Nightingale Health Oyj (HEALTH) Earnings Call Transcript & Summary

Good afternoon, and welcome to Nightingale's half year results. So today, I will be going through the half year results. We will start from a brief recap about Nightingale, and what we do, then we go into the business targets for the fiscal year. And then we have a couple of key achievements that we want to talk a bit more. Then we will have the financial review, and then in the end of the presentation, we have time for Q&A. So please post your questions. My name is Teemu Suna. I'm CEO and Founder of Nightingale Health. I will go through the first part of the presentation and then our CFO, Tuukka Paavola, will join me on stage in the financial review. So let's start. So Nightingale, we are the preventative health company. So everything we do is aiming to bring preventative health as a part of the whole health system. The company's journey is -- has started -- we started as a biotechnology company almost ten years ago and then we built our own proprietary biotechnology platform. Then the next step was that we acquired strong data assets, strong health outcome data assets and now we are in a stage where we have created a technology that can detect from a single blood sample, a very holistic view of the future health risks. The technology is very comprehensively validated. It has a very strong scientific validation. The technology is a regulatory approved and then this is very international operations. So our laboratories are running in Finland, Japan, the U.K., the U.S. And today, I will be talking a bit more about the preventative health. So let's start from here. So this is actually a slide that -- well, I think the first time I showed this slide or a version of this was in 2015. So we've been talking about the need for preventative health for a very long time. In 2015, it was more about, let's say a theoretical discussion in many forums. But what we believe is that when we look at the health system, we actually concluded that if we want to solve this massive burden that healthcare is causing for the global economies. If we want to do something that people can actually live healthier lives. We need to address the primary care system. We need to create a system that can actually help everyone, help the system to prevent the diseases. Now over the past 12 to 18 months, over the past couple of years, there's been increasing amount of discussion about the need for preventative health. The latest one was actually here in Finland, where there was a very, very prudent public discussion about a concept where we should be building a health system that is based on prevention. So there is a major shift ongoing worldwide. It's not only in Finland, it's in a lot of other countries. I think it's not only in a way -- it's not any more in a way that we ask like Nightingale has to bring up the slide and say that it is important. I think everyone more or less agrees that this is massively important. And the key is prevention. So we have read the situation where the goal, what needs to be done. I think it is pretty well shared. So the next question is, then okay, how to do it? And how to do it is in a way, a complicated question. But then on the other hand, there is a certain kind of simplicity in all of this. So what do we need? What is the most essential element for preventative health? Well, we need to find the individuals that have health risks. We need to detect from the healthy population, the individuals who are at risk. Now the challenge is, of course, that if you want to find people with a risk from a nation, like let's think about like Finland, 5 million people, how do you find the ones in a risk? The solution cannot be something like, okay, let's invite everyone to meet GPs. I mean the health system is already -- there's a massive burden already for the health system. We cannot kind of cause more burden. So the solution needs to be easy to implement, and it needs to be very affordable. We cannot like -- the spending is already in a very high level. So it needs to be affordable. Then it needs to be repeatable. So we need to be able to repeat. We need to be able to scale the solution in a way that everyone can be tested. And when we really think about what is feasible to implement, what are the solutions, what are the potential solutions to make prevention actually happen? Nightingale has a very unique, very strong solution. We are one of the best solutions for this problem if not the best. And I think this is what we have been building for several years. This is the capability that we have now ready to roll to the market. So how we do it? How do you profile an entire nation. You do it with blood because what you need is that you need actual molecular data to actually understand the health risks. The power of Nightingale data in this context is that when traditional blood tests, they just detect individual single molecules. And it's a great way to detect -- to diagnose diseases that are already happening. But now the challenge is not to do that. The challenge is to understand the future health risks of people. And now when you have like even you're rolling it into a massive scale, you need a technology that can, from a single sample with a very low price point with very strong value. When you build that, you start to -- you have actual solution to find the people who have the health risks. Once you have found the people, the interventions, I mean, when we can target the interventions for the ones who needs them, the efficiency of the whole system will significantly improve. So what we do is that from this single sample, we bring a lot of molecular data. So now to find the risks, it's not enough just to measure the blood samples. So the capability that we have to find the risks, we have been working with the world-leading health outcome data collections. So we have been working with several biobanks. And these biobanks, what they have, they have collected blood samples from the healthy individuals. So they have -- in a way, they have done the thing that I'm talking about here. So they have collected samples from the population in a very big numbers. Then they have been following up these individuals, all of their health records and now what Nightingale has done, we have measured these samples that are 10-year old from the freezers, and we have connected the molecular data, the biomarkers that we measure from each sample into the health outcomes. And with that, when we put together the capability to measure the biomarkers, we have the health outcome data. This creates the exceptional ability to detect a wide range of health and disease outcomes. And now when we put this -- let's bring this back to the challenge of preventative health. The first step in preventative health is to find the people who are at risk, healthy individuals who are at risk. With this capability, because it's scalable, it's affordable, it's repeatable. It detects the very wide range of different health outcomes -- different health risks. This is a feasible solution to run nationwide. So what do we find if we go a bit deeper in the health outcomes. So when I'm saying that it detects a very broad -- it detects many diseases at once. It really does. But now when you look at this, the -- I think the key things to pay attention are the most typical chronic diseases such as cardiovascular disease, diabetes and complications, et cetera. And the technology when I was saying that this is a solution that can actually -- this can be run. We can run this nationwide it's a feasible solution. It also requires the validation. So the Nightingale is validated in terms of the regulation. It is validated in terms of medical science. And this