Cardinal Health's CEO Presents at Baird's 2013 Health Care Conference (Transcript)

| About: Cardinal Health (CAH)
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Cardinal Health, Inc. (NYSE:CAH) Baird's 2013 Health Care Conference September 10, 2013 8:30 AM ET


George Barrett – Chairman & CEO


Steve Booth – Robert W. Baird

Eric Coldwell – Robert W. Baird

Steve Booth – Robert W. Baird

All right, good morning, everybody. Again, on behalf of all of my Baird colleagues, welcome to this year's healthcare conference. I’m Steve Booth, the very proud Chief Operating Officer of Robert W. Baird. And as we get started this morning, after that wonderful panel discussion by a research analyst, let me take a moment just to highlight some of our conference details for you here this morning.

All the presentations will be 30-minute presentations. The public companies will give fireside chat presentation. This will include a 5 to 10-minute high-level overview from Company management, followed by a 20 to 25-minute Q&A session let by our Baird research analysts. Private companies will give a formal 25 minute presentation, followed by a 5-minute Q&A question. So, now Q&A sessions can be asked out loud or emailed to the email address that’s posted on the tables inside the presentation rooms. And, importantly, break-out sessions will not be held during this conference.

Happily, all of the construction here at the Palace Hotel ended yesterday. Unhappily, there’s still some construction next door, so we may hear some sounds of constructions end going, but trust me we’re working hard to make the conference as enjoyable for you all as possible.

Research reports are available online. Fact sheets and models can also be found with research reports, and these can be found at The access code HCC13 – healthcare conference 13.

One-on-one meetings will take place in various locations throughout the hotel. Please visit the Baird one-on-one meeting desk on the fourth floor to confirm the change in the meetings.

Lunch will be available during today’s panel presentation, which will be in this room.

The panel, which we’re very excited about is called, “Evolution of Accountable Care in Population Health Management.”

We’ll also be hosting corporate dinners tonight with company management teams. Please check with the staff at the Baird registration desk located on the second floor for availability, and transportation to these dinners is on your own.

Thank you very much for your participation. Thank you very much for your support and partnership. We hope you enjoy this year’s healthcare conference.

With that, I am going to turn it over to my colleague, Eric Coldwell, who will introduce Cardinal Health.

Eric Coldwell – Robert W. Baird

Thank you very much, Steve. And given that we are going to kick it off just a couple of minutes after the original start time, I’m going to dispense with the formalities.

I am Eric Coldwell; I cover healthcare distribution services and technology at Baird and we’re very pleased to have George Barrett with us from Cardinal Health. Also in the audience, Jorge Gomez, who is the SVP of Finance in the Pharmaceutical division; and also Jennifer Skinner from the Investor Relations group.

George, let's kick it right off. It has been a very interesting 12 months. I’d love it if you could just reflect for a couple of minutes on where you have been and where you are today before we go into the more direct Q&A.

George Barrett

Sure. Well, first, thanks for having me. Steve had to take off; thanks for inviting us.

It has been a while, about 12 to 15 months for us at Cardinal Health, a really successful one in our positioning strategically and in our financial performance. Let me sort of give you a little bit of context.

Much of what we are doing, and it sounds like you heard a little bit this morning about population health, is really all around what we think are these powerful forces in healthcare. And I’ll just sort of touch on them. Most of them you know extremely well.

Demographics is an extraordinary phenomenon. And if there is anything we talk too little about in healthcare, it is the impact and the implications of demographics. It’s not just that there are 10,000 people a day entering the age of Medicare, but we’re probably looking at a society that today is going to go from having 11 million or 12 million people over the age of 80 in the United States to probably over 20 million, as we get into late 2020. So, it’s an extraordinary change and the implications for us in every sense are huge.

Economically as well, and it means a health system that’s going to have to go through some kind of changes to deal with this and you know many of these. But much of it is around efficiency; how we do what we do, changing behaviors, focusing on outcomes rather than the activities. And our work has been very much centered around these.

