Date post: | 08-Apr-2017 |
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CorporatePresenta,on
NYSEMKT:HLTH•March2017
Forward-LookingInformaAon
1
ThispresentaAoncontainsforward-lookinginformaAon(withinthemeaningofapplicablesecuriAes laws) relaAngtothebusinessofNobilisHealthCorp.(the"Company")andtheenvironmentinwhichit operates.Forward-lookinginformaAonmay include statements regarding the objecAves, business strategies to achieve those objecAves, expected financialresults, economic ormarket condiAons, and the outlook of or involving the Company and its business. Such forwardlooking informaAon or statements are typically idenAfied by words such as "believe", "anAcipate", "expect", "intend","plan","will","may"andothersimilarexpressions.
Forward-lookinginformaAon,includinganyfinancialoutlooks,isprovidedforthepurposeofprovidinginformaAonaboutmanagement'sexpectaAonsandplansaboutthefutureandmaynotbeappropriateforotherpurposes.Forward-lookinginformaAonherein isbasedonvariousassumpAonsand expectaAons that theCompanybelievesare reasonable in thecircumstances. No assurance can be given that these assumpAons and expectaAonswill prove to be correct and theforward-looking informaAon, including thefinancialoutlooks included in thisPresentaAon,shouldnotbe unduly reliedupon.ThoseassumpAonsandexpectaAonsarebasedon informaAoncurrentlyavailabletothe Company, including thehistoric performance of theCompany's business. SuchassumpAons include anAcipated financial performance, currentbusinessandeconomictrends,andbusinessprospectsandaresubjecttotherisksanduncertainAeswhicharediscussedintheCompany'sregulatoryfilingsavailableontheCompany'swebsiteatwww.NobilisHealth.com,www.sedar.comoratwww.sec.gov.Anyforward-lookingstatementsthatwemakearebasedonassumpAonsasoftoday,andweundertakenoobligaAontoupdatethem.TheCompany’smanagementhasapprovedthefinancialoutlookscontainedinthispresentaAon.
CompanyProfile
CompanyProfile
o Own,operateandmanageambulatorysurgicalcenters(ASCs),surgicalhospitalsandclinics
• 4SurgicalHospitals,10ASCs,11Clinics,• 11Markets,7States• 38PartnerfaciliAes
o Uniquedirect-to-paAentmarkeAngmodel• PhysicianmarkeAng• Conciergeexperience–PaAentcoordinaAon
o 2016revenueof$285.7millionandadjustedEBITDAof$34.0million
o Revenue:109%CAGRfrom2013to2016
o AdjustedEBITDA:134%CAGRfrom2013to2016
3
InvestmentHighlights
• BusinessmodeldrivenbyorganicgrowthandacquisiAons
• UniquemarkeAngmodelandproprietarytechnologyastrategicadvantage
• DisciplinedM&AapproachthathasresultedinaccreAveacquisiAonsinafragmentedmarket
• Favorablepayormix(predominantlycommercial)andproceduremix
• CompellingvalueproposiAonforphysicians,paAentsandpayors
• StrongplaiormforscalablegrowthintonaAonalmarkets
• Focusonminimallyinvasiveproceduresalignedwithmarkettrends
• Leanbalancesheet;limitedcapexandworkingcapitalrequirements
4
NobilisFootprint
• 25OwnedFaciliAesin6Markets,2States.NobilismanagesallOwnedFaciliAes
• 38PartnerFaciliAesin5Marketsand5States
5
8MarketswithNobilisownedfaciliAes
MarketswithNobilispartnerfaciliAes
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OpAmizedProcedure&PayorMix
