JSC Evex Medical Corporation A Unique Investment Story

Transcription

JSC Evex Medical Corporation
A Unique Investment Story
Bond Presentation
DISCLAIMER
This presentation contains forward-looking statements that are based on current beliefs or expectations, as well as assumptions about future events.
These forward-looking statements can be identified by the fact that they do not relate only to historical or current facts. Forward-looking statements
often use words such as anticipate, target, expect, estimate, intend, plan, goal, believe, will, may, should, would, could or other words similar
meaning. Undue reliance should not be placed on any such statement because, by their very nature, they are subject to known and unknown risks and
uncertainties and can be affected by other factors that could cause actual results, and JSC Bank of Georgia and/or the Bank of Georgia Holdings’
plans and objectives, to differ materially from those expressed or implied in the forward-looking statements.
There are various factors which could cause actual results to differ materially from those expressed or implied in forward-looking statements. Among
the factors that could cause actual results to differ materially from those described in the forward-looking statements are changes in the global,
political, economic, legal, business and social environment. The forward-looking statements in this presentation speak only as of the date of this
presentation. JSC Bank of Georgia and Bank of Georgia Holdings undertake no obligation to revise or update any forward-looking statement
contained within this presentation, regardless of whether those statements are affected as a result of new information , future events or otherwise.
2
Table of Content
Terms of Bonds
JSC Medical Corporation Evex at a Glance
Overview of JSC Medical Corporation Evex
Market Overview and growth drivers
Business model and key financial information
Strategy
Annex 1: Historical Audited Financial Statements
Annex 2: Ownership Structure
Annex 3: Healthcare Infrastructure Reform
3
Table of Content
Terms of Bonds
Strategy
4
Terms of Bonds
Issuer
JSC Medical Corporation Evex
Bonds
Unsecured and unsubordinated obligation
Issue size
US$ 15,000,000
Duration
2 years
Placement date
May 2015
Coupon*
9.5%
Coupon payment
Semi Annual
Listing
GSE’s official list
* 5% income tax applies in most cases
5
Table of Content
Terms of Bonds
Strategy
6
A Unique Investment Story Supported by Compelling Themes
Evex’s market leading position, a unique business model with significant growth potential and highly experienced
management team make it a credible investment opportunity
1
Significant Growth Opportunities
Market and Quality Leader
 Largest market share: 22.5% market share in healthcare services
by number of beds, with over 37.0% share in West Georgia(1);
 Largest market share: 22.0% market share in healthcare services
Unique “geographic cluster” footprint for hospital services; 37.0%
by number of beds, with over 38.0%
share in West Georgia; (1)
market share in health insurance(2)
Unique “geographic cluster” footprint for hospital services;
 Widest population coverage: Network of 38 high quality hospitals
 Widest population coverage:
Network of 39 high quality hospitals
and ambulatory clinics(3)
, with modern equipment, providing
and ambulatory clinics(2) with modern equipment,
providing
coverage to over 2/3 of Georgia's 4.5 mln(4) population
coverage to over 2/3 of Georgia's 4.5mln population(3)
 Institutionalizing the industry: Strong corporate governance,
 Institutionalizing the industry: Strong corporate governance,
standardized processes, on-going EQS implementation(5)
, world
standardized processes, on-going EQS implementation,(4) world
renowned partners, own personnel training centre
renowned partners, own personnel training centre
2
 Attractive macro:(5) Georgia – one of the fastest growing countries
in Eastern Europe, open and easy(6) emerging market to do business,
with real GDP growing at a CAGR of 5.9% between 2004-13
 Favourable healthcare environment: Supportive government
policy aimed at increasing accessibility and quality of healthcare
services in Georgia
 Further expansion: Opportunities to increase penetration in Tbilisi
(largest market), where Evex is scaling up its presence through
acquisition and development of hospitals and ambulatory clinics
 Non-organic growth opportunity: Potential for further
consolidation in a highly fragmented Georgian healthcare sector
Integrated Synergistic Business Model
3
 “Patient capture” model
Cost advantage through vertical integration
 In-depth knowledge of the local market
–
Referral system & cluster model:
 Strong business management team and corporate governance,
exceptional in Georgia’s healthcare sector
(1)
(2)
(3)
(4)
(5)
(6)
Strong presence across patient treatment pathways from
local doctors (GPs) to specialised hospitals / centres
4
 Valuable international healthcare experience
–
–
Sources:
Strong Management with Proven Track Record
 Successful M&A track record – acquired and integrated over 20
companies in the past decade, including over 25 healthcare facilities
between 2011-14(2)
 Strong and supportive shareholder: Currently, Evex is a 100%
subsidiary of Bank of Georgia Holdings PLC, only entity from
Georgia listed on the premium segment of the main market of the
London Stock Exchange (LSE:BGEO), part of FTSE 250 index
Market share by number of beds. Source: National Center for Decease Control, data as of December 2012, updated by company to include changes before 31 December 2014
Evex internal reporting
Geostat.ge, data as of 1 January 2014. Coverage refers to geographic areas served by Evexfacilities
EQS are Evex Quality Standards developed at Evex for internal control and quality management (benchmark mainly based on JCI and EU standards) to analyse and improve clinical outcomes of hospital operations
Euromonitor, World Bank’s 2012 “Ease of Doing Business Report”, other public information.
