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#4C 2Q FY24
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Added 11 months ago

Beleaguered $ALC reported their 4C this morning, with the investor call later this morning (I won't be able to attend so will have to catch up with the recording)

ASX Announcement

Their Highlights

  • Q2 new TCV sales of $21.8M; $0.7M expected to be recognised in FY24
  • Signed $23.3M South Tees contract extension for an additional 8 years (to 2033 with 2 years remaining on current contract) for Miya Precision Electronic Patient Record (EPR). Further options to extend out to 2038 and add further Alcidion modules which if taken would result in a total TCV of up to $54M over the next 15 years
  • FY24 contracted revenue at end of Q2 of $35.5M, up 4% on pcp
  • Sold & renewal revenue over the next 5 years (excluding FY24) of $126M
  • Q2 cash receipts of $8.7M; up 28% on pcp, resulting in an operating cash outflow of $3.4M. Debtor balance at end of Q2 of $7.3M (PCP: $5.6M) which included $3.9M from a major customer which was collected in the first week of January 2024
  • During Q2, raised $5.4M via Placement and SPP to ensure maximum flexibility and maintain a strong balance sheet to execute on market opportunities and drive revenue growth
  • Cash balance of $7.9M and no debt at 31 December 2023, strengthened further following receipt of $3.9m in early January 2024


My Analysis

2023 was a horrible year for the company, and investors voted with their feet with the SP down almost 2/3rds and the SPP component of the capital raising towards the end of the year essentially shunned by investors.

My usual 4C Cashflow picture below tells the story - no discernible growth trends, a growth stock currently becalmed with the sails flapping in the breeze. I've added the TTM picture for operating CF over a longer timeframe, so you can more clearly see the adverse inflection over the last 12-18 months.

Within all the bad news there is the good news of the South Tees renewal - previosuly announced. We don't know the full terms of the deal in terms of margin; however, this is a high gross margin business, and such a long term contract with the potential to deliver average annual revenue of $3.6m over 15 years and act as a flagship reference case. The South Tees procurement team will have struck a good deal, you can be sure.

The blame on slow procurement is placed squarely on the customers, which I am not sure is totally justified. I have previously published a sample list of recent NHS deal announcements. Product and Sales Capability are two other factors in the mix, and there has to be question-marks on both.

Kate is turning her attention to managing costs, which she has to do. Taking direct control of the UK team by not replacing the MD is a significant step, and she'll have a tough year directly running a microcap operating on two sides of the globe. But that is the work to do, as it is a fight for survival now.

My thesis is broken, and I should exit. However, with the SP on about 1.2x expected FY24 sales there is every chance that some wind might be blown back into the sales. One or more material sales deals, which are as ever said to be in prospect, even a decent upsell to an existing customer would be positive catalysts. There is also the prospect of M&A - not a reason to hold on its own - but $ALC has to be on someone's shopping list at this level.

So, I am not going to shoot myself in the foot by exiting today. My position is small (RL now only 0.5%) and the damage is done. I'm a grumpy HOLD.


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#ASX Announcements
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Added one year ago

Much-needed good news for beleaguered $ALC.

ASX Announcement

Alcidion signs $23.3M South Tees contract extension until 2033

• Alcidion extends contract with South Tees Hospital NHS Foundation Trust for an additional 8 years for Miya Precision Electronic Patient Record (EPR) o Extended contract period is 10 years (to 2033) which includes 2 years remaining on the existing contract

• The minimum contract value is $23.3M (£12.2M) over the new contract period of 10 years

• Further options to include PAS (Silverlink PCS), Emergency Department (ED) and Virtual Care modules would add $9.3M (£4.9M) to the minimum contract value • Options exist to extend for a further 5 years to 2038

• Validates value proposition for Miya Precision Electronic Patient Record (EPR) solution and acts as key reference point for the NHS EPR market 


My Analysis

South Tees was already $ALC's largest and highest-profile NHS client, and this contract is by some margin, the largest even pipping the 15-year potential of the Leidon ADF contract (if I am not mistaken).

