Investor Presentation January 2020 Forward-Looking Statements This - - PowerPoint PPT Presentation
Investor Presentation January 2020 Forward-Looking Statements This - - PowerPoint PPT Presentation
The Innovator in Healthcare Workforce Solutions and Staffing Services Investor Presentation January 2020 Forward-Looking Statements This investor presentation contains forward-looking statements within the meaning of Section 27A of the
Forward-Looking Statements
This investor presentation contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The Company bases these forward-looking statements on its current beliefs, expectations, estimates, forecasts and projections about future events and the industry in which it operates. Forward-looking statements are identified by words such as “believe,” “anticipate,” “expect,” “intend,” “plan,” “will,” “should,” “would,” “project,” “may,” variations of such words and
- ther similar expressions. In addition, statements that refer to performance; plans, objectives and strategies for future
- perations; and other characterizations of future events or circumstances, are forward-looking statements.
The Company’s actual results could differ materially from those discussed in, or implied by, these forward-looking
- statements. Factors that could cause actual results to differ from those discussed in or implied by the forward-looking
statements contained in this presentation are set forth in the Company’s Annual Report on Form 10-K for the year ended December 31, 2018 and its other periodic reports, its current reports and its other filings with the SEC. Developments subsequent to this presentation are likely to cause these statements to become outdated with the passage of time.
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Non-GAAP Measures
This presentation contains certain non-GAAP financial information, which the Company provides as additional information, and not as an alternative, to the Company's condensed consolidated financial statements presented in accordance with GAAP. These non-GAAP financial measures include (1) adjusted EBITDA and (2) adjusted EBITDA margin on slides 10 and 27, respectively. Management believes that adjusted EBITDA and adjusted EBITDA margin serve as industry-wide financial measures. These non-GAAP measures should not be used in isolation to evaluate the Company's performance. A reconciliation of the non-GAAP measures identified in this presentation, along with further detail about the use and limitations of certain of these non-GAAP measures, may be found on the Company's website at http://amnhealthcare.investorroom.com/financialreports.
Key Investment Highlights
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Leader in Attractive Market Trusted partner in healthcare staffing services: nurse, allied, locum tenens, physician and executive search, interim leadership, revenue cycle solutions Innovator in Workforce Solutions MSP, VMS, RPO, workforce optimization, scheduling and credentialing solutions Investing in Technology Enhances recruiting capabilities and improves efficiency Scalable Operating Model Ability to drive attractive cash flow and earnings growth Strong Cash Flow and Balance Sheet Disciplined management and conservative balance sheet
Our Mission
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Every day, we . . .
Deliver the best talent and insights to help healthcare organizations optimize their workforce Give healthcare professionals
- pportunities to do their best work
towards quality patient care Create a values-based culture of innovation where our team members can achieve their goals
A Recognized Leader
2011-
Peer Review Designation to AMN MSP (Managed Services Programs) since 2011
2018
Largest Healthcare Staffing Company in the U.S. Re-Certified through 2020 First Corporate Certification for Staffing Services by the Joint Commission
2018
Exemplary Compensation Discussion & Analysis (CD&A) Award Winner
2016
Healthcare Leader Based on Customer Satisfaction and Quality
2018
The Top Size of Deal Provider Based on Customer Satisfaction and Quality
2018 2019
Gender Equality Index
2018
Top performer in revenue, profits, and stock returns.
