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McKesson Corporation (NYSE:MCK)

June 11, 2013 2:20 pm ET

Executives

Jeffrey C. Campbell - Chief Financial Officer and Executive Vice President

Analysts

Robert P. Jones - Goldman Sachs Group Inc., Research Division

Robert P. Jones - Goldman Sachs Group Inc., Research Division

All right, good morning, everyone, and welcome to the McKesson session. I'm Bob Jones, I cover the health care supply chain and technology sector at Goldman Sachs.

Before we get started, we are required to make certain disclosures and public appearance about Goldman Sachs' relationships with companies that we discuss. The disclosures relate to investment banking relationships, compensation received or 1% or more ownership.

I'm prepared to read the disclosures for any issuer now or at the end of this presentation if anyone would like me to. However, these disclosures are available in our most recent reports available to you as clients on the firm portal.

With that, I'd like to welcome Jeff Campbell to the stage, McKesson's CFO. Jeff has been with McKesson now since 2003, so about a decade's worth of McKesson and supply chain distribution experience. So a lot of knowledge on the stage here today.

Format, I think, you're all familiar with. If you have a question, please raise your hand. We'll be sure to get you a microphone. Try to keep this as interactive as possible.

Question-and-Answer Session

Robert P. Jones - Goldman Sachs Group Inc., Research Division

But I thought Jeff, we would just -- we'd dive right in, I guess it's fair to say, we're coming out of a fairly active pricing cycle, if you will, a repricing cycle, if you will, think about some of the major contracts that have been repriced and, in some cases, changed hands over the last 12 to 18 months. I was wondering is that a high level, maybe you could share some observations about that, that cycle and how you feel the industry and McKesson, more specifically, stands today?

Jeffrey C. Campbell

Sure. Well thanks, Bob, and good morning, everyone. It's good to be here. Thanks for your interest in McKesson.

So when you talk about the pricing environment in our sector, I would -- I always encourage people to step back and maybe think about this with a bit of a historical lens. And we're a 180-year-old company. I probably can't comment very authoritatively on all 180 years but I have been with the company now almost 10 years and when you look at the Pharmaceutical Distribution business, there's a couple of different economic levers, if you simplify the business a little bit from a financial perspective. And there's the economic share with brand manufacturers, with generic manufacturers, what you do from an operating efficiency perspective and how you price to your customers. And I think it's really important, if you want to talk about any one of those 4 levers, to remember that it is a matrix of the 4 levers. And in any given year, as we continue to grow our earnings as a company and, quite frankly, as an industry over the years and decades, the movement in the 4 boxes changes. But often, the movement in one box will be in reaction to what's happening in another box. So with that as context, if you think about the customer pricing environment over the last 12 to 18 months, I think there's been a lot of attention, Bob, paid to a couple of very high profile situations, some of which were more transaction-oriented. But if you step back from that, I think that the pricing environment to our customers remains much as it always has been, which is that it reacts to what's going on in the other boxes, it is about finding ways for us to meet the needs of our shareholders and financial stakeholders for steady, continued growth. And also finding ways to make sure that our customers share in some of the positive economics and upsides that are available to us. And so at times when there are, perhaps, more economics available from some of the manufacturer boxes -- and many of you in the room who follow any of the health care services supply chain sectors would understand that the last calendar year was an unusually positive year for new generic drug launches, certainly, our customers, quite rationally, would have expected to share in some of those economics and did, while we continued to steadily grow the company's earnings. So maybe that's a long-winded answer to your question, Bob, but I do think it's really important to put pricing into this broader context of what's happening across all the levers. And I think the track record of our company and, for that matter, the industry being thoughtful about how we move economics between those boxes in a way that keeps value going to our customers, keeps our manufacturing partners feeling that we're really a good partner and also, allows us to continue to steadily grow our earnings.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

And I think what most of the renewals or even in some cases where volumes are consolidated and maybe moved away from 1 vendor to 1 distributor to another, I think the one that sticks out the most, and obviously we get the most questions on, was the arrangement beyond just the prime vendor contract between AmeriSource Bergen, Walgreens and Alliance Boots. So I guess just, as we think about coming out of the cycle and feeling like things aren't really disrupted and then we try to put this joint venture in that context, how do you view the potential impact from the fact that you do have these 3 large generic purchasers that have formed this joint venture. I know they all participate at different levels but do you see this as being something that could be disruptive to the industry? Could it change the way that generic manufacturers will have to give pricing to this entity versus other entities?