Ranked #15 (of 189 countries) in World Bank’s 2015 “Ease of Doing Business Report”, ahead of all its neighbouring countries and several EU countries.
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Terms of Bonds
Strategy
8
Overview of JSC Medical Corporation Evex: CLEAR
MARKET LEADER (1/3)
Evex is the largest, integrated healthcare service provider in Georgia and is growing
COMPANY OVERVIEW
Largest healthcare service provider in Georgia (JSC Evex Medical Corporation)
–
–
–
–
22.0% market share(1), more than 4x the size of the nearest competitor
Over 2/3 of population covered(2)
Operating 33 hospitals and 6 ambulatory clinics(3)
2,140 beds(3)
c. 8,011 full time employees, including 2,394 doctors(3)
Currently 100% subsidiary of Bank of Georgia Holdings PLC, only entity from Georgia listed on
the premium segment of the main market of London Stock Exchange (LSE:BGEO), part of FTSE
250 index
REVENUES
GEL mln(4)
160
140
120
100
80
60
40
20
-
145.30
93.10
67.70
16.60
FY2011
FY2012
In-house training centre for doctors and nurses and utilisation of modern equipment
Ability to attract highly experienced physicians
EBITDA
35
25
20
Sources:
(1)
Market share by number of companies beds. Source: NCDC, data as of December 2012, updated by company to include new facilities acquired before 31 December 2014
(2)
Source: Geostat.ge, data as of 1 January 2014, coverage refers to geographic areas served by Evex
27.53
30
Collaborations with Mayo Clinic, Emory School of Medicine, University Research
Corporation (URC), John Snow, Inc. (JSI), Rostropovich - Vishnevskaya Foundation (RVF),
Development Credit Authority (DCA), USAID
On-going Evex Quality Standards („EQS“) implementation, which is developed at Evex for
internal control and quality management (benchmark mainly based on JCI and EU standards)
to analyse and improve clinical outcomes of hospital operations
36.65
40
GEL mln(4)
Straightforward procedures, efficient claims settlement and flexible premium policy
Upholding ethical standards (GOG, WHO, Helsinki Declaration, US Gov. DHHS/OHRP)
FY2014
Evex revenue growth, y-o-y
Evex
SETTING NEW STANDARDS IN GEORGIA’S HEALTHCARE
FY2013
25.23%
Evex
EBITDA
margin
15.09
15
10
5
3.90
FY2011
Evex
(3)
(4)
FY2012
FY2013
FY2014
Evex EBITDA growth , y-o-y
As of 31 December 2014; number of full time employees including Tbilisi ambulatory clinic (Nutsubidze) opened in Q4 2014
GEL to USD exchange rate is 1.8636 as of 31 December 2014. Source: nbg.gov.ge
9
MARKET LEADER (2/3)
Broad geographic coverage and diversified healthcare services network covering 2/3 of Georgia’s population
Extensive Geographic Coverage(1)
Geographically Diversified Network
Network of healthcare facilities
Regional market shares(2)
2,140 hospital beds
33 hospitals
6 ambulatory clinics
operated by Evex
2/3 of
population
covered
The Capital city
Tbilisi
Kakheti
Imereti
Ajara
Samegrelo
Bubble size denotes relative size based on % of population (3)
Samtskhe
68.6%
#1
1
51.3%
Russian Federation
38.8%
15
15
15
15
Tsalenjikha
Chkhorotsku
186
+
+
70
Black Sea
