Ventas, Inc. (VTR) Earnings Call Transcript & Summary

Thanks, everybody, for being with us. My name is Jon Petersen. am a research analyst at Jefferies, I lead up our REIT research team. Really happy to have the Ventas team here with us today. One of my favorite healthcare REIT stocks right now. BJ asked me to maybe summarize my thesis. So I was thinking about how to boil it down as quickly as I could. A lot of post-pandemic recovery in senior housing. So 1 of the strongest growth subsectors, I think, in the REIT space right now and an attractive valuation. And I'll just leave it at that and let them speak for themselves. So Debbie, why don't I hand it over to you for you to give us the overview.

Yes. Good afternoon, everyone. It's a pleasure to be here with you today. I'm Debra Cafaro, Chairman and CEO of Ventas. I'm joined by Justin Hutchens, Bob Probst and BJ Grant. And I'll start with a few remarks, and then we'll touch on some of the specific verticals that are of interest we know are of interest to our investors. So Ventas, of course, is a leading S&P 500 REIT. Our portfolio, which is about a $32 billion valuation is really unified by serving a large and growing aging demographics. We have the demand, and that demand is right at our doorstep. And we can talk about the different verticals and how they serve different portions of the demographic as we go forward. We have a unique opportunity right now in senior housing, a recovery opportunity that's like nothing I have seen really in my years at Ventas, which is to recover and hopefully, even though beyond the NOI in our senior housing business. So -- that's a $300-plus million NOI opportunity, that's organic and internal growth story. We're projecting 15% to 21% senior housing operating NOI growth in 2023 and some, but not all of that is embedded of that $300 million is embedded in our 2023 guidance. That growth is also complemented by a stable compounding escalator business that we have in outpatient medical, in our university-based life science and in our triple-net portfolio. And we're really excited about the opportunities ahead. The senior housing recovery is well underway. And the last thing I guess I'll touch on is really the large and liquid scale that we have at Ventas and our access to lots of forms of attractive capital. And that's a real asset in today's environment and one that we intend to take advantage of as we move forward. So with that, we're focused on performance, outperformance. We have a unique opportunity because of this internal growth story and valuation to have a great runway in the next 3 to 5 years of outperformance. So with that, I think we want to start with Justin because we know senior housing is of great interest, and he's the expert. So over to you.

Great. Thank you, Debbie. Starting with this exciting opportunity in senior housing, I'm just going to recap some of the recent results, and then update with recent trends and then touch a bit on our approach to managing the senior housing asset class at Ventas. So first of all, very good results in the first quarter where our U.S. SHOP portfolio grew over 22%. Our Canada portfolio, which has -- it's important to note, it's been 94% occupied and it's been over 90% occupied every quarter since the first quarter of 2019. So through the pandemic and currently above 90% and growing, it grew 5% NOI. The portfolio is benefiting from pricing power that's unprecedented. It's driving REVPOR growth of 6.8%. We had occupancy growth of 80 basis points year-over-year. And then our expenses this year are expected to grow at a slower pace than they did last year. They grew 8% last year, expecting more like 5% this year. One of the quarter-to-date updates is in April, we're seeing expenses come down and that's driven by lower agency costs and therefore, slower growth in labor than we anticipated and other expenses are also coming down a bit. So that's a good trend. And then leading indicators in the second quarter started out very strong, and assisted living is leading the way with the growth thus far. A little bit deeper dive into the U.S., where we have -- we have a legacy portfolio that has 234 communities that's anchored by very strong experienced operators and well invested real estate. That portfolio in the first quarter grew 20% year-over-year NOI. Then we have -- and it accounted for 71% of our NOI by the way. Then we have our transitions portfolio of 200 communities. These are communities, all of which have transitioned to new management over the course of the past couple of years. And we have a number of things underway to help support that performance in those communities. We have already transitioned to new operators and with a huge emphasis on regional operators, establishing clusters and managers that are experienced in those respective markets. We also have invested into the real estate where we had an opportunity to come up to market and go beyond market through redev investment. We have 100 projects that have now completed of the 200. We have 80 that we have early evidence where they've been completed over the past few months, so we're starting to be able to measure the results from those projects and the early returns are very, very strong. And then the other part is just to bring our Ventas OI approach, which is where we bring the combination of our experiential insights, which is driven through my experience in the operating world and other team members that we have at Ventas, combined with best-in-class data analytics that's geared towards operational improvement, this approach is combined with our overall philosophy of making sure that we're in the right markets with the right assets and with the right operators on those assets, and it's been deployed formally for the last 1.5 years. We've had great adoption by our managers. We've had consistent execution by our team and we're helping to drive performance by improving things like pricing and digital marketing and expense control, and it's -- and we're off to a really good start. But we think the best is yet to come for a number of reasons. One is the macro backdrop is very strong, as Debbie mentioned, and then also our ability to execute into that macro backdrop is continuing to improve.