That a core client undertakes such a commitment to the $ALC product suite is great news. However, to maintain the thesis $ALC needs to follow-up over the coming months with additional material NHS contracts, including with new customers.

I cotninue to hold, for now, but am still mulling this one over as it was descended towards the bottom of my merit order.


Disc: Held in RL and SM

#Industry/competitors
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Added one year ago

I wanted to have a look at how the NHS is progressing in its digitalisation stratgy.

So I teamed up with my new buddy Bing Chat Enterprise to generate this list of 40+ accouncements for EMR systems from over the last two years. These are much bigger investments that for $ALC's products. The contract sizes range from about GBP8m right up to GBP50m. (I have not personally verified the whole list, however, a sample do check out.)

I note that the 2023 list is shorter (pro rata) than 2022.

I wondered though, with so many decsions being taken on big EMR platforms, whether that may be one issue for $ALC for the following reasons:

  1. The EMR is a big financial commitment, In the run up to making it and in the aftermath, spending on other systems many be squeezed
  2. In the run up to an EMR procurement decision, it may be hard to get management to take decision on patient flow and other solutions. This could be for reasons including: attention focused on EMR bundles of functionality (which may obviate the need for $ALC investment) and questions of inter-operability
  3. Both in the run-up to and aftermath from an EMR decision, human capacity in the NHS Trust will likely be focused on the success of the EMR. $ALC may be struggling for attention, in some cases.


So, an alternative hypothesis is: "$ALC is reporting slow decsion-making on new contracts, because the systems attention is elsewhere?"

Here is the AI-facilitated list (enjoy)