#1
1
Martvili
Khobi
Chakvi
Abasha
14.1%
Poti
Tkibuli
Khoni
Kutaisi
124
20
45
15
15
Terjola
Akhaltsikhe
Kobuleti
Adigeni
Keda
Akhmeta
Kvareli
Telavi
+
#1
1
25
+
+
50
60
Shuakhevi
Batumi
266 6082 152
Georgia
110
Khulo
+
134
Tbilisi
#1
1
70
Akhalkalaki
21
120
19
15
25
Ninotsminda
Armenia
Referral and Specialty Hospitals
N
Community Hospitals
+
Ambulatory Clinics
Up from 1.3% at
YE 2013
35
26
Turkey
N
#1
1
22.8%
Tskaltubo
15
70
#1
1
15
220
Zugdidi
15
38.0%
Azerbaijan
1.9x higher
hospitalization rate
in Tbilisi
vs Georgian average
Regions of Presence
Sources:
(1)
Evex internal reporting – data as of 31 December 2014
(2)
Market share by number of beds. Source: NCDC, data as of December 2012, updated by company to include changes before 31 December 2014. Market shares by beds are as of 31 December 2014
(3)
Geostat.ge, data as of 1 January 2014
10
MARKET LEADER (3/3)
Leader in Georgia with clear and established #1 market positions in healthcare services
Healthcare Services (Hospitals)
# of Beds
Key Georgian Hospitals(1)
2,140
22%
GPIH-IRAO
484
5%
GudushauriChachava
483
5%
HMTC
450
5%
Aversi
225
#1
1
2%
Market share
Sources:
(1)
Market share by number of beds. Source: NCDC, data as of December 2012, updated by company to include changes before 31 December 2014
11
Overview of JSC Medical Corporation Evex: Recent M&A
Recent acquisitions
Coverage in Tbilisi, the capital city
Caraps is a 60 bed hospital specialising in plastic surgery.
Avante*
Caraps
458
60
Acquisition rationale: reaching new customer base in healthcare through Caraps high-end
customer segment.
60
Traumatology
GEL 4.8 mln is
quarterly run rate
EBITDA
for new acquisitions
A
A
Avante includes 4 mono profile hospitals, operating 578 beds, that serve as a main referral for
mother and child care services.
Sunstone
Acquisition rationale: Increase market share and bed capacity by acquiring the largest service
providers for mother and child care in the country, employing the best qualified medical staff for
these services.
Sunstone is a long-established general hospital in Tbilisi, rented out by previous owners and
152
A
Ambulatory clinic
largely underutilised for several years.
Acquisition rationale: Attractive location and an opportunity to develop hospital with over 300
bed capacity in an untapped region, covering sizable new market with 300k population in East
Tbilisi.
* Avante operates 458 beds in Tbilisi and 120 beds in Batumi out of total 578 beds as of
the date of this presentation
Traumatology is a 60 bed long established hospital, providing a wide-range of in-patient and
out-patient services with particular expertise in traumatology.
Acquisition rationale: Increasing market share and bed capacity in Tbilisi
Block Georgia: a buy-out of a 49% minority shareholder of healthcare subsidiary JSC My
Family Clinic (predecessor to Evex).
Transaction rationale: buy-out gave Evex flexibility in executing growth strategy and an
opportunity to expand regional footprint through investments into development projects via My
Family Clinic (MFC).