And just to put a finer point on the macro backdrop and some numbers, the first quarter annualized SHOP cash NOI is about $682 million. There's $1 billion of NOI that we can get to just by getting back to 88% occupancy and 30% margins, which is what we had going into the pandemic. And there's an opportunity to get beyond that because of supply and demand. And I do want to touch on that. In 99% of our markets, there's no new construction. Construction is at really all-time lows as a percent of inventory. We think starts are going to continue to be absolutely constrained because of liquidity and available capital. And so the combination of that really low supply, coupled with 23% growth in the over 80 population is what gives us the tailwinds that Justin was talking about in this 3- to 5-year runway of multiyear internal organic growth opportunity that's very exciting. So Bob on to...

Outpatient medical, I'll cover 21% of our NOI, which is the outpatient medical business, whereas we have the exciting growth in senior housing, we have what we call continuous compounding growth in our outpatient medical business. We have a fully integrated operating platform within Ventas under the branding of Lillibridge, wholly-owned entity with a very clear strategy, which starts with having the right assets in the right markets with the right health systems, surprising and delighting those tenants every day, managing costs, have a great center of excellence for leasing, which is driving occupancy. And at the end of the day, that's driving NOI. And we have some great results to point to 7 quarters in a row of occupancy growth year-over-year. 6 of our last 7 quarters, we've grown over 3% on NOI in the outpatient medical business, and we have industry-leading margins. So that has been a really reliable compounding cash flow growers for us and leading the pack.

Great. And I'll just touch on our really leading -- industry-leading and advantaged university-based research and innovation business. It's about 11 million square feet. It's principally university-centric with the leaders in research in the United States. And it has been a really great business for us. We're partnered with Yale and Penn and University of Washington, and the demand from these institutional users in research and innovation continues to be incredibly strong. And this is a business that fits really with the Ventas model of compounding growth where you have long leases credit tenancy and that's over really 75% of the NOI in this 11 million square feet. And so that's a business we've really liked. It's been very, very successful, and 1 that we think will continue to grow and be the leading business in the United States. So Bill, anything.

I'll just close with liquidity in the balance sheet. We've got strong liquidity, $2.6 billion when you include planned dispositions in our guidance for the year. We finished really our refinancing of 2023. We're now focused on 2024. We have great access to multiple forms of capital, as Debbie mentioned earlier. I just highlight Canada where we issued [ CAD 600 ] million earlier in the year with great response and demand. So we are very focused on '24 right now.

All right. Back to you.

I have some questions. All right. I got a few questions here. If anybody in the audience has any questions, we'll definitely save time for all that too. So in terms of the senior housing recovery, I think we should start there. You laid out kind of what the opportunity is, I think, a lot of us and investors think about things in terms of same-store NOI growth. So this year, I think your guidance is 15% to 20%, give or take. So huge, give or take, whatever it doesn't matter. But if we think multiple years in the future, like how much like -- how many years of this level of growth are we looking at?

