AMN Investor Presentation February 2020 DRAFT v2Investor... · Microsoft PowerPoint - AMN Investor...

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The Innovator in Healthcare Workforce Solutions and Staffing Services Investor Presentation March 2020

Transcript of AMN Investor Presentation February 2020 DRAFT v2Investor... · Microsoft PowerPoint - AMN Investor...

Page 1: AMN Investor Presentation February 2020 DRAFT v2Investor... · Microsoft PowerPoint - AMN Investor Presentation February 2020 DRAFT v2 Author: Randle.Reece Created Date: 3/6/2020

The Innovator in Healthcare Workforce Solutions and Staffing Services

Investor Presentation

March 2020

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Forward-Looking Statements

This investor presentation contains “forward-looking statements” within the meaning of Section 27A of the SecuritiesAct of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The Companybases these forward-looking statements on its current beliefs, expectations, estimates, forecasts and projectionsabout 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 andother similar expressions. In addition, statements that refer to performance; plans, objectives and strategies for futureoperations; 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-lookingstatements. Factors that could cause actual results to differ from those discussed in or implied by the forward-lookingstatements contained in this presentation are set forth in the Company’s Annual Report on Form 10-K for the yearended 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other filings with the SEC.Developments subsequent to this presentation are likely to cause these statements to become outdated with thepassage of time.

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Non-GAAP Measures

This presentation contains certain non-GAAP financial information, which the Company provides as additionalinformation, and not as an alternative, to the Company's condensed consolidated financial statements presented inaccordance with GAAP. These non-GAAP financial measures include (1) adjusted EBITDA and (2) adjusted EBITDAmargin on slides 10 and 27, respectively. Management believes that adjusted EBITDA and adjusted EBITDA marginserve as industry-wide financial measures. These non-GAAP measures should not be used in isolation to evaluatethe Company's performance. A reconciliation of the non-GAAP measures identified in this presentation, along withfurther detail about the use and limitations of certain of these non-GAAP measures, may be found on the Company'swebsite at http://amnhealthcare.investorroom.com/financialreports.

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Key Investment Highlights

3

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

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Evolution of AMN: Driving Towards Workforce Solutions

4

AMN has evolved from traditional healthcare staffing to providing comprehensive workforce solutions

4%

2008

WorkforceSolutions

ClinicalStaffing 67%

Staffing and Recruitment

Workforce Solutions

Leadership

Workforce Technologies

2019*

Workforce Solutions Now Majority of Revenue Mix

* 2019 revenue mix pro forma for acquisition of Stratus Video

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Revenue Growth with Operating Leverage

5

($ Millions)

$1,036

$1,463

$1,902 $1,988 $2,136

$2,222

2014 2015 2016 2017 2018 2019

$91

$165

$237 $256

$270 $277

2014 2015 2016 2017 2018 2019

Revenue Adjusted EBITDA

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Our Technology Roadmap

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Candidate Engagement More mobile, two-way, seamlessMobile apps for recruiting and engagement

Customer ExperienceInsightful reporting and predictive analytics More data integrations

Total Talent ManagementIntegrate our technology platformsHelp clients manage/optimize total workforce

AMN OperationsCreating new data assetsProprietary algorithms, large data setsIntegrated omni-channel candidate acquisition

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History of AMN Healthcare

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Strategic Transformation in Workforce Solutions

1980s 2000–08 2014-15 2018-19

1990s 2010-13 2016

Travel Nurse

American Mobile Nurses: A founding company

Nurse and Allied Expansion

Preferred Healthcare, Medical Express, NursesRx

Workforce Solutions: MSP, RPO and VMS

MedFinders,ShiftWise

Nurse, Physician, VMS, Interim Leadership, Workforce Scheduling

Onward Healthcare, Locum Leaders, Medefis, The First String,MillicanSolutions, Avantas

