Good morning, ladies and gentlemen. Thank you for joining us today on the Q1 FY27 earnings call of Ikedas Health.

On behalf of ICICI Securities, I would like to thank the management of Ikedas Health for giving us the opportunity to host this call. Today, we have with us Mr.

Sachin Gupta, Founder and CEO; Ms. Nithya Balasubramanian, CFO; and Mr.

Saransh Mundra, Head of Investor Relations. I turn it over to Mr.

Saransh for his brief statement and to take the proceedings forward. Thank you, and over to you, Saransh.

Thank you, Seema. Good morning to everyone.

Thank you for attending our earnings call. We hope you had the opportunity to look at our earnings and presentation.

Before I hand it over to Sachin, a brief disclaimer. As part of our prepared remarks and during question-and-answers, we may make certain statements that involve estimations, significant uncertainty.

We don't take any responsibility to update such forward-looking statements, and your discretion is warranted while making any investment decisions. Thank you.

Over to you, Sachin.

All right. Thank you, Saransh.

Good morning, good evening, everyone, depending on wherever you are. Welcome to our conference call for discussing the financial performance for the first quarter of fiscal '27 ending June 30th, 2026.

On the call today, I will start off with providing a quick overview and sort of state of the union of the business, provide a high-level financial overview, turn it over to Nithya for some detailed remarks on some of the financials, and then take it back to close towards the medium-term outlook of the business, especially as we look to consolidate TruBridge and integrate it effectively and how the next few years are looking, and then we'll turn it over to everybody for Q&A. To start off with, again, because there's always some new participants on the call as well as there's been a significant evolution in the company, just to remind everyone, I think we're a unique platform, a unique care enablement platform that is focused on delegating the chores of healthcare so that healthcare providers can focus on their core.

There are two aspects of our platform now with the acquisition of TruBridge that make us unique. One, in our traditional market, I think we're still the only truly comprehensive system of action that sort of delegates these chore tasks from providers through the right combination of technology and humans, including AI-enabled technology.

Again, in a market that's full of point solution vendors, I think we are pretty much the only comprehensive platform that does that for large medical groups, be those independent or health system-owned. That's been our traditional market.

Now we've added a very important dimension to our business where we are now working towards being the only truly integrated system of action and system of record for the rural and community market. As typically for healthcare systems delivery organizations, they are often straddled between technology that is coming from their electronic health record vendor, which is the system of record, and multiple point solution vendors that delegate chore tasks that are created due to regulations, as well as, in fact, some tasks being created due to the system of record being inefficient.

In the rural and community market, which is a very, very large market with 2,100-plus hospitals, the reality is we will be the first of its kind deeply integrated system of action and system of record such that all of the chore tasks can actually be orchestrated in the native workflows of the EHR itself without context switching. I think it's unequivocally validated that for healthcare provider organizations, that's the holy grail.

If they can actually receive that, that truly takes care of all of their challenges. Excited about the recent evolution that we've had for the rural and community market.

Of course, a lot of work to do to realize it effectively. I think overall, when you combine those two dimensions and the cross-leverage that those two dimensions bring, I think we're really in the process of building a new operating system for healthcare provider organizations to bring them clinical and financial sustainability.

All of this, as is a very large TAM, which is now expanded further for us because of the rural health system market kicking in, north of $260 billion, of which outsourcing is only about $35 billion. Just to remind everybody, the overall market is growing at close to 8%, and the outsourced TAM is growing at about 12%.

Today, prior to TruBridge, we are about 600-odd large provider groups that we've serviced across urban and semi-urban settings. Obviously, most of that, because we are basically the operating infrastructure for these provider systems, most of that tends to be recurring revenue because we're basically part of their operating infrastructure that helps them operate on a day-to-day basis, long-tenure clients.

Prior to TruBridge, we're at about 12,900-odd people, which obviously I'll talk a little bit more about that in the context of our financials because year-on-year, we're continuing to see non-linearity between revenue growth and people growth, which we also witnessed in this past quarter relative to the same quarter last year, of which about 1,900 of our people are clinical, and nearly 600 now technology-focused engineering employees that we're leveraging to continue to build our proprietary technology embedded in our platform, and close to 60 sales and marketing people. Obviously, these are pre-TruBridge numbers because the TruBridge deal closed on July 10th.

These are all numbers for the quarter ending June 30th, 2026. Again, large TAM, great growth opportunity, very significant install base in which we can continue to expand our platform, and really unique positioning as the new operating system for healthcare delivery going forward.

With that, I think it's important to lay out, as the last few conversations, I've always said, what are our key strategic pillars of execution? With TruBridge getting integrated, obviously, those key strategic pillars of execution have evolved dramatically.

Today, I wanted to introduce everybody to what are the renewed strategic pillars of execution from here. We still have five, incidentally.

The first one, which probably is the most strategic and the most exciting for the long term, is this integrated system of action and system of record for the rural and community health system market. This is actually the most strategic rationale of combining TruBridge with Ikedas and creating this new operating system for healthcare.

Let me just lay out a few very important steps in how we are going to go about creating that. As I've laid out before in the conversations about TruBridge, one of the biggest values that the TruBridge acquisition brings to us is this massive dataset of 5 million-plus patients that we now have access to, that we can de-identify and now convert into a structured, unified database that can then be labeled where you can then start labeling and building linkages between the clinical context, the actions taken on the data, as well as the outcomes achieved.