is international operation. So there are already more than 30 countries using this technology, more than 160 different institutions. There are more than 450 scientific publications. It's all out there. What I'm talking -- when I'm talking about the capability to detect the health risks, it's all published. So you don't have to take it from me. You can read the papers. And the number of samples is increasing all the time. 1.8 million samples already analyzed. So this is actually -- because the Nightingale analysis is always -- it's very repeatable. It doesn't matter if you measure a sample in Singapore or Japan or in Helsinki. It's in the same baseline. So this 1.8 million samples analyzed, that is the world's largest virtual biobank. All right. So let's move forward. Regarding the business targets for the current fiscal year, we are not providing an update about this. At this time, we will be providing an update by the end of the running fiscal year. So I will not use more time to go this through. Instead of that, let's go -- let's dive into the key achievements during the half year. We have now put these achievements into two baskets. So we have the scientific validation and then the commercial activities. And now there is a clear kind of bias. So we are looking more strongly to the commercial activities because this is where we are now aligning all of our actions, all of our operations. So the time for the -- to build the core capabilities, the core technologies, we are more or less ready. So now it's time to boost the commercial side forward, and I will give a bit more detail how that is moving forward. But let's start from the science, and we wanted to bring this up because this is a landmark publication based on the UK Biobank data that Nightingale has analyzed it with its technology. To give a bit of context for this, the UK Biobank initiative is really something that is representing the future of health. How health, how medicine will develop in the future. When we joined this initiative, it was still like very early days. So there were a lot of things that we believe that this groundbreaking UK Biobank will allow the medicine to do and discover. But at that point, when we did the decision, it was, of course, just a concept, the results were not on the table. So no one really knew like exactly how well it worked. We believe that it will work very well. But I think now with the results, it's groundbreaking in many ways. So what is like -- I will only like give a very brief summary of what you can see in the slide. So to put it very briefly, what it means, this publication validates that from the single Nightingale blood sample, we can detect multiple key chronic disease risks in equal or better level than existing routine technologies. But none of the existing technologies detect multiple disease in one go. And now if we put this again back to the context of preventative health this multi-disease detection is the key and the fact that you can do it in a very simple way. You need gender and age and then you run Nightingale from a blood sample. That is the scalability of this is massively good in contrast to kind of more traditional way when people are asked to visit the GP, and there are several like different tests done at the clinic, et cetera. So the scalability of this is very good. The risk detection is very good. We can actually help the system to find the ones who would benefit of the early interventions and then the health system knows what to do, but they can do it in a far more targeted way. There is a link to the paper. Please have a look. Then let's move to the commercial side. Let's start from the U.K. And now something that I wanted to highlight with the commercial activities. What we are doing here, we are building -- we aim to build and we aim to help the entire health ecosystem to become preventative. This is very difficult. It takes time, but we are making very good progress. In the U.K., the first stage has been to analyze a lot of -- analyze blood samples that are being sent from the U.K. to Finland. There, we have been very successful. We have completed the Stage 1. Operationally, I think it's been also a very good decision because it has allowed us to do this in a very capital smart way to get the samples to be run in Finland. But now because there seems to be very strong demand and a lot of interest to -- with different stakeholders towards the preventative health, now we are taking the next step, and we are building the Nightingale laboratory also in the U.K. But this goes like step by step. There is no shortcut that you can just like, well, why don't you start selling this to public health care in the U.K. It doesn't work like that. It works step by step, and we have to take these steps carefully. And I think this is very understandable, like if thinking about the problem that we are solving here. Then in Japan, we have a bit of a similar story, but the difference in Japan has been that what we did first, when we made the deal in Japan, so the first step, what you need to do? Well, you build the operations and laboratory. And now if you go to Japan and you say that, okay, so my business is that I want to build a clinical laboratory in Japan. It's quite difficult and it takes time. But this is -- we have completed this. And the next step, once we had the laboratory and operations built, well, the obvious next step is to -- we need to build a distribution network to the current health system. We started to build up last spring, so the spring last year. So in March 2022, we had one clinic. So one clinic that had decided that they will offer the Nightingale technology to their customers. Now one year after, we have 149 clinics. And as you can see from the map, we almost cover all the prefectures in Japan. But having the distribution network built, it doesn't mean that, well, immediately, there is kind of -- there is some kind of an automation that now it starts to like the sales starts to go very quickly forward. Now we need the third stage, which is to do sales and marketing together with our partner, and we have to, and we will be doing it in the context of the Japanese health system. But the situation is extremely good. Getting into this stage is it allows us to make a very strong push in sales and marketing efforts because we have the channel now and we have the laboratory running. Then with Livit. So the first stage with Livit was to build the technology, to build the app. And then we launched it in Finland, which is a pilot market to learn. It's a pilot market to get everything working operationally. But Livit for Nightingale, it's more than when -- if you look at Livit and you see our direct-to-consumer offering in Finland. What you are looking at, you are looking at the tip of the iceberg. Actually, the Livit platform is part of our different offerings. It's part of the business-to-business offerings because it doesn't matter what is the -- where the Nightingale blood sample is run, you can always get this Livit experience also connected to the data that we run. So the next stage there is that we are looking the B2B2C channel network with Livit because we believe that this kind of a multichannel strategy is a good way forward. And Stage 2 is still we need to learn more about the product. We need to optimize it. And then once we have enough data, we can move into the Stage 3, which is scaling of sales. Alright, that's it with the highlights that we wanted to bring up this time. So let's move forward to financial review, and I'll ask Tuukka to join me on stage. I think there is now very positive movement with the commercial activities and now it's also reflected it in the numbers, but Tuukka will talk more about them.