ProcedureMix:• Newtechnologiesallowmorecomplexsurgicalcases
inoutpaAentselng
• Bemercasemixresultsinhigheraverage
reimbursementratesthanASCindustryaverage
• OpAmizedcasemixleadstohighlyspecializedsurgicalstaffandincreasedcenterefficiencies
PayorMix:• Payormixconsistspredominantlyofcommercial
payors
• Strategicallyaddingin-networkcontractstolower
out-of-pocketcostsforpaAentsandtotalcostsfor
payorsanddrivesreferralsfrommanagedcare
companies
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Pain29%
Bariatric22%
Spine13%
Pain36%
Orothopedics9%
Spine9%
GeneralSurgery4%
Plas,c&Reconstruc,ve
9%
Bariatrics21%
Gynecology4%
Other8%
CaseMix2016
IndustryBackground
TradiAonalHospitals• Full-servicehospital• InpaAentandoutpaAent• >5,700hospitals• 60%+not-for-profit
SpecialtySurgicalHospitals(SSHs)
• Typicallyspecializeinorthopedics,spine,ENT
• InpaAentandoutpaAent• ~300SSHs
AmbulatorySurgicalCenters(ASCs)
• OutpaAentonly• >5,400ASCs• 70%+ownedby
independents
7
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GrowthStrategyandM&A
GrowthStrategy
o Driveorganicgrowth• MulAplemarkeAngchannelstodrivevolumegrowth• Physicianemploymentmodeldrivesrevenuegrowth
o AcquisiAonopportuniAes• Highlyfragmentedmarket• Abilitytocross-sellservicelines
o ServicelinesandspecialAes• OpAmizedcasemix• Higheracuityprocedures,higherlevelsofreimbursement
o OperaAonalleverage• DrivecostreducAonsinrecentlyacquiredfaciliAes• Economiesofscale
9
DisciplinedM&AStrategy
o Currentlypursuingporioliocompaniesinstrategicgeographicalregions
o AllporiolioopportuniAesfulfillkeycriteriathatexpandoverallfootprintwhilemaximizingaccreAvevalueofcombinedenAty:
• MulA-facilityporiolio• AbilitytooverlaymarkeAng• Strategicgeographicmarket• PosiAveEBITDA
o NobiliswillconAnuetoseekandpursueothernon-poriolioopportuniAes,including:
• FaciliAesavailableatfairmarketvaluethatNobiliscanquicklyturnaroundandsustainprofitableoperaAons
• AcquisiAonsofuniquedifferenAatorsthataddvalueandcapabiliAeswiththeneedsofastrongin-networksystem
• Ancillarybusinesseswithsystem-widerevenueproducingpotenAal
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HamiltonVeinCenter
Overview
• 6clinicsin3markets(Houston,AusAn,andSanAntonio)
• 26,000paAentencounters,ofwhich8,000areproceduralinnature
• 5,000oftheproceduresareintheHoustonmarketandinpreferreddemographicareas
• 100%In-Network(INN)revenue
TransacAonDetail
• $8.25MMCash
• $4MMTwoYearConverAbleNote
GrowthStrategy
• HVCclinicswillprovidepenetraAonintonewmarkets,AusAnandSanAntonio
• ClaritybrandwillimpactHVCcasevolumeanesAmated5-10%
• MovingclinicbasedprocedurestoNHCfaciliAes,ASC’sandHospitals,intheHoustonmarketwill:
• BroadentheapplicablepaAentbase• Increasetheacuityofproceduresthat
canbeperformedwithinHVCsystem• Increaserevenuepercasewithnominal
increaseorimpacttoincrementalcasecost
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10
UniqueMarkeAngStrategy
UniquePaAentAcquisiAonStrategy
Direct-to-ConsumerMarkeAng• MarkeAngandtechnologyplaiormthattargets
prospecAvepaAents• UniquevalueproposiAontophysicians;superiorpaAent