Well, I'll jump in. So one thing to note is that we're actually -- if we achieve what we said we think we will. It's our second year in a row of double-digit growth. And in fact, our U.S. last year, the NOI in our same-store U.S. portfolio grew 20% last year as well. So we're in our second year of very strong growth. And we're really at the beginning of what we think will be an even stronger supply-demand backdrop because the 80-plus demographic starts picking up. As Debbie mentioned, there's lack of new starts. There's also any construction that was happening pre-pandemic and during the pandemic, that's being absorbed currently. So we have a window of opportunity to really continue to grow. And as we're looking to achieve that 88%, 30% margin, and it doesn't mean that's the ceiling or a target that's just a -- when we get to that point, we'll have picked up that $300 million of NOI that Debbie is mentioning, we anticipate strong growth on the road there. So we'll see how many years in a row we can go for double digits.

It's a lot to ask. But I guess the breakdown between the occupancy recovery side of things and your ability to push rents, just given the supply-demand dynamics, like what are the bigger drivers of revenue growth?

Good question.

Yes. So if you look at our numbers for this year, 80% of our revenue growth is going to be rate driven, which is notable because really over half of those -- the rate increases that we give are in place already, a lot of which happened in the first quarter, but then we do have a portion of our portfolio that is anniversary increases. And so we've been leaning into price but now we're entering the key selling season where you tend to have outsized occupancy growth as well. So we look forward to seeing the lift that we're anticipating from the key selling season that supports our outlook.

Is there anything more to touch on like the spring, summer leasing season and what you guys are seeing?

Just the leading indicators remain strong. We're off to good starts led by assisted living in the U.S. and it goes with the key points. Pricing power is good and expenses are relatively lower than expected.

Yes. There's only 1 other point I would mention, which is that through the OI, Justin's OI initiatives, we have invested CapEx in a very thoughtful way. So do you want to touch on -- that's another kind of key point when you look at performance.

Yes. So we have -- the way we've approached the CapEx investment, what we're looking for is the opportunity to reposition communities to be either at or better than market. And the 200 communities I mentioned earlier that are in that transition pool are communities that really face the middle market, they're mostly assisted living, but we have a chunk of independent living communities in there as well. And as we make investment, we're looking to refresh the asset through redev spend without disruption. So we're not moving walls, and it's not a complex redev. But it is a readout that's anticipating outsized NOI growth. And so far, we have 80 projects that are complete -- we have 100 projects that are complete. We have 80 that we can actually start measuring the results from those projects. And we would have originally said that we would expect an ROI on the new spend to be 10% to 15%. That's looking more like 20% to 30% now. And it's early. It's really early. So we're really encouraged by the impact that we're making through that investment.

And so those are some of the key trends.

Right. Got it. And then maybe 1 more question on your senior housing operating portfolio. So in terms of margins, you talked about getting back to that pre-pandemic margin, can you just talk about maybe some of the details there. What's happening with agency labor, just general wage pressure that seems like that's the biggest impact? Or are there other things that we're not thinking about, like property taxes, or we hear a lot about property insurance going up. What should we be thinking about in terms of closing that gap on margins?

Well, the first thing you should anticipate, given the pricing power and the revenue growth we're anticipating relative to expense growth is margin expansion. So that's the key point. Margin expansion is our expectation. We're seeing that already in the first quarter. I think we expanded a couple of hundred basis points already. The expense growth last year was 8%. We're anticipating 5% this year. Why is it less? Well, a big driver of lower expense growth this year is due to agency costs being a lower percentage of the overall pool of expenses. We're seeing -- we'll still see labor growth because we do increase wages across the broader employee population to be competitive, and that's part of the strategy of getting out of agency but we expect to grow at a slower pace than we did last year. And in fact, so far in the quarter, we're even ahead of our own expectations. So that speaks to our execution on the ground and also speaks to the macro market being supportive of adding new hires, which has been on a multi-month trend. Other expenses are coming down as well. We're seeing utilities, repair, maintenance, just some...