Jeffrey C. Campbell

Let me make a couple of comments. I think for many years, we have had a strategic view of our pharmaceutical distribution businesses that there are really 3 things that matter strategically as you run the company for the long term. One, scale does matter; two, it's a business where operational excellence is key and can never be forgotten; and three, you need to continually think about where the higher growth, higher profit emerging areas are and position yourselves to take advantage of it. So we run our pharmaceutical distribution businesses strategically around those 3 tenets for many, many years. So if you look at the Walgreens, ABC, Alliance Boots transactions, there's nothing about them that really changes our fundamental view that those are still the 3 strategically important elements. And to go specifically to that transaction, Bob, boy, this is a very complex transaction when you look at the minority ownership stake that Walgreens has in Alliance Boots, if you look at the minority investment stakes that, over time, Alliance Boots and Walgreens may gain in ABC, when you look at the complexity of trying to, across geographies and across different customer sets, trying to buy drugs together, very complicated. That suggest to us that we all need to wait and see exactly how the market evolves, how this combination evolves. But for our strategic long-term thinking, we do have to assume it's going to succeed. We do have to assume that those 3 companies draw ever closer together and we have to think about what it means. It doesn't mean probably in the next 6 months, much of anything but you have to think longer-term that we'll make it work and what does that mean? And really, for us, it comes back to well, it just reinforces that scale, operational efficiencies, think about where the next higher growth areas are or things that we need to continue to take strides on. So if you look at the last decade, we had no specialty business a decade ago, and we're a strong #2 player in the U.S. today. We've made a number of acquisitions of regional pharmaceutical distributors in the U.S. We've dramatically grown our Canadian business and we get synergies and efficiencies across our Canadian and U.S. businesses. And that thinking that led to those decisions and those moves, really just gets reinforced, I would say, by the Walgreens, Alliance Boots, ABC transaction, until we need to continue to find ways to thoughtfully and in a financially sensible way, scale the business. And we do continue to position ourselves for the higher growth parts of global market and we need to be really careful about always doing that in a way that does not cause us to lose sight of the importance of operational excellence. Because if you lose sight of that, you can quickly lose customers in this business. It's a business where customers don't really like to switch except when you cause problems.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

One of the other areas of focus from this deal is that, could there -- could it be disruptive to the current customer base of these entities? And so I was wondering if you had a view -- I know it's still early on, but even anecdotally, are you hearing anything or seeing anything in the marketplace that would indicate that the retail-independent pharmacies that have been with AmeriSource overtime, because of this deal, are looking to evaluate other options?

Jeffrey C. Campbell

Well, it is early and, of course, as we would, we think we have a fabulous proposition for retail-independent pharmacies and that they should all be our customers. But I think that the general reaction of that part of the customer base has been much like the broader industry reaction, which is, wow, how hard to know exactly what this means. It's going to take a while to figure that out. Let's just kind of watch how things evolve and I think that's the most of the market is in now.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

It's fair enough. I want to move on to some more McKesson-specific topics. You made a couple of strategic decisions this past quarter and I guess I'll bring 2 of them up and we can maybe talk to them individually. One was the strategic decision to exit your minority investment in a privately held Mexican distributor and then the other big announcement was the realigned structure of the Technology Solution segment. So maybe if you wouldn't mind, just some thoughts behind those 2 decisions?