Sources:
(1)
Evex internal reporting, financials are FY 2014
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Table of Content
Terms of Bonds
Strategy
13
Growth Oriented Reforms
Healthcare sector supported by strong GDP growth and high relative expenditure on healthcare
With demand driven by an ageing population in increasing need of
healthcare(2)
High relative expenditure on healthcare(1)
Health expenditure % of GDP
Population split by regions
38% is pharmaceuticals
100% funded privately
16-17% in Europe
20
15
Tbilisi
28%
Imereti
15%
Age 65+
14%
Adjara
9%
10
Samegrelo
8%
5
Other
26%
Georgia
Healthcare spending grew at 15.9% CAGR
between 2001 - 2011(3)
9.5%
2,300
2,096
1,846
1,438
1,300
800
1,001
523
3%
652
727
7.5%
838
8,000
5.5%
6,000
3.5%
4,000
79%
1.5%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
International Aid
State
Private
Total Healthcare Expenditure Share in GDP
Sources:
(1)
World Bank | 2012; MOH, HSPA 2013
(2)
(3)
moh.gov.ge, NHA 2013, WHO, 2013
(4)
World Bank | 2012
10,000
18%
1,164
300
(200)
current prices, USD
11.5%
2,292
1,723
…Low per capita expenditure on health(4)
9.4%
9.0%
8.7% 8.5% 8.5% 8.6% 8.4%
8.3%
1,800
Age 25-44
29%
USD 328
in Georgia
2,000
0
-0.5%
Private
State
International Aid
Azerbaijan
Belarus
Ukraine
Georgia
Armenia
7.8%
Age 15-24
14%
Age 45-64
26%
Estonia
Russia
Poland
Kazakhstan
Turkey
Bulgaria
2,800
Age 0-14
17%
Samtskhe
5%
High private spending share of 79%(3)
10.3% 10.2%
Kakheti
9%
USA
Germany
France
UK
Japan
In USD mln
Armenia
Belarus
Ukraine
Azerbaijan
Turkey
Bulgaria
Kazakhstan
Russia
Poland
Estonia
UK
Japan
France
USA
Germany
0
3,300
Population split by age group
14
Favorable Government Healthcare Policy (1/2)
Expanding health insurance coverage and creating opportunities for private participation (via top-ups) has been the key
impact of the Universal Health Care reform
Before 2014
After 2014
Healthcare reform
Patients
No healthcare coverage
State coverage of healthcare
Private insurance
= 0.5 million patients
4mln people receive basic coverage of
`
healthcare needs from state
2mln people (c. 45% of population) without
healthcare coverage
•
•
•
with substantial
covered by state
by private insurance companies who received insurance
premium from state
•
Any private or public licensed hospital in Georgia is
Provider choice: limited for patients with private
•
2mln people (c. 45% of population) covered by
state funded insurance program (since 2007), managed
eligible to participate
0.5mln privately insured people
Reform consolidates administration of all
government funded healthcare programmes under state
insurance companies using preferred list of providers to
manage patient flow
•
co-payments from patients newly
•
and patient has free
•
0.5mln privately insured people continue to hold
choice of provider
their policies
Sources:
(1) World Bank – UNICO Studies Series No. 16, Georgia’s Medical Insurance Program
(2) IMF Georgia: IMF Country Report No. 13/264
(3) Evex internal reporting
15
Favorable Government Healthcare Policy(2/2)
Infrastructure renewed, although significant opportunity remains to improve service quality
Capacity-wise Georgia stands alongside US, UK
and Turkey(2)
Bed capacity close to levels in the United States and Europe …(1)
Optimising bed capacity over the years
(Total number of beds)
Number of beds
15
12,000
43,200
Georgia
Armenia
Azerbaijan
Belarus
2014
Ukraine
2010
2006
Turkey
2000
-
Estonia
1995
0
Poland
1990
12,416
Bulgaria
2,000
12,100
Russia
Private sovietera beds
23%
6,247
16,500
Kazakhstan
Private new
beds
60%
4,000
5
21,300
UK
6,000
31,700
Public new
beds
3%
USA
3,480
10
France
10,000
Public sovietera beds
13%
Target Market*
Japan
2,689
8,000
Beds per 1,000 people
Germany
14,000
Specialty beds
Soviet-era
New beds
Note: (*) Target market bed capacity = Total market bed capacity of 12,416
beds - 2,689 specialty beds at penitentiary, TB and psychiatric clinics
However, physician overcapacity yet to be addressed(2)
Number of physicians per 1,000 people
