presentación cb - bupa.cl · 2015-02-05 · resomasa clínica santa lucía clinical service (peru)...
TRANSCRIPT
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April 2013
2
Andrés Varas
CEO Cruz Blanca Salud
Team
Marcelo Bermúdez
CFO Cruz Blanca Salud
3
Our message
Innovative solutions for our clients
Expansion of current facilities and M&A
Diversification in the generation of
cash flow
•New outpatient centers + Integramédica
+ Sonorad
+ Integramédica Perú
•Hospital expansion # medical consultations
# beds
•Hospital in Santiago
•Three business areas Provider
Insurance
International
•Strengthening providers
business (increase its
share in revenues)
Services with cero cost
for our affiliates
•Health plans with
preferred provider in our
own network
(1) 2006 – 2011 compound annual growth in health expenditure
Source: Fonasa, Superintendencia de Salud and Cruz Blanca Salud
We are positioned to gain market share in an industry
that growths 10%(1) per year
•Prospecting opportunities
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Our company
One of Chile´s leading healthcare groups (~ US$1,0 billion sales in 2012)
THREE BUSINESS AREAS
Insurance / Isapre Cruz Blanca / Life Insurance Co. /
Provider
Hospitals / Clínica Reñaca / Clínica Antofagasta /
/ Clínica San José / Clinical Service /
Outpatient / Integramédica / Sonorad /
/ Clínica Santa Lucía / Dr. Pilar Gazmuri /
International / Resomasa / Integramédica Perú /
+ 6.560 employees
+ 2.000 doctors
SUCCESFUL BUSINESS MODEL
Commercial synergies
Health plans with preferred provider in our
own network
• +40% of the new plans sold
• 47% of our Isapre’s expenditure is
captured by our hospitals in their regions
of influence
Services with cero cost for our affiliates
Cost synergies
• Controlled claims rate
• Supply contracts / Centralized back office
• Lower financing cost
Attractive value proposition
for our customers
z
Successful business model
Insurance #2 Isapre in revenues
• +590.000 avg beneficiaries • +314.000 avg policy holders • 78 branch offices throughout the country
Life Insurance Co.
International Hospitals
Outpatient
Initiating Latam expansion
• Perú (outpatient)
#1 provider of private outpatiente service • 24 centers throughout Chile • +1.254 avg consultation rooms • ~5.350.000 visits
Leading hospitals in their regions
• 3 hospitals • 366 beds • ~23.800 hospitalizations • Santiago hospital project
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To double our EBITDA in 5 years through organic growth (2010 – 2015)
Expanding offering of health plans to market segments enrolled in the public insurer
Growing in the provider business
Main driver: Outpatient business
Increasing profitability of current facilities and expanding capacity
Low cost closed plans
New outpatient centers:
• 16 Integramédica centers • 6 Sonorad centers • 6 Integramédica Perú centers
Santiago hospital project:
• 128 beds • 22 consultation rooms
• 298 beds (first stage)
Strategic guideline
6
Increasing synergies among our businesses
Hospitals master plans
Provider Insurance International Outpatient
Hospitals
7
Ownership structure (december 2012)
Main shareholders with a strategic long term vision
Said Group
40,64%
Other
shareholders
21,42%
Securities funds
19,76%
Stockbrokerage
houses
8,25%
Private pension
funds (AFPs)
4,46%
Mutual funds
4,53%
Insurance
companies
0,96%
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FINANCIAL
RESULTS
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560,3
734,9 831,2 942,7
2009 2010 2011 2012
16,0
62,3
80,3
77,6 3,5
2009 2010 2011 2012
2,1
19,7
34,4
36,9 6,1
2009 2010 2011 2012
Revenues
Net profit
EBITDA
Consolidated results (US$ millions)
CAGR (10-12) CAGR (10- 12)
CAGR (10-12)
2011 revenues include business interruption insurance payment to
Integramédica (US$ 3,5 million)
2011 net profit includes insurance payment to Integramédica due to property
damage and business interruption (US$ 6 million)
2011 EBITDA includes business interruption insurance payment to
Integramédica (US$ 3,5 million)
Fx rate: Ch$500/US$
Sustained revenue growth;
+10% CAGR in the last three
years
10
2010 2011 2012
Current assets 129 264 222
Non-current assets 534 594 704
Total Assets 664 858 926
Current liabilities 171 234 259
Non-current liabilities 308 264 286
Equity (Controlling shareholders) 157 331 352
Equity (Minority interest) 27 29 28
Total Liabilities + Shareholder's equity 664 858 926
Net financial debt (NFD) 232 69 144
NFD / EBITDA 3,7 x 0,8 x 1,8 x
NFD / Equity 1,3 x 0,2 x 0,4 x
Summary balance sheet Revenues breakdown 2012
EBITDA breakdown 2012
US$943 million
US$78 million
Consolidated results (US$ millions)
Fx rate: Ch$500/US$
Balanced generation of cash flow
943
(49)
4
101
201
686
CBS
Others(1)
International
Hospitals
Outpatient
Insurance
78
(1)
(0)
16
35
28
CBS
Others(1)
International
Hospitals
Outpatient
Insurance
(1) Consolidation adjustments and other minor subsidiaries (Holding Cruz Blanca Salud S.A. and Servicios de Gestión Ltda.)