Jeffrey C. Campbell

Well, let me take them in the order you presented them. So let's talk about exiting our minority stake in Nadro, a Mexican wholesaler. I wouldn't really even call that strategic. So if you go back to the early 90s, we made 2 very small minority investments at around the same time. One in a small Canadian distributor, one in a, at that time, small Mexican distributor. In Canada, over the subsequent 20-plus years, we were able to get 100% control. We're able to dramatically grow the business and we have a tremendous franchise in Canada now. In Mexico, we were never able to grow beyond the minority stake. We were never able to significantly exert influence. It became clear to us that we were probably never going to get to the point where we could significantly exert influence. So our view is there's no reason we should own that minority stake. We're not adding value. If you want to go buy a stake in a Mexican wholesale, you could do that independently. We shouldn't own assets where we're not uniquely adding value so we are exiting it. So I don't think it's strategic. I think what it is, we tried a joint venture that we were hoping we could grow over time, we couldn't, embracing it. If you look at our International Technology business, I guess I'd probably paint that a little bit more broadly. Part of our responsibility as a management team is to be thoughtful stewards of the capital as we spend new capital. So we believe we built a thoughtful track record around using acquisitions, along with share repurchase, along with dividends to create value for our shareholders. But the flip side of that is being good about steadily thinking about what we should be trimming out of our portfolio because we're not adding value. And we think we can find a way to exit an asset from our portfolio in a way that does create value for you. There are times when you might see an asset where maybe we aren't the natural owner anymore but we're not going to do a value-destroying transaction just to get out of something. If you look at our International Technology business, it really predominantly is based around a payroll system that we run for the NHS in the U.K. And if that seems odd to you that we're running a payroll system for the NHS, which is actually the largest single payroll installation outside of government in the world, interestingly enough. Yet, we don't that anywhere else in the world. We're not generally considered a big outsourcer, which is really what it is. So it's just not a business that we think we need to own. It doesn't really have ties to the rest of our business. But it's a great little business, and we think we can sell it at a value that's going to create value for our shareholders and be a great asset for whoever the buyer is.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

Really the topic that was grabbing a lot of attention this past quarter was around medical oncology reimbursement. Maybe if you could just discuss a little bit about the changes that have gone on there and how permanent you think they are? And then on the back of that, if you could, maybe, discuss a little bit about the unique position that McKesson has in that particular market with the U.S. Oncology model and how that positions you for this seems -- what seems to be a changing environment in medical oncology.

Jeffrey C. Campbell

So a couple of things. So the -- just to level set for everyone, part of sequestration was reducing the reimbursement around specialty drugs, this physician-administered specialty drugs, that is if you are one of those physicians, a particularly painful cut, because it's not really taking a percentage of your revenues that you're going to get some cost cut, it really just drops straight to the bottom line. And so we are very aligned with our physician customers and partners in terms of working in D.C. to help Congress understand what we believe is the very disproportionate impact that, that cut had on a very small part of the health care system. And I don't think that was Congress' intent, to think that go on rightly along, I think the goal of sequestration is to very broadly spread the cuts. Be that as it may, if I put my McKesson hat back on, those cuts are not material in any way to McKesson. For those of you who have followed us for a while, you will recall that one of the things we talked about when we purchased U.S. Oncology a little over 2 years ago is the fact that we thought that was a very interesting model. And for those of you who don't know well, I would simplify it by saying this is a model where we work with oncologists and really manage every aspect of their practice for them other than the actual provision of medicine. So the doctor remains independent, they're not a McKesson employee. And then we split the profits of the practice and the physicians pay and in fact, comes from his share or her share of the profits and we take the remainder. When we made that acquisitions, we built into the business case steady declines in the reimbursement rates around oncology because we believe that's the reality of the environment we're in. We actually think, in the long run, that, that pressure on the physician community is part of what will drive physicians and practices into our model, which allows them to avail themselves of scale and efficiencies, and process technology in ways that can help mitigate a fairly relentless reimbursement pressure. So that U.S. Oncology model is to really simplify, roughly half of what we would refer to as our specialty business. We also have a very thriving specialty business just selling what I'll refer to as ala carte products and services to physicians and practices who don't want to go into that much more integrated model of U.S. Oncology and that's a business that I would say, we really haven't seen any material impact on as we sit here today from sequestration.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

If I recall, I think that split was similar to the split in your customer mix at the time that you closed the U.S. Oncology transaction. Do you anticipate, not just from gaining customers but within your own mix, a shift towards the U.S. Oncology model as we kind of move through this evolution in health care of provider consolidation and oncologists maybe not wanting to be out in their own practice?

