Investor Presentation
November 2019
Investor Presentation November 2019 Cautionary Note Forward - - PowerPoint PPT Presentation
Investor Presentation November 2019 Cautionary Note Forward Looking Statements This presentation contains certain forward-looking statements relating to the Company. All statements, other than statements of historical fact included
November 2019
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This presentation contains certain “forward-looking statements” relating to the Company. All statements, other than statements of historical fact included herein, are “forward looking statements.” These forward-looking statements are often identified by the use of forward-looking terminology such as “preliminary,” “intends,” “expects,” “plans,” “anticipates,” “believes,” “views” or similar expressions and involve known and unknown risks and uncertainties. Although the Company believes that the expectations reflected in these forward-looking statements are reasonable, they do involve assumptions, risks, and uncertainties, and these expectations may prove to be incorrect. Investors should not place undue reliance on these forward-looking statements, which speak only as of the date of this presentation. The Company disclaims any intention or obligation to update or revise any forward-looking information, whether as a result of new information, future events or otherwise, except as required by applicable securities laws. These uncertainties include, but are not limited to, the risk of our identified material weaknesses in the Company’s internal control over financial reporting adversely affecting its ability to report its financial condition and results
financial data, periodic reports or other corporate actions; changes in the demand for the Company’s O&P products and services; uncertainties relating to the results of operations or recently acquired O&P patient care clinics; the Company’s ability to enter into and derive benefits from managed-care contracts; the Company’s ability to successfully attract and retain qualified O&P clinicians; federal laws governing the health care industry; uncertainties inherent in investigations and legal proceedings; governmental policies affecting O&P
affect the Company, see its Form 10-K for the year ended December 31, 2018 as filed with the Securities and Exchange Commission. The information contained in this presentation is made only as of the date hereof, even if subsequently made available by the Company on its website or otherwise. Note Regarding the Presentation of Non-GAAP Financial Measures: This presentation includes certain “non-GAAP financial measures” as defined in Regulation G under the federal Securities Exchange Act of 1934. Non-GAAP measures include Adjusted EBITDA, Adjusted EBITDA Margin, adjusted earnings per share, leverage ratios, free cash flow. As required under Regulation G, Reconciliations of GAAP and non-GAAP financial results are included in schedules at the Appendix. These schedules reconcile the non-GAAP financial measures included in this presentation to the most direct comparable financial measure under generally-accepted accounting principles in the United States. The non- GAAP measures contained herein are used by the Company’s management to analyze the Company’s business results and are provided for informational and analytical context.
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Who We Are:
Industry leader in orthotics & prosthetics services $4.2 billion1 addressable O&P domestic U.S. market Pioneered prosthetic devices in 1861 Focus on custom devices
By The Numbers ($ as of TTM 9.30.19):
Net Revenue $1.082 billion Adjusted EBITDA2 $121.9 million 4,700 FTEs; 900 locations (incl. 801 patient care & satellite locations) in 46 states and D.C. (as of September 30,
2019)
Two segments: Patient Care (82% revenue); Products & Services (18% revenue)
1 Source: Hanger Inc. estimates
2Adjusted EBITDA is a non GAAP-measure. Please see the Appendix for a reconciliation of GAAP to non-GAAP metrics.
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Our Values – Integrity, patient-focused,
are the heartbeat of a cultural evolution that places our patients at the core of everything we do Our Vision – To lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value Our Purpose – Empowering Human Potential Together
page 05 Hanger Net Revenue Hanger Adjusted EBITDA
Patient Care $889.3 million 82.2% revenue Patient Care $159.4 million 17.9% margin Corporate & Other ($68.6) million Products & Services $192.7 million 17.8% revenue Products & Services $31.1 million 16.2% margin
Hanger Net Revenue1
$1.082 billion
Adjusted EBITDA1,2
$121.9 million - 11.5% EBITDA margin
1 TTM through 9.30.19. 2 Adjusted EBITDA is a non GAAP-measure. Please see the Appendix for a reconciliation of GAAP to non-GAAP metrics.