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#1 private outpatient service provider
Multiformat – multibrand strategy
• Integramédica = 16 outpatient centers
• Sonorad = 6 diagnostic centers
• Others (2 centers)
Outpatient services at affordable prices
• Medical consultation / Imaging / Dental /
Ancilliary services/ Others
Chile’s largest private clinical laboratory
• 27 specimen collection points
• Approximately ~4.000.000 annual lab tests
+1.800 doctors
Outpatient business: Integramédica
10%
90%
Integramédica
Others
% market share by revenues
#1 in revenues in the outpatient market
Source: Cruz Blanca Salud
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133.853
159.209
200.611
3.502
2010 2011 2012
24.182
29.451
34.668 3.502
2010 2011 2012
Revenues of 2012 reached US$201 million
(+26%; excluding non recurrent effects) o Growth in current outpatient centers
• Higher activity generated by the beneficiaries of
Isapre Cruz Blanca (18% of sales)
• Expansion and remodeling of outpatient centers
• Commercial agreements and initiatives with other
Isapres and Fonasa
o New businesses (Clínica Santa Lucía, Biolab, Pilar
Gazmuri and Sonorad)
o New outpatient centers (Puente Alto, Maipú y
Talca)
EBITDA of 2012 amounted to US$35 million
(+18%; excluding non recurrent effects) o Sales mix with greater ratio of diagnostic exams
and dental services which contribute with higher
margins
o Savings as result of price negotiations with
suppliers of reactives used in laboratories
o Newly acquired businesses (Clínica Santa Lucía
and Sonorad) effect and the start up expenses
of Puente Alto, Maipú and Talca centers
Integramédica, #1 private outpatient provider
2011 revenue includes business interruption insurance payment to
Integramédica (US$ 3,5 million)
2011 EBITDA includes business interruption insurance payment to
Integramédica (US$ 3,5 million)
Revenues
EBITDA and EBITDA margin
US$ thousands
US$ thousands / %
CAGR (10-12)
CAGR (10-12)
Fx rate: Ch$500/US$
Margen EBITDA
18,1% 20,3% 17,3%
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Presence in three regions of the country
Leading hospitals in their geographic areas
(#1 in market share)
High complexity
37.000 sqm built
366 beds / 80 critical
81 medical consultations
Clinical Service one of the leading home
health care providers
Hospital business: Clínicas Reñaca, Antofagasta
and San José de Arica, and Clinical Service (home care)
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16.753
17.991
15.509
2010 2011 2012
85.618
96.552
100.709
2010 2011 2012
Revenues
EBITDA and EBITDA margin
US$ thousands
US$ thousands/ %
CAGR (10-12)
CAGR (10-12)
Revenues in 2012 reached US$101 million (+4%) o Greater activity in emergency rooms
o Higher lab test exams
o Competitive environment faced by Clínica
Reñaca
2012 EBITDA amounted to US$16 million (-14%) o Decrease of Clínica Reñaca´s occupancy rate (2pp
reduction)
o Higher clinical personnel expenses (collective
negotiations in Clínica Reñaca, Clínica San José
and paramedics in Clínica Antofagasta)
o The effect of a one-time extraordinary increase in
bad debt provisions due to an exhaustive
examination of Clínica Antofagasta´s account
receivables
Fx rate: Ch$500/US$
EBITDA margin
Leading hospitals in their geographic areas
19,6% 18,6%
15,4%
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Insurance business: Isapre Cruz Blanca
Operating since the creation of the private
health system in Chile (1981)
Brand strengh (#2 in market share)
78 branch offices and three mobile offices
(nationwide coverage)
+314 th avg policy holders
+615 th avg beneficiaries
Regulatory framework undergoing revision
o Changes likely to provide increased certainty on
business regulation
Life Insurance Co. under development
% market share by revenues
#2 in revenues in the Isapre market
Source: Asociación de Isapres, December 2012 figures
27,8
21,6 20,1 17,3
13,1
Banmédica Cruz Blanca Colmena Consalud Masvida
16
84,0% 84,2% 86,1%
2010 2011 2012
541.922 609.544 686.491
2010 2011 2012
21.315
32.143 28.329
2010 2011 2012
Isapre Cruz Blanca, #2 in revenues
Fx rate: Ch$500/US$
Revenues in 2012 reached US$686 million
(+13%) o Policy holders growth
• Higher health plans sales as a result of the
favorable economic cycle of the country