Jeffrey C. Campbell

Well, I think, ultimately, the market will decide that and the climate that the various governmental and private payers choose to create will determine that. We like to think of it these were hedged and have a great value proposition for physicians no matter which way it goes. We do believe in the U.S. Oncology model, and we think that, that community setting where the physicians can manage all aspects of a patient's care, where they do so in a way that is very compliant with the best practice protocols that the whole network of over 1,000 oncologists who agrees upon -- that are very compliant with those protocols and in a community setting where you really create -- providing care at the lowest cost, we think that is a model that the health care system, if it's rational, should in fact evolve to best care, lowest cost, most efficient. I think that's what everyone is looking for. Of course, our system doesn't always evolve in the most rational ways. There's a lot of factors that influence that so I don't know that I would predict that. I would just say if that grows faster, that's great. And if our business of selling to physicians who want to remain more independent grows faster, well, that's great, too. We're hedged either way.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

Just shifting gears over to medical, unlike a lot of your other data points we saw in Q1 on the acute side, ambulatory distribution saw some significant growth. You and some your competitors posted some nice results this past quarter. Can you maybe explain a little bit or try to explain a little bit what the difference is that is going on in the physician outpatient setting versus the inpatient setting on the medical side, specifically?

Jeffrey C. Campbell

Well, to level set for everyone, and maybe back to my comments of a few minutes ago about how one of our responsibilities as a management team is to thoughtfully exit assets from our portfolio, one of the assets we exited probably 6 or so years ago was the hospital or acute care Medical-Surgical distribution business. We were a #3 player in the market. We couldn't scale it. We saw it is a low growth market, we exited it and sold our business. That left us in what we refer to as the alternate side of nonhospital medical surgical space, which we think is a great market because it's highly fragmented, which means that there is a steady ability to grow a little bit above market by both consolidating smaller, very small mom-and-pop kind of distributors. There's a steady ability to gain share from those same much smaller distributors and its a market where the customers really value the service. And so it's been a tremendous market for us. And if you look at the last, say, 5 years of the revenue growth in our Medical-Surgical distribution business, once we got out of the hospital business, it's been very steady growth. Right through the financial crisis of 2008, 2009, right through IMS saying physician office visits were down by double digits, well our revenues never declined. They continued to steadily grow in the single digits. And right up to the present time, and we think the particularly strong revenue growth we've seen in the last couple of quarters in the high single digits organically, just was a demonstration of what a great market it is and it's of course, a great platform from which to begin the PSS integration since we closed that acquisition in February. So I -- we are not in the hospital business anymore. I'm not sure I can draw many thoughtful current contrast between nonhospital and the hospital space. I can just tell you our experience why we got out of hospital and what we've seen in the nonhospital space.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

You mentioned PSS. Obviously, the most recent acquisition and part of it, I -- from listening to you, describe this is the sales force engagement is a key component to this acquisition. Can you maybe just give an update on where we are as far as integration of the 2 sales forces and then more importantly, it sounds like salesforce retention?