  • September 2023: Bradford Teaching Hospitals NHS Foundation Trust selected Cerner as its preferred supplier for its new EMR system.
  • August 2023: Alder Hey Children’s NHS Foundation Trust awarded a contract to DXC Technology to deliver its Lorenzo EMR system.
  • July 2023: Nottingham University Hospitals NHS Trust signed a contract with System C to implement its CareFlow EMR system.
  • June 2023: University College London Hospitals NHS Foundation Trust selected Epic as its preferred supplier for its new EMR system.
  • May 2023: The Royal Marsden NHS Foundation Trust signed a contract with Civica to implement its Cito EMR system.
  • May 2023: Lancashire Teaching Hospitals NHS Foundation Trust selected Cerner as its preferred supplier for its new EMR system.
  • April 2023: Surrey and Sussex Healthcare NHS Trust selected Cerner as its preferred supplier for its new EMR system.
  • April 2023: Imperial College Healthcare NHS Trust extended its contract with Cerner to implement its Millennium EMR system across its five hospitals.
  • March 2023: Barnsley Hospital NHS Foundation Trust awarded a contract to DXC Technology to deliver its Lorenzo EMR system.
  • March 2023: Manchester University NHS Foundation Trust awarded a contract to Allscripts to deliver its Sunrise EMR system.
  • February 2023: The Hillingdon Hospitals NHS Foundation Trust signed a contract with InterSystems to implement its TrakCare EMR system.
  • February 2023: Oxford University Hospitals NHS Foundation Trust signed a contract with Epic to implement its EMR system across its four hospitals.
  • January 2023: St George’s University Hospitals NHS Foundation Trust selected Epic as its preferred supplier for its new EMR system.
  • January 2023: Liverpool University Hospitals NHS Foundation Trust selected Cerner as its preferred supplier for its new EMR system.
  • December 2022: Royal Berkshire NHS Foundation Trust awarded a contract to System C to deliver its CareFlow EMR system.
  • December 2022: Guy’s and St Thomas’ NHS Foundation Trust extended its contract with Cerner to implement its Millennium EMR system across its three hospitals.
  • November 2022: North Bristol NHS Trust signed a contract with Allscripts to implement its Sunrise EMR system.
  • November 2022: Sheffield Teaching Hospitals NHS Foundation Trust awarded a contract to InterSystems to deliver its TrakCare EMR system.
  • October 2022: Barking, Havering and Redbridge University Hospitals NHS Trust extended its contract with Cerner to implement its Millennium EMR system across its three hospitals.
  • October 2022: King’s College Hospital NHS Foundation Trust signed a contract with Epic to implement its EMR system across its four hospitals.
  • September 2022: Luton and Dunstable University Hospital NHS Foundation Trust awarded a contract to Epic to implement its EMR system across its two hospitals.
  • September 2022: Mid Yorkshire Hospitals NHS Trust selected Cerner as its preferred supplier for its new EMR system.
  • August 2022: East Sussex Healthcare NHS Trust signed a contract with Civica to implement its Cito EMR system.
  • August 2022: Great Ormond Street Hospital for Children NHS Foundation Trust awarded a contract to DXC Technology to deliver its Lorenzo EMR system.
  • July 2022: Dorset County Hospital NHS Foundation Trust selected Cerner as its preferred supplier for its new EMR system.
  • July 2022: Birmingham Women’s and Children’s NHS Foundation Trust signed a contract with System C to implement its CareFlow EMR system.
  • June 2022: Chelsea and Westminster Hospital NHS Foundation Trust awarded a contract to DXC Technology to deliver its Lorenzo EMR system.
  • June 2022: East Lancashire Hospitals NHS Trust selected Cerner as its preferred supplier for its new EMR system.
  • May 2022: Portsmouth Hospitals University NHS Trust signed a contract with InterSystems to implement their TrakCare EMR system.
  • May 2022: Royal Free London NHS Foundation Trust extended their contract with Cerner to implement their Millennium EMR system across their three hospitals.
  • April 2022: Cambridge University Hospitals NHS Foundation Trust selected Epic as their preferred supplier for their new EMR system.
  • April 2022: Leeds Teaching Hospitals NHS Trust awarded a contract to Allscripts to deliver their Sunrise EMR system.
  • March 2022: University Hospitals Bristol and Weston NHS Foundation Trust signed a contract with Epic to implement their EMR system across their two hospitals.
  • March 2022: The Newcastle Upon Tyne Hospitals NHS Foundation Trust extended their contract with Cerner to implement their Millennium EMR system.
  • February 2022: South Tees Hospitals NHS Foundation Trust awarded a contract to System C to deliver their CareFlow EMR system.
  • February 2022: Northumbria Healthcare NHS Foundation Trust selected Allscripts as their preferred supplier for their new EMR system.
  • January 2022: The Royal Wolverhampton NHS Trust signed a contract with Allscripts to implement their Sunrise EMR system.
  • January 2022: Royal Cornwall Hospitals NHS Trust awarded a contract to System C to deliver their CareFlow EMR system.
  • November 2021: University Hospitals Birmingham NHS Foundation Trust signed a contract with Cerner to implement their Millennium EMR system across their four hospitals.
  • November 2021: Norfolk and Norwich University Hospitals NHS Foundation Trust awarded a contract to DXC Technology to deliver their Lorenzo EMR system.
  • October 2021: County Durham and Darlington NHS Foundation Trust signed a contract with Civica to implement their Cito EMR system.
  • October 2021: Barts Health NHS Trust secured £12m of funding from NHS England and NHS Improvement to invest in a new EMR system and selected Cerner as its preferred supplier.


Note: I don't have an up to date number, but there of the order of 200-250 NHS Trust in the UK, so this is a minor but significant fractoin of the whole.

#Trading Halt
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Added one year ago

$ALC in a Tading Halt pending annoucement of the Capital Raise.

There is a call later this morning on the 4C Quarterly, which is yet to be released.

I can't attend, so hoping to read reports from other StrawPeople.

Not sure why a CR is required, as they had $14m at end of June, and cash flow generative. It's hardly an opportunistic raise given the SP!