• Successful commercialization of MaxSalud plans
• Lower disenrollment rate
• Higher productivity of sales force
o A real increase in the price of health plans of
6,9% performed in July 2011 and 2,7% in July
2012, which is gradually captured according to
the turnover rate of the affiliates base
o Successful administration of collection
2012 EBITDA amounted US$28 million (-12%) o Higher claims rate (84,2% v/s 86,1%)
• Temporary disabilities claims increase
• Increase in hospitalizations expenses and elective
surgeries
o Offset by lower SG&A expenses as proportion of
sales (from 11,3% in 2011 to 10,6% in 2012)
Revenues
EBITDA and EBITDA margin
US$ thousands
US$ thousands / %
CAGR (10-12)
Claims rate %
EBITDA margin
CAGR (10-12)
3,9% 5,3%
4,1%
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INVESTMEN PLAN
2013 -2015
18
34 32 24
21 18
16
5 5
4
1
11 14
10
34
60
56
6
Capex (2013- 2015): US$ 350 million
Life Insurance Co. US$ 6 million
Santiago hospital US$ 150 million
Perú US$ 35 million
Isapre US$ 14 million
Hospitals (existing) US$ 55 million
Integramédica US$ 90 million
Inorganic growth and development of new businesses
Analysis of growth through M&A (recently P. Gazmuri, Biolab, Resomasa, Clínica Santa
Lucía, Clinical Service and Sonorad)
Investment plan : 2013 - 2015
2012 2013 2014 2015
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129
110
Fx rate: Ch$500/US$
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Clinical
Service
Clínica Santa
Lucía
Sonorad
• Main outpatient center of the San Bernardo area of
Santiago
• Acquisition of 100% of equity = US$ 6,2 million
• 4.000 sqm / 75 consultation, exam and procedure rooms
• Home health care provider, #2 in market share
• Acquisition of 100% of equity = US$ 2,8 million
• Bed days 2011 = 11.480
Acquisitions 2011 - 2012
2011 2012
Biolab Centro de
Diagnóstico Dra.
Pilar Gazmuri
Clínica Santa Lucía Clinical Service Resomasa
(Peru)
Sonorad
• Outpatient network of diagnostic exams
• Acquisition of 100% of equity = US$ 13,8 million
• 6 outpatient centers / 670.000 lab exams / 180.000
imaging exams
Fx rate: Ch$500/US$
2011 2012
Revenues (US$ mm) 6,9 9,4
EBITDA (US$ mm)
0,7 1,4
2011 2012
Revenues (US$ mm) 3,4 3,0
EBITDA (US$ mm)
0,6 0,3
2011 2012
Revenues (US$ mm) 14,6 15,5
EBITDA (US$ mm)
1,2 2,1
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2011 2012 2013
Puente Alto
Talca
Maipú
Santiago
S. Bernardo
Integramédica
24 30 # centers
La Florida
S. Bernardo
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Opened Location contract signed Acquisition
Reference:
Investment plan: Integramédica
2014
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Integ. 24
2010
13 centers
13
Concepción
P. Gazmuri
Sonorad 6 centers Sonorad 7
Sonorad 8
Sonorad 11
Integ. 25
Others
Integ. 28
Integ. 22
2015
42
Integ. 26
Integ. 27 Integ. 23
Integ. 29
Sonorad 12
Sonorad 9
Sonorad 10
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Investment plan : Integramédica
Recently opened:
• US$4,5 million investment
• Opened in December 2012
• 3.900 sqm
• Consultation rooms:
• 39 medical consultations
• 15 dental
• 5 kinesiology
• 10 sample collection points
• MRI
Fx rate: Ch$500/US$
• US$2,2 million investment
• Opened in December 2012
• 2.318 sqm
• Consultation rooms:
• 32 medical consultations
• 8 dental
• 4 kinesiology
• 8 sample collection points
Maipú
center
Talca
center
22 Investment plan: Isapre Cruz Blanca
Max Salud
Life Insurance company
Fx rate: Ch$500/US$
• Group of closed plans initially sold only in Santiago
• Patients are served by a general practitioner (GP) and
specialists at Integramédica´s outpatient centers and a
defined hospital network
• The goal is to offer an integrated product; low cost and
high quality
• Target segment is the high-end of the public system
(FONASA)
• 8.639 policy holders at the end of 2012
• Flexible business model for possible outcomes from
Isapre´s regulation changes
• Seeks to participate in new health market segments,
which have had a strong development through the last
years (US$411 million market)
• Diversification in the generation of revenues
• Group synergies
Additional products
Health insurance
Mandatory personal accident
insurance
Complementary companies
insurance
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Investment plan: Clínica Reñaca