We also know that care is going to have to be much more highly coordinated as we move forward and our thinking is very much touching that. We know that care is going to need to be delivered in the right setting, at the right sequence, at the right cost. Our work is very connected to that. We know that care is going to be increasingly delivered in the home. I have two parents in their 90s. I know what it is like for them and I think this is common around the country at this point where we have a growing number of people that are going to need care in the home.

We know that our business is going to have to look not just at providing the innovative pharmaceutical products, but the generic products that deal with the more mature side of the business. As you know, 83% roughly of prescriptions are now generically penetrated remains a very important driver for us.

But on the medical side, you can essentially think about an analog to that, which is we need in the system innovation on the medical device side, but we also need an alternative for those products that are mature and at a later lifecycle, so we can fund innovation. There needs to be more competitive alternatives to that, and we’ve been focusing in and around that.

So, that is some of the powerful trends driving it. We had a very strong fiscal 2013, operating income of 10%, EPS growth of – excuse me – 11%, EPS growth at about 16%. Really growing margins throughout our business through a heavy focus on rebalancing our business mix of product lines and customers. That was accelerated during the course of this year with an announcement in March that we would not be renewing our contract with Walgreens. So, obviously a big moment for many of us, but that's in a way accelerating on the evolution that we have been working on. And I’ll just give you one frame of reference and then I will go to questions.

If you think about how much our business has changed – A, since our spinoff of CareFusion, I believe our annualized TSR rate is about 20%, 21% since the spinoff. I’ll give you that point.

Also one other point, just to understand the impact implications of the mix change that we have had, if you go back to 2012 when we were a supplier to Walgreens full and to Express Scripts at the time, who is no longer a customer. If you’re talking about – today, we are at about $30 billion in business. Obviously, it was a little smaller at that time.

Our midpoint of our guidance for our fiscal 2014 is 10% larger than the number in 2012 when we had those customers. Just to give you an order of magnitude of how much we have been able to shift the balance and the mix of this business. So, really excited about where we're positioned.

We’ll talk about those drivers during the Q&A, but I just wanted to just give a bit of a framework – A, saying I think we have had a strong couple of years, but also that we have been very heavily focused on positioning ourselves for continuing growth in an environment that is going through some extraordinary transformation.

Question-and-Answer Session

Eric Coldwell – Robert W. Baird

So, you just mentioned Express and Walgreens.

George Barrett


Eric Coldwell – Robert W. Baird

$30 billion plus of revenue, obviously low margin bulk revenue

George Barrett

Yes. It was probably, at the time, was $27 billion or $28 billion.

Eric Coldwell – Robert W. Baird

Exactly. That is either annualized or annualizing over the next 12 months out of your business. So, an optics issue on the top line; obvious margin lift due to mix and optics there.

What did you do – you talked about earnings actually being higher than they were a couple of years ago. What did you do internally to respond to that kind of volume not renewing with Cardinal?

George Barrett

Well, part of it was not about responding to that moment, but the work that we have been doing for five years. So,, I think part of it is about constantly rebalancing that business model to be better positioned in places where we think the opportunities exist and to reduce exposure in other areas. So, at the point that these happened, we were obviously better positioned to handle that, specifically related to Walgreens, which was probably a bigger issue operationally.

We did – that contract, by the way, expired at the end of August, so we are done. We are completely done with that contract and the supply is done, and I’d add just for what it is worth, our service levels probably on the last day to Walgreens were probably 99%. We have a very clear sense that this is a world out there of patients and pharmacists. And our team was very clear. The contract will go, we are going to do it full blast and then it will stop.

We eliminated a fair amount obviously of all the variable costs that went with that. That is not just the people and the warehouses that are picking; those who are supporting the daily inventory and supply chain management interface, but also in call centers and those folks that are fielding calls and activity coming from the individual pharmacies. So, we’ve had to do some work to reduce obviously all the variable costs associated with that work.

And we did – in anticipation of sort of evolution of our business, we have been sort of attacking fixed costs over the last couple of years. I think we’re doing a pretty good job of doing that.

Having said that, we are still a very large scale player with a national footprint. And we need those warehouses. We look at every warehouse to say, look, given some of the change in volumes, could you support that at another location, and the answer is no. We need to be serving the customers the way we are. So, there’s some built into our estimates. There’s some essentially stranded cost that is associated with some loss of volume.