So presumably there is an acquisition on the horizon?

Interesting.

Disc: Held in RL and SM

#4C Report
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Added one year ago

I agree with @NewbieHK and @Remorhaz that the $ALC result today was a postive.

I'll skip the usual summary of results and analysis and focus instead on an assessment of my usual CF trend analysis and take a look at contracted revenues. The common thought process I am bringing to all of my small caps that are approaching inflection is: "now that costs are under control and also now that we are seeing the organic growth engine exposed, is the revenue growth and operating leverage strong enough to make this an interesting investment?"

First some general observations:

  • The selling of incremental modules approach appears to be working.
  • The mix of renewals and new contracts is good.
  • NZ appears to have reached a possible turning point. No point writing too much, as it is the size of an Aussie State, but worth a mention. Kate has commented before on the slow progress in NZ, because they have been impacted by the consolidation of District Health Boards into a consolidated structure. This kind of reorganisation plays havoc with IT procurement decisions because of all the energy that is consumed in the internal reorganisation. So I am sure they will be focused on trying to get a roll out of the module that is in place in one of the former DHBs. And after that more modules? Eventually, the new organisation will kick into action and start making decisions. (I have three members of my extended family working in the NZ health service, and the staffing pressures are as real there as in Aus and UK.)
  • The key message of "we're saving clinicians time", be it doctors, nurses, or orderlies will resonate strongly with decision-makers, given the perennial staffing pressures in all markets.
  • They are building strong "reference cases". This is important because public health services are not in competition with each other and openly share good practices, and coalesce around common solutuions. $ALC are doing a good job on social media with this, as others here have observed.
  • Costs appear to be reasonably under control, with Kate setting clear expectations for FY24.


Now to the analyses.


1. CF Trend Analysis

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Above is the usual CF analysis. I usually prefer to focus on FCF, but because of the acquisitions within the 8Q window I am going to focus on OpCF. (Although, you can see that absent the Silverlink earnout, $ALC is solidly in the exploitation phase with minimal capex.)

Previously, I have shown the trend lines over the entire dataset, but I am increasingly using the last 8Q, as above, because I think that is a better reflection of the impact of management efforts in the more recent capital constrained environment.

If you compare the above chart, with earlier editions, the good news is that the slope of the OpCF line is increasing significantly. Obviously, the very strong most recent Q helps a lot.

Given the high Q-on-Q volatility it would be wrong to say that the last 3Qs shows a positive trend. So, I won't say that! But the longer term trend is there. Again, I'm not going to show the FCF trend line, as the one-off Silverlink impact renders this meaningless.


2. Analysis of Contracted Sales and Revenue

In lieu of an explicit outlook, I've noticed that in each Q4 report, Kate gives a statement of how much of the contracted revenue is expected to be realised as revenue in the following FY.

So, in the graph below I compare that component of the CR (denoted as "CR(Q4-1)FY") with the revenue or the forecasted revenue from the FY (denoted as "Rev FY").

Above each blue bar (the CR), I plot the % of how much of the next year's revenue is already contracted.

You can see that over the last 3 years, it has been 69% (2021), 58% (2022) and 71% (2023), yielding and an average of 66%.

For FY24, I have used these %'s from the previous years with $33.7m of CR to be recognised as revenue in FY24 to project a range of forecast revenue outcomes for the FY24.

These revenue projections equate to FY23-FY24 revenue growth rates ranging from 19% in the low case to 45% in the high case, with a mean of 28% revenue growth.

This is where I have to write "past performance is no guarantee of future performance" and indeed, with a constant sales force going in to FY24, you might expect being at the lower end of the range to be more likely. It might even be lower (all things being equal) because a constant level of incremental sales represents a progressively declining % increase of each year's base.

However, if $ALC lies anywhere on that range, and provided costs can controlled as Kate has indicated, then we should expect FY24 to be both significantly cash generative at the OpCF and FCF levels.