Yes. Thank you, Teemu. Great to be here and great to be presenting, I would say, rather positive numbers. So let's jump right into it. Starting from the top, so our revenue for the half year period was roughly EUR 2.24 million, which is 76% higher than the revenue in the first half of the previous financial year. And we are already almost at the same level as we were for the full previous financial year. Like Teemu mentioned, we've had good traction in the U.K. So actually cost estimates from the U.K. brought almost 80% of our revenue in the first half. And we are now leveraging this good momentum by establishing the U.K. lab operations this year as we actually announced earlier this year. Looking forward, we expect a continued positive revenue trend. But however, we also expect some cyclicality or volatility with the revenue in the coming periods. Moving onwards. On the other lines, our EBITDA landed at roughly minus EUR 5.5 million. Operating profit at minus EUR 8.7 million and net income at minus EUR 8.6 million, which reflect our continued efforts to grow the business, commercialize our services and also expand internationally. And all these efforts we do with frugality, meaning that we are really cost-conscious in what we do and how we do things, where do we invest to really grow wisely and I would say maximize our probability to really make this company a success story. We still maintain a strong balance sheet. We have a good capital structure. We have a strong liquidity position, which is reflected with the cash -- cash at hand at roughly at EUR 88 million at the end of the first half. So we continue having a good foundation to continue executing on our strategy, continue the growth, continued internal expansion and reach eventually our vision, our mission. That's it briefly on the numbers. Now back to Teemu.