Jeffrey C. Campbell

So to level for everyone, we closed on our acquisition of PSS in February. And when you look at an acquisition like this, as Bob points out, the retention and continued enthusiasm of the sales team is critical. Because this is a business where those salespeople really tend to own many of the customer relationships, more than PSS as a company does, more than McKesson does as a company. So we are extremely focused, over the next few years, on finding ways to make the combined sales teams feel that their ability to do great things for their customers has actually been enhanced by this combination. Because as long as they feel that, they'll continue to do a great job and deliver more revenues for themselves and for their company. That's going to be a long battle. As -- so we built in, to be conservative, the original business case for the acquisition of PSS through big synergy upsides you get rid of sort of overhead costs, you get some purchasing synergies and over a long period, 3 or 4 years, you take out some infrastructure, a lot of infrastructure. And we then -- we netted against that an assumption that we would lose some sales reps and we would lose some revenues. Now our goal is to lose no reps other than normal attrition. Our goal is to lose no revenues. And so far, so good. But we're only, gosh, 100 days in. And so we've seen no abnormal attrition along sales. But this is really a multiyear question because we know how to do this but the reason people say, "Well, how can it possibly take 3 to 4 years to integrate these companies?" And the answer is because you really have to do it thoughtfully and carefully, never losing sight of operational excellence because the day one of those sales reps feels that, boy, I can't get to my customer what they want because they just closed 1 distribution center and a new one doesn't have what I need, that's the day you create customer risk and create risk for those salespeople, and we're going to be really thoughtful over the next few years about how we do that.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

I just want to make sure we cover all base and obviously, a lot of them -- a lot of different segments within McKesson. On the HCIT front, it seems like the industry is moving kind of beyond the EMR phase and more towards the emerging areas, such as population health, analytics, more of a value-based reimbursement model. Can you maybe just tell us about McKesson's position as we come through the back half of the EMR cycle and then obviously, more importantly, how do you think McKesson is set up for what could be this next frontier of growth in HCIT?

Jeffrey C. Campbell

Well, when you look at our technology segment, it's a collection of different businesses. And if you think about it from an earnings perspective, the 3 most significant businesses are actually our payer-facing franchise, which is built around 2 market-leading very strong franchises, InterQual and Claims Extent [ph]. It's our RelayHealth transaction processing franchise, which is a tremendously strong position in the pharmacy segment and a strong leading position in hospitals and physicians. And it's actually our imaging, software imaging business based up in Vancouver, Canada, which is a, again, has is a very strong market position in the marketplace. And then you do have, although it's not as important from an earnings perspective, the legacy -- what people think of as the legacy hospital EMR business, which we are in the process of migrating to our Paragon platform. When you think about that range of assets, we think we have an unusually broad view about what happens with payers, what happens with pharmacies, what happens with hospitals, what happens with physicians. In a world where the next battle is not about getting the EMR into the hospital or the EMR to a physician, the next battle is now what do you do with that data and how do you interconnect it more effectively and how do you use it to create useful analytical, financial, clinical insights? We think our collection of assets is actually fairly strongly positioned for that world given the breadth of our perspective and our ability to bring those pieces together.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

Just wanted to close off one of a couple of topics. One was guidance. I think there was some confusion or some surprise, at least, on the top line growth implied by guidance. So maybe if you could just help us understand that a little bit better? And then if I think about the EPS range for fiscal '14, this $0.30 range, can you maybe talk just about what some of the swing factors really are that could us towards the top or the bottom end of that range?