But I think importantly for us, it really had no impact on our generic scale and I think that is something people sometimes don't get. We are – this was primarily branded business and the work that we were doing for Walgreens on the generic side was essentially contract backup work for them where they have a relationship contract with the manufacturer and then we were supplying them backup.

So, essentially from a scale standpoint, we did not de-scale on a level. So – but it has really been not just about the moment, it has been about taking these last few years to start to look at the business and the places where we are most relevant where we can really drive value and it is an ongoing process.

Eric Coldwell – Robert W. Baird

That's great. So, your generic – you just mentioned generics. Your penetration on pricing in generics market pricing were relatively good last quarter. We‘ve all been expecting for a long time an abatement in the launch cycle and now this was going to be the challenging period. It turns out you and one of your large peers put up some pretty big gross margin numbers on pretty good generics trends last quarter.

Thinking about your generic purchasing scale, obviously, Walgreens, as you said, didn't impact you, but are there game changing opportunities, whether it be through global expansion, M&A, other opportunities for you to become even more proficient and get more purchasing power in generics?

George Barrett

So, I’m going to go back to the first part of your comment because it is an important – maybe given my background. As some of you know, I have some long history on the pharma side and the generic side. I will give some observations about that launch cycle dynamic, and then I will come back to the issue of our strategies.

So, one thing that is sometimes not completely apparent, we have a tendency, all of us, to just be completely aware of these blockbuster drugs losing their patent protection and the dynamic around that. I think it’s pretty well understood; it gets tons of publicity. I think the investment community understands it pretty well.

What is less well understood is the lifecycle of a generic drug, and they can be very long. We have drugs that probably went generic in the late ‘90s that are still contributing very nicely to our business. And so what is happening is we’re getting larger, we’re getting more, I would say skillful and strategic around how we source products on a global basis and we’re able to capture value during that very long lifecycle of that drug. And there is a stage in the middle of that lifecycle where those who can move markets have some significant influence. And those are points where we can continue to have margin.

So, what’s happening – and just let's take a very concrete example. In our fiscal year, remember, we are a June 30th fiscal year.

In our 2014 projections, there’s less launch value; value from new launches than there will be in our 2013 numbers actual. But our generic contribution in total is going to go up next year because we’re capturing value all along the lifecycle of these 4,000 drugs.

So, it’s a unique dynamic. We tend to see 10 or 20 or 30 drugs, but the reality is there are thousands of them and the optimization of each one of those is critical to our business, and it’s one of the things that we focused on. We invest a lot in advanced analytics to make sure that we’re optimizing each little moving part in the business like ours that matters. So, that’s number one.

Second, we’re continuing to be a business of enormous scale. I hope (ph) scale as well. Scale.

We are growing our business. There is a virtuous cycle related to scale. As you gain more, you’re able to deliver more value to your customers. As that happens, you pick up more business, et cetera, et cetera.

We do that very, very competitively right now. We are already a very globally-driven company in terms that we source and procure drugs. I am not, at this point, a big believer in a global distribution market. I don't believe that such a thing exists.

They’re very local, very unique characteristics, financing systems, regulatory systems, but we will always be open-minded about ways to increase our scale and our influence provided that we understand the implications of what that means and the complexity of that and whether or not you actually can create more problems by adding, so you can wind up with supply issues. So, there’s a fine line. I have a little bit of a background in this area, as you know.

So, I think it is reasonable to assume that we – right now, we are doing very well on our generic program. We like where we are. We’re very optimistic about 2014. But we’re going to be observers; and we’ll be watching carefully to see whether we think there is anything that puts us in any kind of competitive disadvantage.

Right now, I am not seeing it, frankly. But I think one of the cardinal sins, excuse the pun, for any leadership team is to think they are the smartest people all the time every minute and the reality is we need to be watching and we will continue to do so.