2019
Corporate Equality Index
2018
Best Proxy Statement
5
Evolution of AMN: Driving Towards Workforce Solutions
6
AMN has evolved from traditional healthcare staffing to providing comprehensive workforce solutions
4%
2008
Workforce Solutions Clinical Staffing
67%
- Staffing and Recruitment
- Workforce Solutions
- Leadership
- Workforce Technologies
2019*
Workforce Solutions Now Majority of Revenue Mix
* 2019 revenue mix as of Sept. 30
Revenue Growth with Operating Leverage
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($ Millions) $1,036 $1,463 $1,902 $1,988 $2,136 $2,164 2014 2015 2016 2017 2018 LTM $91 $165 $237 $256 $270 $268 2014 2015 2016 2017 2018 LTM
Revenue Adjusted EBITDA
Our Technology Roadmap
8
Candidate Engagement More mobile, two-way, seamless Mobile apps for recruiting and engagement Customer Experience Insightful reporting and predictive analytics More data integrations Total Talent Management Integrate our technology platforms Help clients manage/optimize total workforce AMN Operations Creating new data assets Proprietary algorithms, large data sets Integrated omni-channel candidate acquisition
Industry Overview
Healthcare Staffing: Large, Fragmented Market
Source: AMN internal estimates of other markets 10
Hires, Openings & Quits Other Addressable Markets: Greater Than $5 Billion
Interim Leadership, Perm/Search, RPO, Revenue Cycle, Workforce Consulting, VMS, Credentialing
2019E 17.5 $0 $5 $10 $15
Revenue in $ Billions
Source: Staffing Industry Analysts/Crain Communications
US Healthcare Staffing
Job Openings and Labor Turnover
- Healthcare hiring has struggled to match need
- Hiring is largely offset by voluntary attrition
- One-third of the healthcare workforce turns
- ver each year
Source: Job Openings and Labor Turnover Survey, US Bureau of Labor Statistics
3% 7% 6%
Hires Openings Quits
Five-Year CAGRs
Healthcare Staffing Market Landscape
11
Top 10 largest firms ranked by estimated US healthcare temporary staffing revenue
(1) Medical Solutions includes acquisition of Aureus Medical Group Source: Staffing Industry Analysts FY 2018 estimates of total healthcare temporary staffing revenues
(1)
$0 $500 $1,000 $1,500 $2,000
Most Comprehensive Set of Solutions
12 Staffing Solutions Staffing Solutions Workforce Solutions Workforce Solutions Travel Nurse Travel Nurse Allied Health Allied Health Locum Tenens Locum Tenens Leadership & Search Leadership & Search RPO RPO MSP MSP VMS VMS Revenue Cycle Services Revenue Cycle Services
#1
✓
#1 #3 #1
✓ ✓ ✓
#1 #1 #1
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Projected Healthcare Labor Shortage in 2032 Aging Healthcare Professionals
~ 50% of RNs and physicians are age 50+
Annual Growth in Healthcare Spend Aging Population and Healthcare Utilization
Drivers of Healthcare Employment Growth
Sources: National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers – 2013 data and Association of American Medical Colleges April 5, 2016; AMN Healthcare survey, November 2017; AMA Physician Master File and 2012 Physicians Foundation Survey conducted by Merritt Hawkins – 2012 data; National Health Expenditure Projections – CMS, February 2019; AMN Healthcare 2013 Clinical Workforce Survey of Hospital Leaders; “The Complexities of Physician Supply and Demand,” Association of American Medical Colleges, April 2019; Future of the Nursing Workforce, Health Resources and Services Administration, December 2014.
- Over 65 - 3x more
hospital days
- Over 75 - 4x more
healthcare days
2010 2015 2020 2025 2030
Source: U.S. Department of Health and Human Services
5.5% 4.4% 3.9%
40 72
U.S. population aged 65+
in millions
~38% of active physicians are age 56 & older
Up to 121,900 physician shortage Regional & specialty nurse shortages
2018–27 2017 2018
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Business Overview
Staffing and Recruitment
- Travel nursing
- Allied staffing
- Locum tenens
- Local staffing
- Revenue cycle solutions
- Rapid response
- EMR implementation
- Labor disruption
Workforce Solutions
- Managed services programs
(MSP)
- Vendor management systems
(VMS)
- Scheduling and labor
management
- Credentialing solutions
- Education services
- Float pool management
AMN Portfolio of Solutions
Executive Leadership
- Interim leadership
- Executive search
- Physician permanent placement
- Clinical leadership search
- Leadership training and
development
- Workforce analysis and
- ptimization
- Predictive modeling and analytics
