea or any view when the Supreme Court would eventually restart or resume the case of (inaudible)?

Virgilio Deloy Capobianco Gibbon

This is Virgilio. So about the first question, there is a restriction about 2 proposals for each institution. They are also allowing small players to (inaudible) and also in 2 different cities.
So thinking about the M&A opportunities here, for sure, we may have some small players that they can come to the table with new opportunities for M&A, but being very sincere, it's not something that we are thinking right now. We still have a hot pipeline for more traditional schools. And seeing the size of our pipeline coming from the Mais Medicos 3, more than 30 new possible institutions, I think this is much more important than thinking about acquiring additional institutions that will be implemented using Mais Medicos 3, so this is what we are thinking right now.
Secondly, about the Supreme Court, we are seeing that the other judge, the other federal judge is moving and having a lot of question coming to the sector. I think they are preparing to release additional votes. Maybe we'll have some additional votes that is still pending by the end of this year. So maybe in November, we can have one or 2 additional judges voting, but for being very sincere, we don't know if they will complete this session by the end of this year or start in 2024. So we still -- a lot of speculation about that. We don't have anything that would be more tangible for you guys right now, okay?

Luis Andre Carpintero Blanco

And Blanco speaking, just to give more color on the first topic regarding M&A in Mais Medicos, you need to remember that we always keep our capital discipline allocation, okay? So the first restrictions regarding this possible new targets with Mais Medicos, first, we needed to buy the entity as a whole. And as you know, we have this threshold of having 60% of the revenues coming from medicine business. So if an institution that doesn't have medicine, just want this Mais Medicos 3 license, we need to see how important these licenses will be under the future operations of this company.
Why I'm saying that because it's important to remember that's not the Mais Medicos program, you cannot carve out the license from (inaudible) if you don't have the course recognized. So it's not possible to carve out just the medicine course and buy this medicine course coming from Mais Medicos if the course is not recognized by the Ministry of Education. So I think this will take some time to get to the table. But that's for sure, with or without these kind of targets, we'll keep have in our capital discipline allocation, okay?

Renata Couto

Okay. So next question comes from Lucca Marquezini from Itau.

Lucca Generali Marquezini

As regarding the Digital Services segment, so the release mentioned that the company had a strong increase in B2B engagements. Can you please provide some color on this performance and also comment what should be the next steps within this vertical if you have new initiatives and you expect still strong growth in the coming quarters? That would be very helpful.

Virgilio Deloy Capobianco Gibbon

So just to remember, we started offering the B2B offerings to the market beginning on first quarter of 2022. Today, we almost have around 200 contracts signed, most of them with pharma companies to give them all kinds of access to our physician ecosystem, the spreading content, new protocols, education and learning objects to the physicians and also typical ads using our social network here.
So this type of offering is getting even more used for the pharma companies, the kind of exchanging the traditional way that they have the sales representative reaching physicians to do the marketing to sell their medicine, their drugs. So they are using even the more the digital channel and with a strong of -- not only reputation, but we are, I think, the right pattern to them to have the right way to reach physicians and the best time using their time in the best way.
So what we think is that, well, our strategy here to reach the pharma industry as on the B2B contracts, it's more basically on landing-and-expanding strategy. So today, we have like for the fifth, the five big companies, we have more than 10 contracts with them. So it's been more recurring relationship with them and ramping out B2B contracts. So that's the type of offer that we are offering to B2B and to pharma companies and also start using this type of product also to providers in the same way that we are doing to pharma companies. By the end of the day, providers, they also want to reach physicians to generate more demand and also to drive more volume for their operations for their hospitals.
So this is the type of solutions and opportunities that we are offering using our ecosystem.

Luis Andre Carpintero Blanco

And if I may add, Lucca, one point here, is that until the first semester of this year, most of our contracts basically were campaign-based, okay? So the pharmaceutical companies hire us for specific campaigns for specific drugs for a specific type of physicians.
From the third quarter, we started new products. We launched it as a matter of fact, our first product that is generate recurring kind of revenues and recurring type of relationship that is -- it is Rx Insights that provides insights for prescribed drugs under our ecosystem. So we are moving from campaigns to these kind of recurring revenues, that's very, very important for us in the ramp-up of the business.

Renata Couto

(Operator Instructions) While we wait for next question, I'm going to read a question that we received from the Q&A. It is regarding the Mais Medicos 3, how does the CapEx in terms of cost per seat compare to usual M&A per seat cost of roughly BRL 2 million per seat? You want to take this?

Luis Andre Carpintero Blanco

Yes. I'm going to take this. We are seeing that these Mais Medicos 3 will be around BRL 25 million to invest and deploy the site. Just making a round calculation, if we consider BRL 30 million, just rounding with 60 seats, we would say about BRL 500,000 per seat that is much, much less than this BRL 2 million per seat that it's kind of number of multiple that you see in the market. So it's doing this, getting the license and deploying these greenfields is accretive for us.

Renata Couto

Yes. And BRL 25 million to BRL 30 million is our expectation as of today. So the next question comes from Lucas Nagano from Morgan Stanley.

Lucas Dai Nagano

I have a follow-up question on the regulation related to (inaudible). So now that the Ministry of Education revoked that measure that basically invalidated the (inaudible) that didn't comply with Mais Medicos 3, the current value decision is from (inaudible) to evaluate some of those requests. Do you think that more medical schools could be opened outside of Mais Medicos in the meantime, like while the (inaudible) trial doesn't resume? Like how do you perceive this risk?

Virgilio Deloy Capobianco Gibbon

Lucas, so that's a very good question. That's our opinion here. So in my opinion, I think the Ministry of Education, they will expect the final decision from the Supreme Court in order to evaluate and give the final word if that process that we analyzed and through the injunctions, we will follow or not. So what -- if you read this new ordinance, they expect that they will follow the process. They will visit these institutions. But by the end of the process, they still have a final world from Ministry of Education in order to approve or not that new medical institution. So I think with that measure, the Ministry of Education is waiting for the final word coming from the Supreme Court in order to analyze what they are going to do with all this process coming from injunction. So I think that's the main point. We are -- I think we are not going to see any approval before the decision coming from the Supreme Court.

Renata Couto

Maybe if I may add, Lucas, this (inaudible) Virgilio is saying, it's after what we are seeing since (inaudible) give his decision on beginning of August. And since then, while this normative was not released yet, we were not seeing (inaudible) of seats being released because of that because they were not in the municipalities as they mentioned. So we don't see a big risk here (inaudible).

Virgilio Deloy Capobianco Gibbon

Yes. By the end of the day, they still have to follow the Mais Medicos requirements that they have to have the hospital beds, they have to follow the social demand and how critical is for that region for that city to open new medical school and also to follow all the academic and also the necessity that they have to pay to the municipality and the health secretary in order to approve the new medical school. So that is -- when we analyze that and apply for all the regions that they are trying to open this new Mais Medicos, these new injunctions, I think the impact on overall demand will be much lower than the overall process that we are seeing being analyzed by the Ministry of Education.

Renata Couto

Since we do not see any other questions here, I appreciate you all participating, and we, from Investor Relations, we are available if you still want any follow-up question. Thank you, and have a nice night.