Yes. So yes, I think something that we have been looking quite a bit on what we are very happy about -- I think the company is in a pretty good situation like as I said earlier, like all these investments to build the core technologies, all these capabilities, it's pretty much done. It's pretty much there. Now we are also seeing that the market momentum is changing. There's more discussion, more conversation about preventative health, its in the political level, it's in the private companies, it's like -- it's just all the time in broader form. So I think there is a very good alignment that this needs to get done. This needs to be solved. And then we are in a strong cash position. I guess that what we are doing and this like operational challenge is like to move the company, move everything we do towards like step-by-step to the commercial direction. I think it's going pretty good.

Exactly.

Yes. So well, with that, let's move into the questions and answers, and our Chief Operating Officer, Satu Saksman, will join us on stage, and we will go through some of the questions to provide more clarity. Welcome, Satu.

Thank you, Teemu, and good afternoon on my behalf, too. So let's start the questions continuing with this revenue. So can you open up a little bit about the revenue growth like drivers behind it, the role of the U.K. And then what's driving the revenue?

Yes. All right. So maybe, Tuukka, you can take this first one.

Yes. So still biggest part of our revenue comes from research customers or research collaboration. And the nature of where we are at the moment is that we have several quite big projects that we have been doing on and are still in our pipeline, where we analyze the samples over several months or even over a year. And that does have this impact on the cyclicality. So it always depends when we are analyzing and done with certain projects when those revenues are recognized. And this also creates a notion of the cyclicality also going forward. And as it has happened now that we have completed several few big projects in the U.K. in the first half, which is then shown in the numbers. And again, what the split between the countries is in the next half, that's still -- you can expect some variation there as well.

Yes. Yes. I did think like this when you saw the slides about this staged approach that it takes time to build the different stages. And now the commercial activities, they are moving well forward, but it takes time. And now because of this then the -- there are still like the size of the funnel is not as wide and as broad as we would like it to be, but it's growing all the time, and we are working with that when the size of the funnel grows, then this kind of the forecast capability also improved. So I think we have a pretty clear plan how to get this sorted out. So it's not that cyclical anymore, but it takes a bit more time still.

So continue with that, will revenue growth continue like as we have seen now? What's your estimation?

Do you want to start?

Yes. So we don't guide anything on the growth, we don't guide anything on exact numbers or the percentage growth. We just can repeat what we -- what I said earlier that we expect a positive revenue trend to continue, but that's all. As Teemu said, we still don't have enough evidence or enough cases in the pipeline to give a more exact estimate. But when we are at that stage where we can give a better estimate, then of course, we will do that.

It's in this -- from my point of view, when we look at these growth companies and this kind of changes when there is a momentum that is kind of a very big system like primary care, when there is a need to do something about it. It's -- it takes -- it's impossible to predict like when it actually happens. But the key question and the key kind of driver that we are looking at is the amount of conversation, amount of requests coming inbound also to Nightingale, like we are looking at the problem. We are looking at the customers if they are actually kind of seeking for real solutions to solve -- to get the problem solved. And I think this momentum is now it looks a lot stronger than if we look at like 12 months ago, for example. So there is a clear shift in the momentum. And the nice thing about this is that we are ready. So we are ready to solve the -- to help to solve the problem.

So you already answered the next question as well which was, that can you elaborate a little bit more how customer discussions have evolved in the last year. So are you saying, I understood -- and based on what you said, the customers are more receptive to Nightingale's message now than before and how the interest and readiness to move forward. Has there been a change, if we think about like maybe 12 months?

Yes. I think there is a clear change in that end. It's not only like you don't have to take it only from me and what we are saying here. Like if you read the public discussion around preventative health, if you read the public discussion about the challenges in health care and how to find solutions that can be actually integrated as a part of the system. So this is -- you can see this in the public discussion. And then if you think about it, how much there is similar discussions and conversations in the private sector. It's not like -- it's also very strongly in there. So we have to see how it builds up. It's still -- we need still like we need to be patient about this. We need to continue working. But there are many indications that the demand, the interest in our solution -- there seems to be a good fit.