Physician, Allied, Nurse and Search Expansion

Merritt Hawkins,Staff Care,MedTravelers, O’Grady Peyton

Interim Leadership and Executive Search, Labor Disruption, Medical Coding

BE Smith, Peak Health,HealthSource Global

Revenue Cycle, Interim Leadership, Executive Search,Credentialing,Allied and Nurse, Float Pool Management, VMS

MedPartners, Leaders For Today Phillips DiPisa,Silversheet, Advanced,b4health

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Stratus Video at a Glance

Delivered in Three Key Modalities

Across 1,600+ Healthcare Clients

3,000+ Interpreters

Medically qualified with ongoing continuing

education requirements

$1.2 Billion Market

Video remote interpreting is fastest-growth segment

Stratus has leading share in video segment

Video Hospitals

Community Health Centers

Clinics

Ambulatory Surgery Centers

$108MRevenue in 2019A

$30MAdjusted EBITDA

in 2019A

8

$119MAnnualized revenue

run rate in 4Q19

$34MAdjusted EBITDArun rate in 4Q19

Over the Phone

In Person

Serving a Growing Population

26M+ Limited English Proficiency | 11M+ Deaf/Hard of HearingNote: Stratus financials are unaudited and subject to change

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• 35 languages today

• Improves patient experience

• Available on any device, anytime

• Applicable for nearly all in-person interactions

Stratus Video Core Services Overview

Video 66%

In-Person

& Other11%

Phone 23%

Video Remote Interpretation

• 200+ languages available

• Covers less common languages and roll-over support for VRI

• Applicable for inbound patient calls, scheduled calls

Over-the-Phone Interpretation

• Tech-enabled, efficient deployment

• Enables hospitals use of in-house and contract interpreters

• Applicable for complicated / sensitive appointments

In-Person InterpretationStratus Revenue Mix

Note: Revenue mix is based on 2019A

Hospital Request

Interpreter Response

Provider Requests Interpreter

Provider Hires Interpreter

Interpreter Arrives

Interpreter Receives Requests

Interpreter Accepts & Confirms

Interpreter Sees Earnings & Ratings

9

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Stratus Key Financial Metrics

($ in Millions)

$68

$84

$108

$-

$20

$40

$60

$80

$100

$120

2017 2018 2019

$33

$40

$51

49%47% 47%

40%

45%

50%

55%

60%

65%

70%

$0

$15

$30

$45

$60

2017 2018 2019

Gross Profit and MarginTotal Revenue

Adjusted EBITDA and Margin

$14

$21

$30

20%25%

28%

0%5%10%15%20%25%30%35%40%45%50%55%60%

$0

$15

$30

2017 2018 201910

Key Financial Highlights

• Purchase price: $475 million cash

• Proposed financing: $250 million Term Loan, $175 million revolver draw and $50 cash

• Pro forma leverage: Debt/EBITDA 3.3x

• Immediately accretive to gross margin, EBITDA margin and adjusted EPS

Stratus financial results are pro forma for acquisitions

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Industry Overview

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Healthcare Staffing: Large, Fragmented Market

Source: AMN internal estimates of other markets

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Hires, Openings & Quits

Other Addressable Markets: Greater Than $5 Billion

Interim Leadership, Perm/Search, RPO, Revenue Cycle, Workforce Consulting, VMS, Credentialing,

Language Interpretation

2019E17.5

$0

$5

$10

$15

Re

ve

nu

e in

$ B

illi

on

s

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

over each year

Source: Job Openings and Labor Turnover Survey, US Bureau of Labor Statistics

3%

5%

8%

Hires Openings Quits

Five-Year CAGRs

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Healthcare Staffing Market Landscape

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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

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Most Comprehensive Set of Solutions

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Staffing Solutions Staffing Solutions Workforce SolutionsWorkforce Solutions

Travel NurseTravel Nurse Allied HealthAllied Health Locum TenensLocum TenensLeadership &

SearchLeadership &

SearchRPORPOMSPMSP VMSVMS

Revenue Cycle Services

Revenue Cycle Services

#1

#1 #3 #1

✓ ✓

#1 #1 #1

✓ ✓ ✓ ✓✓

✓ ✓ ✓ ✓ ✓ ✓✓

✓✓

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Projected Healthcare Labor Shortage in 2032Aging 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 2030Source: 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 121,900physician shortage