experience• Generateshigheracuitycasesvs.tradiAonalreferralmodel• Scalable
PhysicianSales• BuildandexecutemarkeAngplansonbehalfofphysicians• Helpsexpandphysicians’pracAces• HighROIforNobilis
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Direct-to-ConsumerCampaigns
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Direct-to-ConsumerMarkeAng
• PaAenteducaAon,medicalreview,
insuranceverificaAon,surgicalscheduling
• PaAentfollow-up,experiencesurveys,referrals
• Insidesalesteam+ITplaiormto
maximizepaAentexperience
• 9brandsmarketeddirectlytopaAentsviaomni-channelmarkeAngstrategy
LeadGenera,on
ConciergeService
ConversiontoSurgicalPa,ent
Pa,entTracking
BenefitsPhysicians• DevotemoreAmetotreaAngpaAents• GenerateaddiAonalpaAentvolume• GrowtheirpracAce• Increasedprofitability
NobilisHealth• Enhancedphysicianrecruitment/
retenAon
• IncrementalpaAentvolumeHighreturnonrevenuepercase
• Scalable
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Direct-to-ConsumerMarkeAng
PaAentCoordinatorswillinteractwitha
paAentanaverageof17Ames
End-to-EndConciergeModelthatleveragesNobilis’proprietary
schedulingapplicaAons
DedicatedPaAentCoordinatorreviewsandmanagespaAent’sjourneyfromAmeofiniAalcontactthroughpostsurgicalrecovery
FeaturesstandardizedcorporatereporAngconsolidaAon,EMRs,
post-operaAvefollow-upprogram.Allowsfasteronboardingofnew
faciliAes.
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PhysicianSales
• In-housemarkeAngteamworksone-on-onewithphysicianstodevelopanddistributecustomizedmarkeAngplans
• LowerpartneracquisiAoncosts/increasedpartnerprofitability
• EnhancedrecruitmentandretenAonNobilis ROI Average
5: 1
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• Nobilis’in-housemarkeAngteamworkscloselywithphysicianstodevelopanddistributecustomizedadverAsingplans
• AdverAsingplanstypicallyincorporateacombinaAonofonline,TV,radioorprintmedia• Nobilisexpectsa5:1returnonrevenueperphysicianmarkeAngagreement
PhysicianSales
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ConcerAs
ATechnologyPlaiormthatTransformsHealthcareDelivery
• ConcerAsconnectsproviderswithpayorstoimplementnewreimbursementmethodologiesfocusedonpaAentoutcomes
• ThisiseffecAvelyanin-networkmodelathigherthanin-networkratesandacceleratedpaymentAmeline
Payor
Ancillaries Surgeon Facility
ConcerAsProducts:• ClinicalIntegraAonNetworkFormaAon
andAdministraAon• PopulaAonHealthManagement• CareCoordinaAon
“Bundledpaymentsarethefutureofreimbursementinmedicine.AtNobiliswearewell-posi;onedtotakeadvantageofthis."-Dr.NeilBadlani,ChiefMedicalOfficer 19
AligningPayors,Providers,andFaciliAes
ConcerAsAlignsPayors,Providers,andFaciliAes
• OpportunitytoenhancerelaAonshipswithbothpayorsandprovidors,aswellasdeveloprelaAonshipswithself-insuredemployers
• Greatersavingsonbundlesthanlarge,acute-carefaciliAes• PhysiciansencouragedtocooperateforenhancedrevenueincenAves• RepresentsasignificantmarkeAngopportunity
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19
FinancialPerformance
*Guidance as provided on March 13, 2017
FinancialPerformance
(US$ Millions)!