(OK. I'll stop there and put my inner analyst back in the box).


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My Key Takeaways

Overall, the $ALC analysis indicates that the company is passing through the CF inflection point. Given the very large Q-on-Q variations, it is important to take today's positive result in its wider context, and I think Kate's measured and qualified delivery did justice to that.

However, in the UK (and to a lesser extent in NZ), the health systems face particular head winds. In the UK the NHS is widely perceived to be in crisis. I have lived in the UK for 20 years and much of my business network and extended family live there today. At a personal level, I am aware of stories that show the system to be under stress, subject to industrial unrest and suffering from political interference. Kate made reference to these headwinds, and again to her great credit was very balanced in how she tells the story.

$ALC's continued progress despite these headwinds is encouraging. My only issue, is in the case of the UK, there is no end in sight.

I am considering increasing my position in $ALC. With the SP at 25 x EV/EBITDA(FY25), it is sitting between $M7T (12) and $VHT (38), and my current position size indicates a higher risk rating than it deserves. One to mull over, and I will likely wait until Monday, when $M7T reports. There's enough data now that it might even be time to build a DCF. Now there's a cheery thought.

Disc: Held in RL (0.9%)

#Q3 FY23 4C Report
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Last edited 2 years ago

Straw significantly edited as there were some errors in the earlier cash flow figures, now corrected.

Text also updated following the presentation Q&A and some observations added. Apologies for what is now a very messy straw ... but accuracy is important!

Figure 3 added to show the quarterly new sales from the presentation.

@Valueinvestor0909 has picked out the key issues.

Based on Q2 FY23 report we were all expecting at least $2m (edited from $3m) of the cash receipts (** see below comment) to be due to the late payments in the previous quarter. So the reported receipts of $10.446m are really only c. $8.5m (edited from $7m) from the quarter, so meh.

Also, Q3 Sales are unimpressive, - the graph wasn't in the 4C release, but is included in the presentation. (Edited out my earlier comment, throwing shade at Kate for not reporting this metric!) I've included it in Figure 3, below.

Taking a step back, I've updated my usual 4C Cashflow plot (Figure 1). And because $ALC is lumpy from Q to Q, I have plotted the same data in a trailing 12 months (TTM) format.

Basically, $ALC is running hard to stand still - there being no significant trend now in OpCF since the Silverlink acquisition.

I'm hanging on because Kate appears to be controlling costs well, and the UK implementations are providing reference sites. It should be expected for these implementations to take time, given the long sales cycle. So I am holding for now, but I think another year or so, and the strategy needs to start delivering operating cash flow growth.

** Comment:

During the Q&A today, one investor asked about the "late $5.6m receipt", to which the CFO (correctly) replied that the questionner was mistaken. He then clarified that there was a late payment of $2m in Q2 and, because some payments in Q3 were also received late, that Q3 receipts could be considered "normal" (swings and roundabouts argument). This confused me, because if this is true, why did they make a song and dance about it in Q2. Doesn't it just mean that a portion of payments falling due towards the end of the Q will always risk falling into the next Q?

CFO was adamant that Q4 will be the strongest receipts of the year. This is also in the release, so that indicates to me that >$13m Q4 receipt is in the bag. Given that the cost base is stable and investments are dialed right back, this means they will likely have a final Q that is OpCF and FCF positive.... provided they get paid ;-)

Key Takeaway

Management are trying very hard to get the most out of each quarterly report, for example, to achieve the (now abandoned) promise of being EBITDA positive this year. Personally, I think they are trying too hard to put a positive gloss on their communications. Now I don't believe Kate and her team would mis-state the facts, but they need to be careful with the spin, as it is easy to trip yourself up over time. For example, it is fine to talk about NHS staff shortages and strikes. But we all watch the news, and that is a characteristic of the market they are playing in. It is a fair headwind countering the tailwind of the drive to digitally emable the NHS.