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1:1.6
Nurse to Doctor
ratio (3)
With significant room for optimization in terms of service quality, as indicated by:
under 5 mortality rate…(2)
… and life expectancy at birth(2)
Under 5 mortality per 1,000 live births
Total (years)
40
90
30
80
20
70
Source::
(1)
Evex internal reporting, Market share by bed capacity. NCDC, data as of December 2012, updated by company to include changes before 31 December 2014; NCDC, 2013 on 2011 and 2012 data
(2)
World Bank | 2012, 2013
(3)
Geostat.ge | 2013
Belarus
Ukraine
Azerbaijan
Armenia
Georgia
Russia
Kazakhstan
Poland
Bulgaria
Estonia
Turkey
60
Japan
Germany
France
UK
USA
Belarus
Ukraine
Azerbaijan
Armenia
Georgia
Russia
Kazakhstan
Poland
Bulgaria
Estonia
Turkey
0
Japan
Germany
France
UK
USA
Belarus
Ukraine
Azerbaijan
Armenia
Georgia
Russia
Kazakhstan
Poland
Bulgaria
Estonia
Turkey
Japan
Germany
France
UK
USA
10
16
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Terms of Bonds
Strategy
17
Business model and Key financial Information(1/2)
Well established hospital network allows a seamless patient treatment pathway from local doctors to multi-profile
or specialised hospitals
Evex operates a highly integrated
patient capture business model
A vertically integrated care pathway
14 referral & specialty hospitals provide secondary and tertiary level healthcare services
Referral & Specialty
Hospitals
operating 1,679 beds
19 community hospitals provide primary out- and inpatient healthcare services
Community Hospitals
operating 461 beds
6
ambulatory clinics provide primary outpatient healthcare services
2/3 of Georgia's 4.5mln(1) population covered
Sources:
(1)
(2)
Evex internal reporting. Note: revenues do not add up due to intercompany eliminations
Ambulatory Clinics
Patients
18
18
Business Model and Key financial Information (2/2)
Improving margins with the increasing scale of business (1)
Revenue growth & profitability
160
140
120
100
80
60
40
20
-
Revenue growth, annual
145.30
EBITDA growth, annual
GEL mln
GEL mln
93.10
67.70
16.60
FY2011
FY2012
FY2013
FY2014
40
35
30
25
20
15
10
5
-
36.65
27.53
15.09
FY2011
Evex
Evex revenue growth, y-o-y x%
25.23% Evex
EBITDA margin
3.90
FY2012
FY2013
FY2014
Evex EBITDA growth, y-o-y x%
Ev…
Capturing growth driven by the recent healthcare reform
Healthcare service revenue by sources, FY 2014 ( before
corrections and rebates)
+56.1% y-o-y
GEL mln
160
140
120
100
80
60
40
20
-
(1)
147.17
Healthcare service revenue, quarterly
GEL mln
+79.7%
60
+13.7%
50
40.3
93.15
82.73
20.11
30
53.97
31.81
19.07
32.62
FY2013
FY2014
35.4
40
22.4
20
10
Out of pocket
-
Insurance
State
Note: all amounts are for Evex, unless otherwise indicated, Source: Evex internal reporting
Q4 2013
Q3 2014
Q4 2014
Total healthcare services revenue
19
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Terms of Bonds
Strategy
20
Strategy
Evex’s strategy is focused on growing market share while consistently increasing profitability
Hospitals
To achieve 1/3 market share, currently 22.0%(1)
Ambulatories
Aggressive launch of outpatient clinics
– room to grow in Tbilisi, where Evex’s current market share is only 14.1%(1)
– 20-30 ambulatory clinics, within 2-3 years, in highly fragmented and under-penetrated outpatient segment
Market Leader with Unique Business Model
Supported by Compelling Macro
Themes
…And a Highly Experienced
Management with a Proven Track
Record
Largest healthcare service provider in Georgia
–
–
–
22.0% market share(1), more than 4x the size of the nearest
competitor
Over 2/3 of population covered(2)
Operating 33 hospitals, 6 ambulatory clinics(3) and 2,140 beds(3)
c. 8,011 full time employees, including 2,394
doctors(3)
Currently 100% subsidiary of Bank of Georgia Holdings PLC, only entity
from Georgia listed on the premium segment of the main market of the
London Stock Exchange (LSE:BGEO), part of FTSE 250 index
In-depth knowledge of the local market
Increasingly favorable healthcare
environment
– Real GDP growth rate ~ 6% in 2004-2014