The growth rates...

Some moderating expenses relative to our expectations.

They don't stop growing...

Yes, they don't -- they're not down.

It's just like the federal budget. When they say it's being cut, [indiscernible].

Exactly. So maybe you can talk about just the triple-net senior housing portfolio. I would imagine the fundamentals of your operators are very similar to what you're seeing in your SHOP portfolio. But I guess, how do you think about that business line in terms of the greater strategy of the company. I think you have transitioned some of those things to SHOP over time. Just what do you think about the health of those operators and just the long-term business plan of that business line.

Well, on the triple-net senior housing side, of course, the biggest component is Brookdale. Brookdale is a public company, and you probably saw they grew year-over-year NOI 100% plus. And so as they're largest landlord, of course, we heartily endorse that. And we have the ability to capture upside in that portfolio, even though it's in a triple-net structure through rent resets upon renewal, plus we have 16 million warrants on the company. So we're rooting hard for them to do well, and they seem to be doing so, and they'll benefit from the tailwinds going forward.

Okay. Great. I wanted to ask about life science. You guys approached life science office a little bit differently than I think some of the other REITs in this building with more of a university focused. Can you talk about some of those drivers there? And then we hear about oversupply. We hear about VCs pulling back funding. Like how do we think about that in terms of your portfolio?

Yes. Thank you for asking. So with our partner, Wexford, we really have the best track record in the country on these university-based businesses. We always felt at Ventas that this was a business that is unified by catering to a large growing aging demographic because a lot of this discovery, of course, is because our societies aging. Half the country will have chronic conditions. So this is a business that fits well with us. At the same time, we really went in for this longer lease term credit. So 75% of our NOI with this business is really companies that have over $1 billion market cap or mostly kind of long-term leases with universities and credit. And so we're uniquely positioned, and this is a time when that business model is really shining and you can see that the demand continues from these institutions, and all of these universities are getting significant NIH funding. They are the leaders, Penn is a leader in genomic research. And so they're continuing to try to attract faculty and researchers, and they want to be in these buildings that are effectively on campus, and it's just been a great business for us, and it has that compounding growth that we like.

Got you. I guess how should we think about expansion in that space development opportunities. Is that something you're eager to ramp up right now?

Well, I would say that we've done really well with our projects. We focus significantly on credit and pre-leasing. And we are approached by all the leaders in research because of the track record. That having been said, this environment and the capital environment is less conducive to development projects than what has been in the past in terms of the value creation. And so we are upping our underwriting considerations, given the cost of capital and making sure we have credit and pre-leasing if we are going to start any projects. But it's a jewel of a business that we have, and we want to make sure that we maintain that business and over time, grow it. But we're conscious of the environment in which we're operating.

Sure. Maybe sticking to the office but a different types of medical office. I guess talk about the opportunity there. What kind of cap rates are you seeing in the market today in terms of acquisition opportunities? MOB, the MOB portfolios.

Yes. So well, as it pertains to outpatient medical or MOBs, whichever your favorite title is -- we are seeing a very strong bid for that asset in the market. And in spite of the macro conditions, there's still sporty cap rates, Class A high-performing, high-quality medical office building, will still go mid-5s. And you might see an asset like that a year ago that may have gone lower 5s or closer to 5. And so there's some discount built in, but still a very strong bid for that asset just due to the credit and the stability and the high-quality real estate.

And 1 other really important feature of how we've built the outpatient medical business is really that it is almost all on-campus with leading growing hospitals. And it's filled with specialists, who want to be next to the hospital or on the campus of the hospital. And that is a moat, if you will. That's very important, and we have a retention rate in the mid-80s. And that's really important and that stability in the core like aspect and the reliability of our MOB portfolio and the numbers that the performance that Bob talked about.

I want to make sure we get the questions that we might have.