your logo
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services in the United States
20% of all O&P services in the United States
prescription prostheses,
across injuries and multiple, high prevalence disease etiologies
through investments in clinical outcomes, centralized revenue cycle management, patient engagement and supply chain to drive growth
margins and pursue M&A to drive incremental growth
Premier scalable provider in a large market for specialized healthcare services
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Prosthetic devices replace a missing limb or portion of a limb Provided to patients with amputated or congenitally absent limbs to replace the function and appearance of a limb Prosthetics are customized to meet the unique location and characteristics of the patient and their residual limb Prostheses have an average useful life ranging 3-5 years
Orthotic devices modify the structural and functional characteristics of the neuromuscular and skeletal system Prescribed for injuries, musculoskeletal, neurological or
Hanger Clinic emphasizes fabrications of customized devices
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Approximately 350,000 people with major limb loss utilize a prosthesis +90% are lower extremity Typically have a 3-5 year replacement cycle (70% recurring revenue) Prosthetics total approximately 50% of the prescription O&P market
Source: IQVIA (IMS) 2016 data; EpiSource 2014 data; Ziegler-Graham, et al., “Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050”, Arch Phys Med Rehabil 2008:89, 422-429; Dillingham et al., “Rehabilitation Setting and Associated Mortality and Medical Stability Among Persons With Amputations”, Arch Phys Med Rehabil 2008:89, 1038-1045; Science Daily, “Prosthetic knee type may determine cost of care for amputees”, July 11, 2017
3% Other Disease 50% Trauma 47%
Addressable market currently growing at 1.5 - 2.0% annually
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$1,420 $1,170 $960 $450 $210
drive the majority of major amputations. Mix of prosthetics and orthotics
requiring braces, boots and supports. Orthotics-only market
+65, cerebral palsy, multiple sclerosis. Ankle-foot orthosis, braces
congential limb difference) or orthotics (i.e.cranial orthosis for plagiocephaly)
$ millions
Sources: IMS Health, Hanger Estimates Note: “Major amputation or limb loss refers to a lower extremity, above or below the knee and upper limb, or combination thereof
are due to injury. +$1 billion spent on prosthetics secondary to injury
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Hanger Net Revenue
Patient Care1 $889.3 million 82.2% of revenue Patient Care1 $159.4 million 17.9% margin
Hanger Adjusted EBITDA2
1 TTM through 9.30.19. 2Adjusted EBITDA is a non GAAP-measure. Please see the Appendix for a
reconciliation of GAAP to non-GAAP metrics. Products & Services Products & Services G&A Expense
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Hanger employs over 20% of the board certified, O&P clinicians in the U.S. Competitors are spread out in small local practitioner settings.
Hanger is the only O&P provider operating a nationwide network of patient care clinics in 46 states and D.C.
Hanger’s broad provider footprint allows for a healthy diversity of payor and referral sources. Geographic diversity insulates Hanger from local or market specific challenges.
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Hanger Patient Care Clinics
Hanger has the highest volume of O&P patients as compared with any provider. Enables Hanger to develop and deliver best practices in O&P care.
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695 327 79 2,099
O&P Patient Care Clinic Market
(by location) Approximately 3,200 Clinics
10 next largest O&P providers
ranging from 22 - 68 clinics
Veterans Administration Rest of market
695 patient care clinics 106 satellite locations
Source: American Board For Certification 2017. Figures reflect Hanger as of 9.30.19
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Clinicians and Peer Visitors connect with new amputees in the hospital at the time
Net promoter score measured nationally at the patient and clinic level. TTM Average score of 84 (as of September 30, 2019) Outcomes, patient satisfaction and quality life tracked and reported at the patient and referral source level Patient Events designed to support mobility and utilization of devices Active social media program including patient and clinician stories as well as community outreach
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Chief Clinical Officer and clinical leadership group 1,500+ certified / licensed clinicians 500 technicians and assistants Specialists and centers of excellence
Enterprise-wide electronic health record to digitize clinician documentation and practice administration Implementing a patient portal and consumer engagement platform
Comprehensive outcomes programs across Hanger Clinic, as standard of care Collaborations with leading clinical and academic institutions Six multi-center publications released to measure the impact of prosthetics on mobility Annual education conference
Achieving clinical results for patients, payors and referral sources
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$20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000
2014 2015 2016 2017 2018
Reduced to $38 million in 2018
Localized claims process pre-2015
Disallowed revenue rises to $82 million,
revenue1
Disallowances peak in 2014
Hired Chief Revenue Officer Established centralized RCM function Executed a claims documentation initiative in 2016