Jeffrey C. Campbell

Yes, so let's start -- I think what surprised people, to your point, is our view of the likely revenue growth in our Distribution Solutions segment. And I think the -- our view of the strength there comes from a couple of things. When we just look at the market, you're going from a calendar 2013 with a record number of brand to generic launches, which have a very depressing impact on industry revenue, to a year that's probably the 10-year trough year in terms of new generic drug launches. And so that will significantly cause just the whole industry revenue, we believe, to be much stronger. Number two, when you look at our customer base in our U.S. Pharmaceutical and our Canadian pharmaceutical business, we just happen to have a number of customers who have said to us of that through their own either business decisions or customer wins, they're going to grow well above market. Number three, in our Canadian business, we do have a competitor who is exiting that market and that's driving some unusual revenue opportunities that market. And of course, in our Medical-Surgical business, because of the acquisition of PSS, you're adding all the revenues into PSS. You put all of those things together and when you think about our Distribution Solutions segment, you will have revenue growth that's, I think, will appear outsized relative to the last couple of years. Because the last couple of years have been driven down by large numbers of brand to generic combinations, that's the revenue story. In terms of the EPS guidance range, and I think we gave a $0.30 range this year, which is, I believe about what we gave at least last year, if not the year before, we haven't changed it in a while. Our earnings keep growing. I -- what we try to do, if you go back to our May earnings release where we laid the guidance out is we actually then list some key assumptions and those key assumptions are meant to be the things that we don't necessarily have full control of or where you may have your own view and these are things that are needle movers and can cause us to be near the top or the bottom end of the range. But the most important things on that list really are what happens with the brand manufacturer price increases and we've assumed they continue with the kind of rates you've seen over the last 12 to 24 months, that they would not necessarily be stronger or weaker. As generic drugs have become an ever larger part of the overall drug supply chain in the U.S., we are increasingly sensitive to what happens to generic price trends as well. So not -- this is putting aside new generic drug launches which are always very unique and have to be thought of drug by drug in terms of the price behavior. But if you look at more mature generic drugs, we are increasingly sensitive to price trends in that world as well and we have assumed they look pretty similar to what you've seen over the last 12 to 24 months, neither stronger nor weaker. And third, you always have to be watchful about what we do with capital deployment, although every data goes by as you get further into the year, we're unlikely to do anything that's going to materially impact this year. Those are probably the biggest things I would point to.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

You mentioned capital deployment. Actually, just quickly check with the audience if there is any questions. A question, we do have one, down here in the front.

Unknown Analyst

I guess going back to the health care IT discussion. Just wondering what are your thoughts in the future of the ambulatory market, where do you see yourself fitting in? Whether it's the -- some of these services you might offer like Med3000 and I know PSS has a relationship, very public one out there. How are you thinking about that relative to the products you sell, what services you sell and is it even on your radar for you right now?

Jeffrey C. Campbell

So let me take those maybe in reverse order. You're correct that when we bought PSS, they have a long-running relationship with Athena, that is not a material relationship to PSS. And so as we thought about the acquisition of PSS, I think we had 1 conversation and they said, yes, the sales reps sort of like having this in their toolkit of things they offer to customers and we said, great, we moved on, it's not material. If you think about my earlier comments about how sensitive we are to the salespeople at both PSS and McKesson feeling they continue to have a great range of things to sell, we are not particularly motivated to change that. We're just looking for business relationships that make sense. Our broader view from a McKesson perspective in the ambulatory world is that we have evolved our own organization so that we have 1 fellow, a great guy in the name of Pat Leonard now who leads a combined effort. We run across both providing services to physicians so we have a very large business that will do outsourced billing and coding for physicians. Very successful business, very steady business. Interestingly enough, it is a business that is completely system-agnostic. So we provide this service for people who run McKesson ambulatory systems, for people who Cerner, who run Allscripts, who run Green way, you name it, we -- I think, at last count, it was up over 10 different systems that we will provide this service on. So we think that's a great business for us to be in. Med3000 strengthened us in that business. We love this kind of business because it's a steadily -- steady business, transaction base grows every year. We also do offer lots of different ambulatory software products I think at last count, we had 9 or something ambulatory EMRs because we have a special one for oncology, Med3000 had one, we have a couple of different ones. We offer as a business for us, the ambulatory software business is not a material business and not what we expect it to be. It's a luminary fragmented market. It's very small. However, we will continue to offer most of these products because they are important to our broader value propositions in some of our other businesses.

Robert P. Jones - Goldman Sachs Group Inc., Research Division

That's great. And unfortunately I think we're out of time. But I do want to thank Jeff for being here today and thank everybody for coming.

Jeffrey C. Campbell

Great, well thank you all for your time and interest.

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Source: McKesson Corporation Presents at Goldman Sachs 34th Annual Global Healthcare Conference, Jun-11-2013 11:20 AM
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