On the SHOP, you spoke about the recovery almost as purely a demographic-driven trend, Debra mentioned it macro economic [indiscernible] is there a risk that either kind of economic slowdown or price sensitivity kind of mute some of that demographic tailwind?

May I interject please. So it's tailwinds, but it's also the OI, the active insightful experiential data-driven asset management of the portfolio. And that, it's actions that we have taken to best position the portfolio to do well. So we love the micro backdrop. We have the demand. We have the tailwinds. But we're also taking -- and have taken over the last 2 years significant actions to make these market clusters change operators. You heard Justin, invest CapEx, all the things that we're doing to make sure that we are best positioned to take advantage. On the economic side, I do think Ventas is 1 of the best positioned companies across real estate to do well in a variety of economic environments. And in a slower economic environment, we will -- basically, the cost side on senior housing and healthcare gets better and the demand continues, while it may be affected at the margins. But the demand is more inelastic than most other real estate asset classes. So I think we'd be relatively advantaged, not to say we wouldn't be affected but relatively advantaged in that environment. And Justin, why don't you talk about -- we have experience in prior cycles of how healthcare performed, which is...

Yes. So senior housing, it's a need-driven sector, especially when you're talking about assisted living and memory care, which is over half of our U.S. portfolio. So the demand tends to persist. Independent living is also need driven, but it's more discretionary and the same macro demand characteristics we mentioned that support AL, support IL. If you think about different cycles, and we've seen this play out before. I'll go back to the -- I won't go back 20 years, but I go back around a decade to after the great financial crisis, when we saw housing get impacted severely, which, by the way, we're not seeing in our markets today. But it did, and it did cause some slowdown in demand, but what ultimately happened is senior housing ended up outperforming every real estate asset class. I mean it has and healthcare REITs outperformed as well. So why does that happen? because the demand persists, and if you face a recession, then the cost to deliver care and service reduces, so you tend to have the opportunity continually to generate NOI growth. So we have a lot of confidence around the asset class and experience we've had in previous cycles and also the opportunity moving forward.

Can you give us your perspective on inorganic opportunities that [indiscernible] And are you guys more happy to spend more capital there or [indiscernible]

Yes. I'm going to repeat the question. The question is, do we have an appetite to invest in senior housing inorganically. But I'm going to answer with the organic part first because the best use of capital is really investing into our existing portfolio to help to support the growth that we're seeing. I mentioned the CapEx spend on the 200 communities. And so that's number one. And then from there, we're committed to leaning into senior housing because we have an asset class that's growing double digits with the macro backdrop that I described. So we do anticipate growing externally into senior housing. We also anticipate maintaining our strategic advantage as a diversified healthcare REIT. And the other 2 asset classes we're going to focus on are going to be medical office. And then as Debbie mentioned, we're going to maintain our best-in-class R&I platform, and we'll continue to grow that when the time is right to continue developing again. But a lean into senior housing is appropriate given the backdrop.

Can you just talk a little bit about on life science side of things, where you are growing, what -- geographically speaking, where are you growing? And what -- trying to understand you're not doing -- you mention you're not going to be further in development because of the environment driven so what -- are you looking to purchase buildings [indiscernible] at the universities, where?

Yes. I mean right now, the -- so our university-centric business, which is the majority of almost all of the on-balance sheet business is really based in markets with university -- where our university partners are like Yale, like Penn, like Wash U, et cetera. And so -- and then we have a fund with -- we have third-party investment capital management business called VIM. We have cluster market life science, its assets in there [ were the GP. ] And in terms of growing that business, it really is an organic -- it continues to be an organic growth story. And so our capital allocation has been mostly in the development area, and we will continue that selectively, but with higher expectations around credit pre-leasing and returns. So that's -- and then if there are core incredible assets in life science that fit within our third-party investment management business, then we're able to use that pocket of capital to acquire those. Good. John anything further? All right. I want to thank everyone for being here with us today. It's a pleasure to be here in person with you, and we look forward to see you again next year, if not sooner. Thank you.