RCM deployed in 2015
$ thousands
Reduced disallowed revenue dollars by 53% from 2014 through 2018
Disallowed Revenue: Peaks in 2014 at $82 million
1 Disallowed revenue expressed as a percentage of adjusted gross Patient Care segment revenue.
Strong documentation regimen Focus on eligibility and preauthorization Low first pass denials and payor friction Sophisticated level of service to patients and payors
Program results to date
page 019 Cash investment of approximately $22 - $27 million in supply chain reengineering and technology in 2020 and $6 - $8 million in 2021 Ongoing operating expense of approximately $5 million annually
Patient Care purchases 75% of materials for its own use through its central supply chain Provides scale and purchasing power
Patient Care Materials Costs (COM) were 30.6%
months ending 9.30.19) Opportunities exist to achieve further economies of scale Lower freight costs
Hanger operates five distribution centers across the U.S. Investments in systems, processes and on-line channels aim to lower supply chain costs Inventory consignment
In addition to laboratories within local clinics, Hanger operates eleven fabrication facilities nationwide Opportunities to streamline production through use of central fabrication facilities
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5.0% net revenue growth in 2019 (TTM through 9.30.19 compared to full-year 2018) Comprehensive catalog for independent O&P providers One-stop O&P industry destination with 450,000 SKUs across more than 300 manufactures Leading dedicated O&P distributor in the industry
Rehabilitation technologies and clinical programs to skilled nursing facilities (SNFs) Facing headwinds due to challenging conditions and the reimbursement environment in SNFs Goal to stabilize revenue and earnings
Hanger Net Revenue
Products & Services1 $192.7 million 17.8% of revenue
Hanger Adjusted EBITDA2
Products & Services1 $31.1 million 16.2% margin
1 TTM through 9.30.19. 2 Adjusted EBITDA is a non GAAP-measure. Please see the
Appendix for a reconciliation of GAAP to non-GAAP metrics. Patient Care Patient Care G&A
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Exceed industry growth rate of 1.5 - 2.0%
Disciplined approach to O&P acquisitions
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Achieve consistent operating leverage
costs, contributing to gradual margin expansion
margin expansion
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$262.9 $279.6
2018 2019
Third Quarter
$763.9 $797.2
2018 2019
Nine Months
+6.3%
+4.4%
Third quarter 2019 same clinic, day-adjusted growth of 2.1% driven by 4.0% prosthetics growth Year-to-date same clinic, day-adjusted growth of 1.8% and prosthetics growth of 2.7%
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$31.1 $32.6
2018 2019
Third Quarter Nine Months
Patient Care margin increased to 18.3% in Q3 as compared with 17.8% in Q3 2018. Year-to-date segment margin of 17.0% versus 16.5% in prior year The decline in therapeutic solutions revenue as well as lower margins in O&P distribution have moderated consolidated Adjusted EBITDA margin year-over-year
$81.0 $81.9
2018 2019
11.8% 11.7%
Margin %
10.6% 10.3%
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0.6% 0.9% 2.1% 1.1% 1.7% 2.1% 0.3%
3.0% 2.1%
Q1 17 Q2 17 Q3 17 Q4 17 Q1 18 Q2 18 Q3 18 Q4 18 Q1 19 Q2 19 Q3 19
1 Same clinic revenue growth per day excludes the effect of change in rate of disallowances for 2017. Beginning in 2018, Hanger instituted reporting same clinic revenue
growth per day that includes the impact of disallowed revenue, as this measure now better reflects year-year changes.
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30 35 40 45 50 55 60 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000
2014 2015 2016 2017 2018
Accounts Receivable, net
(Orange Bars) $ thousands
Day Sales Outstanding
(Black Line)
Commercial mix excludes Medicare and Medicaid Managed Care Diverse reimbursement mix combined with improved A/R aging has driven stronger working capital characteristics
Peak in late 2014
Balances as of December 31,
DSO 46 and A/R balance at $144 million
Medicare Medicaid Commercial VA Private Pay
10% 7% 36% 32% 15% Payor Mix, Percentage of Patient Care Net Revenue YTD 2019
page 030 $144.8 million in liquidity, comprised of:
capacity under revolving credit facility
equivalents
Net debt of $455.8 million
bearing fixed rate
interest expense, or 6.3%
20191 Free Cash Flow (Adjusted EBITDA2 - CapEx) of $90.5 million 20191 Capex, including purchase of equipment leased to third parties totaled, $31.4 million Estimated CapEx of approximately $35 million in 2019
Pro forma leverage of approximately 3.7x at end of Q3 2019 Investing now in supply chain and financial systems and re- engineering to achieve freight, labor efficiencies, investing approximately:
Remain focused on leverage
1 Referenced amounts reflect TTM through 9.30.19. 2 Adjusted EBITDA is a non GAAP-measure. Please see the Appendix for a reconciliation of GAAP to non-GAAP
metrics.
3 Amounts stated as of September 30.2019
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Note: Guidance affirmed as of November 7, 2019. This presentation is not a reiteration or affirmation of prior guidance.
1 Adjusted EBITDA is a non-GAAP-measure.
Adjusted EBITDA is provided on a non-GAAP basis only because a reconciliation to the most comparable GAAP financial measure, net income, is not available without unreasonable effort due to the unpredictable nature of reconciling items that render such a reconciliation not meaningful for investors. Please see the Appendix for a reconciliation of GAAP to non- GAAP metrics.