Regional & specialty nurse shortages

2018–272017 2018

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Business Overview

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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)

• Language interpretation

• Scheduling and labor management

• Credentialing solutions

• Education services

• Float pool management

AMN Portfolio of Solutions

ExecutiveLeadership

• Interim leadership

• Executive search

• Physician permanent placement

• Clinical leadership search

• Leadership training and development

• Workforce analysis and optimization

• Predictive modeling and analytics

• Recruitment process outsourcing (RPO)

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Value through leadership, innovation and strategic insight

Staffing and Recruitment Workforce Solutions Leadership and

Search

Green text represents solutions offered within managed services programs

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Leader in Managed Services

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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

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2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

$134 $185 $265 $296 $350$454

$649$786

$892$985

$85$106

$115 $110$154

$308

$369

$379

$346

$451MSP Direct Fill Revenue

Filled by Affiliate Network

Managed Services Programs Drive Growth

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AMN Leads the Staffing-Led MSP Wave

AMN manages another $1.3 billion of client spend through VMS and vendor-neutral MSP

MS

P G

ros

s B

illi

ng

s U

nd

er

Ma

na

ge

me

nt

($M

)

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AMN Healthcare Segments

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• 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

61%of 2019

AMNRevenue*

Nurse & Allied Solutions

* 2019 revenue mix is pro forma for the acquisition of Stratus Video

25%

14%

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

• Language interpretation

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Financial Overview

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Financial Summary

22 ($ in Millions)

$1,463

$1,902 $1,988 $2,136 $2,222

$-

$500

$1,000

$1,500

$2,000

$2,500

2015 2016 2017 2018 2019

$469

$620 $644 $696

$743

32.1% 32.6% 32.4% 32.6%33.5%

25%

30%

35%

40%

$0

$200

$400

$600

$800

2015 2016 2017 2018 2019

$165

$237 $256

$270

11.3%

12.5%12.9%

12.7% 12.5%

5%

10%

15%

$0

$50

$100

$150

$200

$250

2015 2016 2017 2018 2019

Gross Profit and MarginTotal Revenue

Adjusted EBITDA and Margin Free Cash Flow

$29

$110

$134

$192 $190

$0

$50

$100

$150

$200

2015 2016 2017 2018 2019

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Historical Credit Statistics

23

Capital Expenditures Return on Invested Capital

Total Leverage Ratio* Debt and Credit Facilities

($ in millions)

$27

$22

$27

$35 $35

$0

$10

$20

$30

$40

2015 2016 2017 2018 2019

1.4x1.6x

1.3x

1.7x

2.0x

0.0x

0.5x

1.0x

1.5x

2.0x

2.5x

2015 2016 2017 2018 2019

* As defined by AMN’s credit agreement

Balances as of 2/14/20. Pro forma leverage ratio is 3.3x.

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$ -

Term Loan 3.500% Feb 2025 250.0$ -

Revolving Credit Facility 3.500% Feb 2025 175.0$ 207.6$

16%14%

16%14%

10%

0%

5%

10%

15%

2015 2016 2017 2018 2019

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Allocation of Strong Free Cash Flows

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($ Millions)

* Pro forma for acquisition of Stratus Video

$657

$-

$100

$200

$300

$400

$500

$600

$700

2015 2016 2017 2018 2019

$ M

illio

ns

Cumulative Free Cash Flow

$657 Million Free Cash Flow Generated Since 2015

$(1,260)

$(119)

$888

$(1,500)

$(1,000)

$(500)

$-

$500

$1,000

Acquisitions Stock Repurchases Net Borrowing

$ M

illio

ns

Selected Other Uses and Sources of Cash*2015 to Date

$1.4 Billion Spent on Acquisitions, Stock Buybacks

Balance Sheet Remains Strong

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Key Investment Highlights

25

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