I am observing a pattern in several tech holdings that, when sales and receipts in the quarter fall off the growth trend, there is a tendancy to talk about timing of payments, slow sales cycles, delays in renewals, and the strength/growth/record nature of the pipeline. (Examples from $3DP, $EVS and $ALC). As investors, we only have to wait 13 weeks to see if the story plays out so, thank goodness for the 4C and quarterly reporting! Equally, it is important to recognise that 13 weeks is a short period of time and the lumpiness from quarter to quarter can be very significant, as Figure 1 shows. It is as important not to over-react to one bad quarter as it is to over-react to one good quarter. Whatever the fair value of $ALC, I don't believe that today's result warrants a 10% markdown. Of course, using a cricket analogy, for every over that you don't hit the target run rate, it means more boundaries are needed in subsequent overs to stay on target overall.


Figure 1

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Figure 2

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Figure 3

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Disc: Held IRL and SM



#Staff costs
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Added 2 years ago

@Seasoning I have been looking at the same question. Silverlink acquisition closed on 16th Dec 2021.

So staff costs in 1H22 are essentially pre-Silverlink at 11.814m (cash costs).

In 2H22 staff costs were $12.196m (up from $9.641m or 26.5% from PCP). So, I take that as the approximate Silverlink impact.

Now looking at 1H23 over 1H22, we have $14.47m over $11.814m or +22% - slightly less than you might have expected given Silverlink in a zero inflation environment. There will be early overhead synergies. So if you then consider wage inflation, its actually a very reasonable result.

In summary, I don't see any issues with the increase in staffing costs.

Disc: Held IRL and SM

#4C Report
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Added 2 years ago

@composerI don't see your straw as unduly negative or down-ramping at all.

I've been too busy this week (with commitments outside of investment management) to post my own straw, but I watched the recording of the results and presentation and came away with very mixed feelings. For me the biggest concern was that I sensed that Kate herself was ill at ease in discussing the results, which weren't great from a cashflow perspective. I attach my standard analysis below. The numbers support your general tone.

For now, I am going to continue to hold my small RL position in $ALC. But (just as with $3DP and $EVS discussed in other straws over the last week), $ALC is not making the progress necessary for me to increase my allocation, which clearly in the success case I am aiming to do.

Disc: Held in RL and SM


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#4C Report
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Added 2 years ago

$ALC reported their 4C today.

Reported Highlights:

  • Cash receipts of $12.0M, an increase of 83% on the prior corresponding period (pcp)
  • Q1 new TCV sales of $1.8M, with $1.3M recognisable in the current year
  • Total contracted revenue at end of Q1 of $29.0M, up 69% on pcp
  • On constant currency basis total contracted revenue was $29.3M
  • Further $2.6M of scheduled renewal revenue expected to be recognised in FY23
  • Q1 negative operating cashflow of $0.5M, significant improvement versus negative $3.4M pcp
  • Cash balance of $16.2M at 30 September 2022, with no debt 


Release contains the usual annual comparions briken down by Q,

Below is my usual 4C trend analysis for another view.

The Qs OpCF is weaker due to lower receipts. FCF only slightly lower, due to lower investment costs as a result not having M&A costs this Q offsetting the weaker receipts.

Kate notes that Q1 historically contains larger operating cash payments.

Overall, a reasonable update with evidence of good cost control.

Disc: Held in RL (1.1%) and SM (6%)


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#Quarterly update
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Added 3 years ago

Soft Q results for ALC. I think the next 3-6 months are key to upholding the thesis, with Kate setting clear expectations, as follows:

Growing Pipeline: Pipeline continues to develop with several sizable opportunities now entering the contract negotiation stage which has provided a heightened optimism about the broader opportunity for Alcidion, particularly in the UK market. Increasingly seeing the potential to cross/up sell our products to existing customers.”

Add to this the expected finalisation of the ADF contract before year. Confirmation of this will be a catalyst.

I would not be surprised to see SP weakness today, so will initiate a SM position to match my RL one.