- Recruitment process outsourcing
(RPO)
15
Value through leadership, innovation and strategic insight
Staffing and Recruitment Workforce Solutions Leadership and Search Green text represents solutions offered within managed services programs
Leader in Managed Services
16
Outsourced partner to manage all supplemental workforce needs AMN manages staffing vendors, credentialing, clinical support, reporting, consolidated invoicing Complete range of solutions from vendor management systems (VMS) to vendor-neutral and staffing-led managed services programs (MSP)
Client Benefits AMN Benefits
- Faster and higher fill rates
- Increased visibility
- Staffing optimization
- Controlled spend
- Accountability
- Credentialing compliance
- Cross-selling opportunities
- Recruitment advantages
- Less cyclicality
- Improved demand visibility
- Strong client relationships
- High client retention
2010 2011 2012 2013 2014 2015 2016 2017 2018 LTM $134 $185 $265 $296 $350 $454 $649 $786 $892 $971
$85 $106 $115 $110 $154 $308 $369 $379 $346 $404
MSP Direct Fill Revenue Filled by Affiliate Network
Managed Services Programs Drive Growth
17
AMN Leads the Staffing-Led MSP Wave
AMN manages another $1.3 billion of client spend through VMS and vendor-neutral MSP
MSP Gross Billings Under Management ($M)
AMN Healthcare Segments
18
- Short- and long-term travel and
local staffing
- Nursing, therapists, respiratory,
imaging, lab
- Travel assignments are
typically 13 weeks
- Over 60% of segment
revenue comes through exclusive MSP relationships
63%
- f 2019
AMN Revenue* Nurse & Allied Solutions
* 2019 revenue mix based on the nine months through Sept. 30
22% 15%
Locum Tenens Solutions
- Placement of physicians, advanced
practice clinicians and dentists throughout the United States
- Typical assignments range from days to
multiple months Other Workforce Solutions
- Interim and permanent executive
leadership and physician placement
- Recruitment process outsourcing
- Vendor Management Systems
- Revenue cycle solutions
- Workforce optimization
- Credentialing solutions
Financial Overview
Financial Summary
20 ($ in Millions) $1,463 $1,902 $1,988 $2,136 $2,164 $- $500 $1,000 $1,500 $2,000 $2,500 2015 2016 2017 2018 LTM 3Q19 $469 $620 $644 $696 $719 32.1% 32.6% 32.4% 32.6% 33.2% 25% 30% 35% 40% $0 $200 $400 $600 2015 2016 2017 2018 LTM 3Q19 $165 $237 $256 $270 $268 11.3% 12.5% 12.9% 12.7% 12.4% 5% 10% 15% $0 $50 $100 $150 $200 $250 2015 2016 2017 2018 LTM 3Q19
Gross Profit and Margin Total Revenue Adjusted EBITDA and Margin Free Cash Flow
$29 $110 $134 $192 $169 $0 $50 $100 $150 $200 2015 2016 2017 2018 LTM 3Q19
Historical Credit Statistics
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Capital Expenditures Return on Invested Capital Total Leverage Ratio* Debt and Credit Facilities
($ in millions) $27 $22 $27 $35 $37 $0 $10 $20 $30 $40 2015 2016 2017 2018 LTM 3Q19 1.4x 1.6x 1.3x 1.7x 2.2x 0.0x 0.5x 1.0x 1.5x 2.0x 2.5x 2015 2016 2017 2018 Q3 19 * As defined by AMN’s credit agreement Balances as of 10/31/19. AMN’s $400M revolving credit facility has $17 million pledged as collateral for letters of credit. Interest Rate Maturity Date Debt Outstanding Available Borrowing Senior Unsecured Notes 5.125% Oct 2024 325.0 $
- Senior Notes
4.625% Oct 2027 300.0 $
- Revolving Credit Facility
3.900% Jun 2024 $ 0.0 $ 383.0 16% 14% 16% 14% 10% 0% 5% 10% 15% 2015 2016 2017 2018 LTM 3Q19
Allocation of Strong Free Cash Flows
22 ($ Millions)
$588
$- $100 $200 $300 $400 $500 $600 $700
2015 2016 2017 2018 YTD 2019
$ Millions
Cumulative Free Cash Flow
$588 Million Free Cash Flow Generated Since 2015
$(760)
$(119)
$458 $(800) $(600) $(400) $(200) $- $200 $400 $600
Acquisitions Stock Repurchases Net Borrowing
$ Millions
Selected Other Uses and Sources of Cash 2015 to Date
$879 Million Spent on Acquisitions, Stock Buybacks Balance Sheet Remains Strong
Key Investment Highlights
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Leader in Attractive Market Trusted partner in healthcare staffing services: nurse, allied, locum tenens, physician and executive search, interim leadership, revenue cycle solutions Innovator in Workforce Solutions MSP, VMS, RPO, workforce optimization, scheduling and credentialing solutions Investing in Technology Enhances recruiting capabilities and improves efficiency Scalable Operating Model Ability to drive attractive cash flow and earnings growth Strong Cash Flow and Balance Sheet Disciplined management and conservative balance sheet