So kind of can you be even more specific, there's been many questions about Nightingale's technology when it will be available in public healthcare because that's expected to be the slowest to move. So do you have any?

Yes. Yes. I think in this public health, we were actually -- when we were estimating like different business avenues and different customer segments, we were actually placing the public health -- we were expecting that it will take a very long time to get implemented. We were looking at like 5-year time lines. Now based on the conversations we are having, based on the public discussion, we actually expect that the time line is shorter. So instead of like in the scale of 5 years we believe that it will -- it can be like half of that. So we have to see how it builds up. Of course, we don't know how it goes, but it's -- I think there is a shift in the -- clear shift in the conversations.

All right. Then let's talk a little bit about Livit. There have been a couple of questions. So talking for example, about the recent Genetics feature in Livit that has been released, what are the next features on the Livit, I mean if thinking about the development road map or commercial activities? And how do you see -- what is really the -- I mean -- what is the role of Livit in the company's big, big picture, so to say?

So as I said earlier also, the important point is to think Livit as a kind of a very comprehensive asset as a part of Nightingale. So when you look at the direct-to-consumer service, as I said, you see only the tip of the iceberg. It's just the kind of -- for offering Livit for direct-to-consumer, it's only one of the channels that we are bringing the technology available for our customers. In the bigger picture, Livit is actually a way -- it's a method. It's a technology to provide the results that we measure from the blood to like individual use. And now the channel can be also something different. It can be B2B channel. It can be B2D channel. It can be in B2B2C. So it's very broadly part of the Nightingale solution portfolio. And now when we look at the development road map, it's -- we are balancing and we are looking at the different business segments and different business, different channels and their needs, and then we prioritize the road map according to that. So you can imagine that our B2B channels are looking this like development needs a bit differently than D2C channels. And this is the kind of the balancing we are doing and this work is guided by the business growth and the business opportunities.

All right. Then a little bit maybe outside of today's agenda you released just recently about the capability of measuring the Nightingale's analysis also from the finger prick and kind of the capability around that with this -- acquiring this license. Can you open up that a little bit?

Yes, that's a good question. So not going into very kind of detailed level with this Velvet device that we acquired the license, but I wanted to just share that it's also part of our offerings very broadly in different channels, not only direct to consumers but there is a lot of interest towards this self-collected blood samples in other business channels as well. What is the logic? What is kind of the business reasoning behind acquiring the license? So to our understanding, like when you want to measure something from blood. So the market works in a way that there are companies who manufacture and build these blood collection devices, and then there are companies who analyze the blood that is being collected by the device. Now if someone wants to buy this kind of a solution, they go and they buy this blood collection device. And they pay the price and the margin for the device manufacturer. Then they buy the analysis service from another company, and they pay for the service and they pay the margin of that company. There are at least two different margins to get the data from the self-collected samples. Now to our knowledge, Nightingale is the only company in the world that has this built capabilities in-house. What it means, it means that when we can bundle the collection device and the analysis capability with very strong value, single margin. So that's kind of the business reasoning why we acquired the blood collection technology license in-house.

Okay. Let's take one more question. So there seems to be a lot of activities going on in different countries and in different business areas and different capabilities. So how does the company runway look like if we're thinking about now the years ahead considering all these activities.

Yes. So of course, yes, we had the roughly EUR 88 million cash at hand. And if you look at our numbers from this first half and also previous years, that gives us a runway of roughly 3 to 5 years. Of course, like mentioned, we are being really cost-conscious about things. We try to maximize our runway by investing smartly and doing smart things. And of course, the more revenue we get, the longer the runway also becomes. So -- but I think this -- to summarize, we are not in -- we are in a good place. There's no hurry. There's no critical need to look at our cash position or liquidity. But we can, in a way, safe -- from a safe position to continue executing on our strategy for the time being.

Okay. Still one more question. So all this said, do you still have confidence that you will achieve all the targets set for this financial year? What is the current situation? And what will happen?

Yes. So the work continues. And I think there are like several very good and very strong initiatives ongoing. So I think our confidence to continue working with those is good.

All right. Then that's it for the questions, answers.

All right. So I think that's it for today, enjoy the spring. Take care and see you later.