So, we’ll challenge ourselves to make sure that we’re taking advantage of full opportunities in generic, and those opportunities are going to continue. Generic penetration will continue to go up, demographics is driving it. Every policy that we have in this country is driving our utilization of lower cost products. So, we will continue to drive it. But we have options available to us, but no need for us to sort of reflex – react.

Eric Coldwell – Robert W. Baird

Shifting gears for a second, you’re – historically, I had – years ago, had concerns that Cardinal was not exposed enough to the independent pharmacy channel, wasn't exposed enough to generics, wasn't exposed enough to specialty. You’ve made some acquisitions in independents. You’ve grown that business. You’ve obviously done quite well with your generics programs.

Let's hit on the third topic, which is specialty.

George Barrett

Yup, yup.

Eric Coldwell – Robert W. Baird

How can you grow that business? Is there enough left to acquire? Do you want to acquire? What areas will you focus on?

George Barrett

Okay. So, let's start with sort of I think a profound pharmaceutical dynamic.

One is that we have sort of become this – we have a little bit of a bifurcated system now in which we have an incredibly high number of products that are generically available, right? So, the percentage of generic penetration in the system is incredibly high.

And then in the other end, you have enormous innovation research work being done in the specialty areas. And the word “specialty”, as you guys know, probably means different things to everybody, but we tend to think of these products – products that have unique characteristics or very specialized disease areas that require sort of high touch; often very unique handling.

We’re seeing those two worlds are the real priority areas. That – so, specialty remains a priority to us. It’s a priority for our upstream partners. We are growing and we’re growing very rapidly. We’re becoming increasingly innovative in the way that we do our work. I think we’ve been able to do some really interesting work with technology and our PathWare solutions that link providers with payers, who are all trying to figure out what’s going to change in this game. We also – many of the providers, as you know, physicians' practices, are being affiliated or acquired by hospitals, and we’re trying to navigate that whole world.

So, the starting point – A, we are growing quite dramatically. We probably grew by 60% some odd, 70% last year at the top line, but we’re still much smaller than a couple of our peers in this space.

That can be a challenge at times. It can also be an opportunity for us because I really do believe that this is one of the areas in healthcare that’s going to go through change. And because we’re not giant in this area, we sort of have the liberty to experiment and to try new models.

And I would say our specialty business has actually changed a lot in two years. The focus of the business has changed, the capabilities of that group has changed and our growth rates are reflecting some of that. So, it would be great for it to be bigger moving the needle for us today.

But our growth rate is very high. I think we are uniquely positioned and we have the latitude to continue to innovate with that business and we will continue to do so. So, I would call it a continued priority area. It is growing. It is a margin expander for us, and I expect us to continue to work there.

Eric Coldwell – Robert W. Baird

Historically, one of the tenets of that sector, if you will, is that it would be hard to get services without a distribution platform to pay for it and it would be hard to get distribution without great services to support it. You’ve made an acquisition a few years ago – P4 – that was a little more focused on the service side.

George Barrett


Eric Coldwell – Robert W. Baird

You tried to grow your distribution piece. Where are you today in terms of balancing your service capabilities and maybe talk about a couple of those relative to just the growth in core. Where is it exactly?

George Barrett

Yes. I would say – I would certainly – we got started in this, our service capabilities were actually in front of our positioning in the market, and actually we probably didn't have enough sort of critical mass on the distribution side to have those touch points to have the services be relevant.

That‘s changing now. So, what’s happening is our distribution business is growing quite quickly, which makes it much easier. That sort of opens the gates to have this discussion about how we can help a practice operate. If you don't have those touch points, you can have wonderful services and no one is really listening. So, I think part of that has been happening and I think we probably had a little bit of the cart before the horse, but I think that is starting to get righted.

Eric Coldwell – Robert W. Baird

Okay. Again, if there’s any questions from the audience, feel free to send them in. Hopefully the iPads are working here. We believe that preferred products are going to be a pretty significant piece of your future in the medical business and I’d like to spend some time on medical.

George Barrett


Eric Coldwell – Robert W. Baird

Perhaps it would be great if you could just talk about your preferred lines, whether they be sourced or internal, globally, manufactured.