– 9.2% spend on healthcare services in 2012
and growing
– Favorable healthcare reform
Evex’s current position as the market
leader in scale and quality
Sources:
(1)
Market share by number of beds. Source: National Center for Decease Control, data as of December 2012, updated by company to include changes before 31 December 2014
(2)
Source: Geostat.ge, data as of 1 January 2014
(3)
As of 31 December 2014; number of full time employees including Tbilisi ambulatory clinic (Nutsubidze) opened in Q4 2014
Valuable international healthcare experience
Successful M&A track record – acquired and
integrated over 20 companies in the past decade,
including over 25 healthcare facilities between
2011-14(3)
21
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Terms of Bonds
Strategy
22
Annex 1: Statement of Comprehensive Income ( GEL ‘000)
Audited
Audited
Unaudited
2014
2013
2012
Healthcare revenue
145,349
93,145
67,723
Revenue
145,349
93,145
67,723
Cost of medical services rendered
(83,375)
(52,164)
(41,932)
Direct costs of services
(83,375)
(52,164)
(41,932)
61,974
40,981
25,791
2,722
2,326
1,705
Salaries and other employee benefits
(15,263)
(8,281)
(6,403)
General and administrative expenses
(6,932)
(3,871)
(3,109)
Impairment of accounts receivable and other debtors
(4,209)
(2,575)
(1,969)
Gross Profit
Other operating income
Other operating income, net
(1,640)
(1,051)
(922)
(28,044)
(15,778)
(12,403)
Profit from operations before depreciation
36,652
27,529
15,093
Depreciation and amortization
(6,998)
(5,191)
(3,324)
297
343
1,411
(13,436)
(12,747)
(8,189)
(2,819)
(4,157)
(1,091)
578
-
-
Profit before income tax expense
14,274
5,777
3,900
Income tax expense
(1,145)
(454)
(238)
Profit for the year
13,129
5,323
3,662
Attributable to:
– shareholders of the Group
10,072
1,371
472
3,057
3,952
3,190
Operating Expenses
Finance income
Finance costs
Net losses from foreign currencies
Net non-operating income
– non-controlling interests
23
Annex 1: Statement of Financial Position ( GEL ‘000)
Audited
Audited
Audited
2014
2013
2012
25,586
1,086
290
-
46
-
46,568
15,919
14,285
Inventory
6,967
4,355
5,008
Loan Issued
3,193
2,614
2,603
259,274
168,943
143,875
5,340
4,068
697
897
938
90
Deferred income tax assets
1,225
427
-
Prepayments for long-term assets
2,605
494
2,293
Cash and cash equivalents
Amounts due from credit institutions
Receivable from healthcare services
Property and equipment
Goodwill and other intangible assets
Current income tax assets
Other assets
3,762
4,685
8,312
Total assets
355,417
203,575
177,453
Accruals for employee compensation
9,505
5,107
2,861
151,155
114,805
93,215
Trade payables
8,081
5,901
9,297
Current income tax liabilities
4,708
1,509
-
Deferred income tax liabilities
8,877
2,043
3,155
Payable for investments purchased
9,967
454
1,374
Other liabilities
8,427
4,966
6,930
Total liabilities
200,720
134,785
116,832
Share capital
24,165
10,961
10,961
Additional paid-in capital
88,040
26,298
26,298
(16,627)
355
355
33,607
6,553
5,183
Total equity attributable to shareholders of the Group
Non-controlling interests
129,185
25,512
44,167
24,623
42,797
17,824
Total equity
154,697
68,790
60,621
355,417
203,575
177,453
Borrowings
Other reserves
Retained earnings
Total equity and liabilities
24
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Terms of Bonds
Strategy
25
Annex 2: Ownership structure
JSC Medical Corporation Evex is a member of Georgia Healthcare Group, which was established after reorganization of JSC Aldagi
Insurance Company BCI. 100% owner: JSC Bank of Georgia
Healthcare business
P&C and life insurance
business
Healthcare service
Health Insurance
26
Table of Content
Terms of Bonds
Strategy
27
Healthcare Infrastructure Reform (1/2)
Before
Note: pictures are from Evex healthcare facilities
After
28
Healthcare Infrastructure Reform (2/2)
Note: pictures are from Evex healthcare facilities
29

JSC Evex Medical Corporation A Unique Investment Story

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