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services in the United States
20% of all O&P services in the United States
prescription prostheses,
across injuries and multiple, high prevalence disease etiologies
through investments in clinical outcomes, centralized revenue cycle management, patient engagement and supply chain to drive growth
margins and pursue M&A to drive incremental growth
Premier scalable provider in a large market for specialized healthcare services
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2018 2017 2016 Net loss - as reported (GAAP) (858) $ (104,671) $ (106,471) $ Adjustments to calculate EBITDA: Depreciation and amortization 36,455 39,259 44,887 Interest expense, net 37,566 57,688 45,199 Loss on extinguishment of debt 16,998 — 6,031 Non-service defined benefit plan expense 703 736 786 Benefit (provision) for income taxes 5,238 27,297 (15,910) Loss from discontinued operations, net of taxes — — (935) Adjustments - Net loss to EBITDA 96,960 124,980 80,058 EBITDA (Non-GAAP) 96,102 20,309 (26,413) Further adjustments to calculate Adjusted EBITDA: Impairment of intangible assets 183 54,735 86,164 Third-party professional fees 12,461 32,301 37,244 Equity-based compensation 13,065 12,930 9,763 Acquisition-related expenses 510 — — Disaster recovery / unclaimed property settlement (2,221) — — Severance expenses 957 64 2,487 Further adjustments - EBITDA to Adjusted EBITDA 24,955 100,030 135,658 Adjusted EBITDA (Non-GAAP) 121,057 $ 120,339 $ 109,245 $ For the Years Ended December 31,
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2019 2018 2019 2018 Patient Care Net income from operations - as reported (GAAP) 36,130 $ 32,502 $ 93,661 $ 84,615 $ Depreciation & amortization 4,943 4,651 13,997 14,547 EBITDA (Non-GAAP) 41,073 37,153 107,658 99,162 Further adjustments to calculate Adjusted EBITDA: Equity-based compensation 1,087 1,023 3,282 3,262 Severance expenses
1,087 1,023 3,271 3,262 Adjusted EBITDA (Non-GAAP) 42,160 38,176 110,929 102,424 Products & Services Net income from operations - as reported (GAAP) 5,111 6,839 14,133 20,171 Depreciation & amortization 2,723 2,564 7,862 7,569 EBITDA (Non-GAAP) 7,834 9,403 21,995 27,740 Further adjustments to calculate Adjusted EBITDA: Equity-based compensation 236 238 726 343 Further adjustments - EBITDA to Adjusted EBITDA 236 238 726 343 Adjusted EBITDA (Non-GAAP) 8,070 9,641 22,721 28,083 Corporate & Other Net loss from operations - as reported (GAAP) (23,838) (23,417) (69,267) (67,910) Depreciation & amortization 1,707 1,735 5,047 5,436 EBITDA (Non-GAAP) (22,131) (21,682) (64,220) (62,474) Further adjustments to calculate Adjusted EBITDA: Third-party professional fees 2,136 2,230 5,530 8,870 Equity-based compensation 2,051 2,406 6,081 5,968 Acquisition related expenses 350
Severance expenses
Further adjustments - EBITDA to Adjusted EBITDA 4,537 5,002 12,459 12,983 Adjusted EBITDA (Non-GAAP) (17,594) (16,680) (51,761) (49,491) Total Adjusted EBITDA (Non-GAAP) 32,636 $ 31,137 $ 81,889 $ 81,016 $ For the Three Months Ended For the Nine Months Ended September 30, September 30,
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For the Trailing Twelve Months Ended September 30, 2019 2018 2019 2018 2019 Net Revenue (a) Patient Care 230,931 $ 214,080 $ 652,700 $ 620,745 $ 889,337 $ Products & Services 48,707 48,866 144,455 143,162 192,671 Net revenue 279,638 $ 262,946 $ 797,155 $ 763,907 $ 1,082,008 $ EBITDA (b) Patient Care 41,073 $ 37,153 $ 107,658 $ 99,162 $ 154,414 $ Products & Services 7,834 9,403 21,995 27,740 29,975 Corporate & Other (22,131) (21,682) (64,220) (62,474) (87,282) EBITDA (Non-GAAP) 26,776 $ 24,874 $ 65,433 $ 64,428 $ 97,107 $ Adjusted EBITDA (b) Patient Care 42,160 $ 38,176 $ 110,929 $ 102,424 $ 159,386 $ Products & Services 8,070 9,641 22,721 28,083 31,141 Corporate & Other (17,594) (16,680) (51,761) (49,491) (68,597) Adjusted EBITDA (Non-GAAP) 32,636 $ 31,137 $ 81,889 $ 81,016 $ 121,930 $ Adjusted EBITDA Margin (Non-GAAP) Patient Care 18.3 % 17.8 % 17.0 % 16.5 % 17.9 % Products & Services 16.6 % 19.7 % 15.7 % 19.6 % 16.2 % Net revenue 11.7 % 11.8 % 10.3 % 10.6 % 11.3 % (a) Excludes intersegment revenue (b) EBITDA and Adjusted EBITDA are "Non-GAAP" measures For the Three Months Ended For the Nine Months Ended September 30, September 30,