George Barrett


Eric Coldwell – Robert W. Baird

You can talk about what you do, percent of mix and then talk a little bit about what the future holds in this space.

George Barrett

So, I think the way to think about this, and it is a – let's call it sort of an over – it might be sort of a little bit of an exaggeration, but I think conceptually this is the notion, which again is this idea of what do we do in a system in which we have mature products that have been around for decades.

In our existing hospital system, for example, over many, many years, we treated those like highly differentiated, clinically differentiated products, and every department made its own choices. And as a result, we wound up with this proliferation of products, which is sort of gumming up the system, reducing efficiency, but also the pricing on those I think sort of was really becoming a major issue for hospitals.

And I think it’s time that we look at that from a different perspective. We desperately need innovation in the system and we’ll continue to drive it and you know medical device companies that are heavily focused on innovation, but there has been a lot of sort of product proliferation that wasn't innovative, and I think we see these opportunities now and the health system is now ready to explore that.

So, we call this our preferred products area. These include some of the products that we produce, but also some products that we’ve done in private label, products we have done in partnership. A good example is the work that we’re doing in orthopedics and in trauma, okay?

We’re starting relatively low on the clinical side. So, if you think of this as a spectrum from the most complex, highly differentiated, clinically relevant product to something that essentially is a supply, we work – obviously working at the lower end up.

So, in the orthopedic area, things like screws, cannulas, guide wires, these are not highly differentiated products. We know how to get those manufactured, where to manufacture them, and we’re seeing a huge demand for this kind of product. And I think this is going to be a spectrum of products. And it’s a high priority for us. We launched a lot of preferred products in our line last year. That will accelerate during our fiscal 2014.

And these tend to be products where we can create value. It is again this sort of virtuous cycle. We can create value for the customers downstream. That allows us to aggregate demand. The bigger we get, the more we are capable of building out that system, which allows us again to be more efficient for the downstream partner. So, it’s about it – again, about aggregating demand.

But this is an area where you have to have clinical know-how. So, there isn't a simple go-to-market model like you have an AV rating in a generic drug where the pharmacist can substitute and so you have to have the credibility in the technical community. So, our orthopedic group, our work that we are doing in these kinds of things, our whole program is overseen by a neurosurgeon, okay? So, we have clinical capabilities inside our organization that can speak the language with those departments and say, “Look, we are going to organize around this one group of products.”

So, we’re really excited about this. We think it is a great opportunity. I think the system needs it. I think we’re as well-positioned as anybody to deliver on this and we’re going after it quite fully and I think it will grow during the course of 2014.

Eric Coldwell – Robert W. Baird

So, we had dinner last evening with a large supply chain technology and service company, not a distributor, who claims that even pacemakers are now commodities in hospitals. Are we going to see Cardinal rolling out pacemakers, hips, knees?

George Barrett

Well, he..

Eric Coldwell – Robert W. Baird

Is this on the future?

George Barrett

I’ll give you sort of a weasel answer to this say.

Eric Coldwell – Robert W. Baird


George Barrett

You should see us continuing to move that product lines. I’m not going to give you the specific products.

I think it is easy to say from the outside that every product should be available generically, but you have to know the – you have to know the clinical area. You have to know the technologies, you’ve got to know the physicians who are thought leaders and you have to have the data.

So, the answer is we will be driving those products, where we feel that we’ve got the partnership in the community of physicians to say, “You know what? We should be doing this.” So, it’s going to come over time, but I won't give specific products, but you should assume that we are going to move up the scale.

Just to give you a sense of the economics for us, our preferred product program, other medical revenues is somewhere about 21% or 22% of our medical revenues, but it’s 30% some odd of our contribution to the system.

So, we have a higher margin rate on those products where we are essentially moving markets. And so, it doesn't take that much to move the margin needle for us and we think it moves the needle for our customers and for those partners upstream who work with us. So, we think there is a great opportunity here.

Eric Coldwell – Robert W. Baird

That's great. You made a nice acquisition. At least I thought it was a nice acquisition, earlier this year, AssuraMed. It moves you into the full continuum of care, moving into the home. I’m curious if we could get your updated thoughts on that. We have now had a few months to see the acquisition integration go, so…

George Barrett

So, I said something in my opening comments that probably – I’ll just repeat in very simple terms.