Fx rate: Ch$500/US$
(40% of advance) Master plan ~ US$21 million
Remodeling and expansion of the
Hospital
Operating room remodeling
Increase of parking space
Additional 10.870 sqm
28 new beds by 4Q’14 (with the
capability of an additional 54 beds)
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Investment plan: Clínica Antofagasta and San José
Fx rate: Ch$500/US$
Master plan Clínica Antofagasta
• Maternity hospital - Pediatric
• Starting in 2013
• US$15 million investment
• 5.670 sqm
• 70 additional beds at the beginning of 2015
Master plan Clínica San José
• Outpatient center
• Starting in 2013
• US$3 millones investment
• 1.285 sqm
• 22 new consultation rooms for 2015
25
Investment plan: new projects
Perú Recently initiated activities in Perú:
• Creation of the subsidiary Cruz Blanca Salud Perú S.A.C.
• Acquisition of Resomasa (imaging)
• Analysis of opportunities in the outpatient, hospital and insurance
businesses in Perú
• Integramédica Perú development plan: 2 centers per year for the
next 3 years; reaching a total of 6 new centers
• Contract signed for the first location in Megaplaza
Independencia, which allows to open the first outpatient center
for the end of 2013. The center will have 3.000 sqm surface
with an investment of US$4,9 million
Fx rate: Ch$500/US$
26
Perú
New Hospital
in Santiago
Investment plan: new projects
• Property acquired (42.000 sqm)
• Total estimated investment of US$ 170 million (US$20
million already invested in 2012)
• Initial capacity of 298 beds (up to 432 beds)
• New subsidiary created: Inversiones Clínicas CBS S.A.
Fx rate: Ch$500/US$
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• Decision on which health insurance to
choose (public or private) is made by policy
holders
• Policy holders contribute a mandatory 7%
of their salary, with a cap, and can contribute
an additional voluntary amount
• Employers only collect employee
contributions and pay them to insurers
• Members decide according to their health
plan where to get care
• Insurers pay care providers up to the plan
coverage and members pay the difference
(“copayment”)
Fonasa
(public health
insurance)
Policy holders and
their dependants
(together
“beneficiaries”)
Public provider
(outpatient or hospital)
Private provider
(doctors, outpatient or
hospital)
Institutional
mode
Closed or
preferred
provider
plans
Free election
mode
Lower income population
Q: 82%
$: 65%
Higher income
population
Q: 18%
$: 35%
(1) Source: Cruz Blanca Salud, from Superintendencia de Salud (National Health Authority) figures and Fonasa (National Health
Fund). Does not include Armed Forces, worker’s compensation, medical leave expenditures and voluntary health insurance
(2) Fx Rate: Ch$500/US$
Insurance
Market(1)
US$ 9.583
million
Can be the same
Closed or preferred
provider (outpatient or
hospital)
Cruz Blanca Salud
business areas
Isapre
(mandatory
private health
insurance)
Appendix: Industry dynamics
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The information contained herein shall not be deemed an indication of the state of the company’s
business, financial condition, results of operations and/or prospects.
The company assumes no responsibility for, or makes any representation or warranty, express or
implied, with respect to, the accuracy, adequacy or completeness of the information contained
herein.
The Company expressly disclaims any liability based on such information, errors therein or omissions
therefrom.
The information contained herein has been prepared to assist interested parties in making their own
evaluation of the company and does not purport to be all-inclusive or to contain all the information
that a potential counterparty may desire. In all cases, interested parties should conduct their own
independent investigation and analysis of the company. Interested parties can only rely on the result
of their own investigation and the representations and warranties made in any definitive agreement
that may be executed.
Prospective investors who require additional information or have questions regarding the company
should direct correspondence to or contact: Joaquín Solís de Ovando ([email protected]).
Disclaimer
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April 2013