$(10,000)
$10,000
$30,000
$50,000
$70,000
$90,000
$110,000
$130,000
$150,000
$-
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
2013 2014 2015 2016 2017E*
Adj.EB
ITDA
(LessN
CI)
Revenu
e
TotalRevenue Adj.EBITDA(LessNCI)
RevenueandAdj.EBITDA(LessNCI)
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FinancialPerformance
FY2016• Revenueof$285.7M,increase24.9%yearoveryear• 19,941cases,increase11.9%yearoveryear• $14,329revenuepercase,increase11.4%yearoveryear• $34.0MAdjustedEBITDA,decrease15.8%yearoveryear
RecentDevelopments• AcquiredHamiltonVeinCenterinMarch2017• AcquiredArizonaVeinandVascularinQ42016• Closedan$82.5McreditfacilitywithBBVACompassBankinOctober2016• AcquiredMedicalParkDriveinSeptember2016• TalentAcquisiAonsfromlargenaAonalsystems
• CFO–DavidYoung;formerlySVPatSt.JudeMedical,VPatCardinalHealth• EVPOperaAons–MarcCelia;formerlyVPConAnuousImprovementatUSPITenet• ChiefAccounAngOfficer–MarcosRodriguez;formerlyatDeloime&Touche
2017Guidance*• Revenueof$310Mto$325M• AdjustedEBITDAof$40Mto$45M
23
*Guidance as provided on March 13, 2017
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Appendix
Facility Market Equity
Hospitals
FirstNobilisHospital Houston,TX 51%
HermannDriveSurgicalHospital Houston,TX 54.75%
PlanoSurgicalHospital Dallas,TX 100%
ScomsdaleLibertyHospital Scomsdale,AZ 75%
ASCs
FirstNobilisSurgicalCenter(HOPD) Houston,TX 51%
KirbySurgicalCenter Houston,TX 25%
MedicalParkDriveSurgicalCenter(HOPD) Houston,TX 100%
DallasMetro Dallas,TX 35%
NorthstarHealthcareSurgeryCenter-Houston Houston,TX 100%
NorthstarHealthcareSurgeryCenter-Scomsdale Scomsdale,AZ 100%
ChandlerSurgeryCenter Phoenix,AZ 100%
OracleSurgeryCenter Tucson,AZ 100%
PhoenixSurgeryCenter Phoenix,AZ 100%
SurpriseSurgeryCenter Phoenix,AZ 100%
Clinics
ChandlerClinic Phoenix,AZ 100%
OracleClinic Tucson,AZ 100%
ParadiseValleyClinic Phoenix,AZ 100%
PhoenixClinic Phoenix,AZ 100%
SurpriseClinic Phoenix,AZ 100%
SugarLandClinic Houston,TX 100%
WoodlandsClinic Houston,TX 100%
ClearLakeClinic Houston,TX 100%
KatyClinic Houston,TX 100%
StoneOakClinic SanAntonio,TX 100%
RoundRockClinic RoundRock,TX 100%
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Facility Special,es Facility
PlanoSurgicalHospital • Bariatrics• Spine• PlasAcs• Orthopedics• GeneralSurgery• Painmanagement
• 26InpaAentbeds• 6OR’s• 2ProcedureRooms
KirbySurgicalCenter • Orthopedics• Generalsurgery• Pain• ENT
• 4OR’s• 1ProcedureRoom
HermannDriveSurgicalHospital
• Bariatrics• Spine• PlasAcs• Orthopedics• GeneralSurgery
• 22Beds• 18Privaterooms• 6OR’s• 2ProcedureRooms
FirstSurgicalHospitalFirstStreetSurgeryCenter(HOPD)
• Bariatrics• Spine• PlasAcs• Orthopedics• GeneralSurgery• Painmanagement
Hospital
• 4OR’s• 1Procedure
Room
ASC • 4OR’s
NorthstarHealthcareSurgeryCenter-Houston
• Spine• Bariatrics• GeneralSurgery• Pain• Podiatry• PlasAcs• GI
• 3ORs• 2Treatmentrooms
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Facility Special,es Facility
NorthstarHealthcareSurgeryCenter-Scomsdale
• PlasAcs/ReconstrucAve• Orthopedics• Generalsurgery• Pain• Bariatrics• Podiatry
• 4OR’s• 1ProcedureRoom
ScomsdaleLibertyHospital • Spine• Orthopedicsurgery• Generalsurgery• Podiatry• Bariatrics• Migraine• Vascular
• 2OR’s• 1ProcedureRoom• 12InpaAentbeds
ArizonaVein&VascularCenter • Vein • 5Clinics• 4ASCs• 15OR’s
HamiltonVeinCenter • Vein • 6Clinics• 20RFAs
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