One, we had a system for decades in which the components did not talk. The components operated distinctly. We know that that is changing, and you can call it an accountable care organization. You can call it Kaiser. Call it whatever you want. We know that care is delivered more effectively when it is coordinated in some way.

Second, we know that care is going to be delivered in different settings. Probably the people in hospitals are going to be really sick, as opposed to what has happened historically and those who can be treated in more ambulatory settings or in the home…

Eric Coldwell – Robert W. Baird


George Barrett

Are going to be treated there. We believe it is inescapable that more care will be delivered in the home. And the decision to acquire AssuraMed was really interesting because it hit that button, but it was a natural extension of what we do. Virtually every product that AssuraMed sells in the home, we’re already buying at a very large scale for our system in the acute care settings or surgery centers, etc. And so, the opportunity to drive synergy of scale through those products into the home is really powerful.

Second, it really is the first time in Cardinal's history that we’re directly in touch with the patient. AssuraMed has two components to their business.

One is sort of the B2B business in which we say to, for example, “And I’ll come back, at a retail pharmacy or a home health provider, we will do the fulfillment for you, for your patient.” There’s another part of the business that is directly to that patient based on a reference from an IDN or a health insurer or a physician's office.

We like that we are touching patients now. We have between 8,000 and 9,000 direct conversations every day with insulin-dependent diabetics, with a urologically compromised patient that needs a catheter, and our ability to touch that patient is a really important new experience for us.

So – A, that business – the first priority for that business has really been “Do no harm because it has been growing very well and we want to continue to grow it.” They’re doing a great job of doing that.

We think the general trends are positive; meaning the demographics are working in our favor and care is going in that direction, and we believe that there are significant synergies, not just from our scale, but in terms of broadening the product line and even in terms of connecting that to other businesses, and I’ll give two quick examples.

One is that we just completed, in the last few weeks, our large retail show. We have a big retail show, where we invite all pharmacists here. First of all, it’s the biggest we’ve ever had. I think that’s noteworthy.

Second, we have the opportunity in that meeting to introduce AssuraMed to our retail customers because some of those retailers on the B2B side, those retailers have patients that need certain kinds of medical products in the home, but it is not their thing to do that. They are primarily pharmacy-oriented and they don't have the space for those kinds of things and they don't really know how to do the fulfillment and so we can offer the opportunity to do fulfillment for those independent pharmacies. So, that’s one example of a synergy.

Another would be the work that we are already doing between our specialty group, and this group – we’re in urology offices with our specialty group. That is a referral source for the AssuraMed products. And so, we’re beginning to see the linkages from one business to the other. But again first priority is “Keep it driving. Make sure that we are not doing anything to undermine the growth of that business.”

Eric Coldwell – Robert W. Baird

Well, George, I was watching the podium clock, which gives us 4 and a half minutes, but I see that the doors are open, so the podium clock goes off. I think we’ve actually run…

George Barrett

Shot clock.

Eric Coldwell – Robert W. Baird

We have one quick question from the audience on China. Let's get that one out of the way…

George Barrett


Eric Coldwell – Robert W. Baird

To make sure we fulfill that, and it really is just the opportunities and challenges of the China expansion. If you could knock that out for us in 30 seconds, that would be great.

George Barrett

Okay. China has been going great for us. So, we’ve been growing organically. We’ve been growing geographically, primarily through acquisition, largely small acquisitions, mostly along the coast and we’ve been growing our product lines. It used to be pharmaceutical distribution almost entirely and now it is medical supplies, lab.

We think there’s some unique things happening in China. Obviously, it’s an area of a lot of intensity, but over the long term, we believe China will grow. We think we are well-positioned. Our value proposition, which is about the partnership with a company you know, high integrity. I think is going to offer great opportunities for us. So, we’re excited about China.

Eric Coldwell – Robert W. Baird

That's fantastic. Everyone, please join me in thanking George for the presentation.

George Barrett

Thank you.

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