That eventually becomes the AI training moat or the AI training corpus on which you can start to build your own proprietary language models. Obviously, we're going to do that.

We're already well into our journey of starting to build that database. TruBridge is already starting to do it.

We're quickly bringing momentum to that. As that structured database comes together, we will start training our own SLMs.

It's really important because these SLMs are a very, very strategic aspect of our future because in absence of these SLMs, you are constantly relying on frontline large language commercial models, which, as people are discovering now, as exciting as they are, they're extremely expensive. The token cost is hard to justify over a period of time.

With this model where we are going to be able to build our own SLMs, train our own models, tune our own models by specialty, by task over a period of time, we will very significantly reduce our dependence on the LLMs for all the generative AI that we are going to use. I think this is a really, really important strategic aspect of this pillar of execution.

Then I think one of the other things that's important for our shareholders and our customers to recognize is that one of our big philosophies is that in healthcare, you don't just need generative AI, but you need explainable generative AI. Because in healthcare, it's not good enough to just arrive at an answer, but you also need to be able to explain how you arrived at an answer.

One of the things that we are pioneering is building this construct of a glass box or explainable AI construct. We're doing that through another recent acquisition that we did called RIAI, where we've built a whole bunch of knowledge graphs that actually bring that ability to not only leverage our proprietary models to generate the intelligence and accomplish the task or orchestrate the task, but it also allows us to explain how we arrived at the task.

I think this is a very, very important dimension of our strategy and could be a differentiator over a period of time. Then of course, I want to remind everybody about the key distinction.

We are all hearing so much noise that sometimes it's easy to lose the signal between what generative AI is really going to do versus not. I think a simple concept at the risk of oversimplifying it a little bit that I want to continue to emphasize is that there's going to be multiple tasks in our system of action.

Some of these tasks are essentially going to be deterministic in nature, where the outcome of the task is a finite binary outcome, right? Like it could be a medical code.

It's very deterministic. There's going to be a few tasks that are non-deterministic in their outcomes, like narratives, like clinical documentation, which is a whole narrative.

Generative AI is exceptionally good at these non-deterministic task outcomes, right? That's where when there are tasks that have non-deterministic outcomes, you can start to get autonomous to a great extent.

You'll still need human-in-the-loop for some edge cases, but you can get to very high levels of autonomy when the outcome of the task is non-deterministic in nature, like clinical documentation. When the outcome of a task is deterministic in nature, you have to constrain the generative AI models with further rules-based AI and human-in-the-loop.

That rules-based AI can take the form of a knowledge graph or what have you. Again, the way we are approaching building and evolving all the features in our platform is we've clearly stratified deterministic versus non-deterministic.

Based on that, we have created a very pragmatic autonomy aspiration by task. Based on that autonomy aspiration, we have a roadmap by feature on what that journey to autonomy or appropriate autonomy is, and what that human-in-the-loop will continue to evolve to look like by task.

I think that's a very, very integral part of the strategy. As we build explainability, we will constrain the generative AI appropriately through human-in-the-loop as well as knowledge graphs.

Then last but not the least, obviously, embed these system of action workflows in the native workflow of the EHR so that there is no context switching for the users, and they are able to orchestrate all of these tasks within their native EHR workflows. That's the vision of this very important first pillar, which is the biggest strategic rationale from a long-term perspective of combining the two organizations.

In the medium to long term, I think this will become a very, very important strategic differentiator and driver for growth and profitable growth for us. Then one of the byproducts of doing that is the very models that we are going to train, the SLMs that we are going to train for the rural and community system market, actually will feed into the similar system of action that we have for the urban and semi-urban market, because the reality is 70% of care that's delivered in these rural and community settings, even in the hospitals, is outpatient care.

Obviously, our traditional business is all around outpatient care. As we build out these proprietary SLMs, with a little bit more tuning and adaptation, those SLMs will be extensible or extendable, if you would, into our traditional market, which is where our second pillar is, where we actually translate these trained agentic workflows from the rural community market into those features for our traditional market and continue to empower our comprehensive system of action for the urban market, for the large group market, continue to empower that with these agentic, generative AI-enabled interconnected workflows.

Obviously, in that market, we will have to continue to rely on API-based integration with the EHRs. There, we don't obviously have native workflow integration, which obviously is not the most optimal solution, but it's still a huge differentiated moat because the other option that large medical groups have is to buy multiple point solutions and integrate all of them with the EHRs.

They're much better off having a comprehensive platform from us that starts to integrate with their EHRs. Then again, we'll obviously continue to embody explainability in the generative AI as well as human-in-the-loop where appropriate, depending on deterministic versus non-deterministic outcomes.

Then our right to win in this traditional market will continue to be that for the large health system-owned groups, where they buy by feature and then expand into other features of the platform, we need to be number one or two or three in each of those features, which is demonstrated through our KLAS ratings, which is sort of call them the Gartner of healthcare IT, if you would. Obviously, Black Book ratings is another demonstration of our leadership in those features, and then yet continue to be one of the only comprehensive systems of action for that market.

Again, these two strategic pillars relative to both of our key markets going forward are a very important part of our strategy. Third, of course, is now we have very clearly stratified go-to-markets for the rural and community market and for the independent medical group market as well as the health system-owned market.

As I've always said, in the health system-owned market, we pivoted our strategy from a full comprehensive platform go-to-market approach to a more land-and-expand approach. Both in the results of this quarter and the last couple of quarters, we're starting to see the fruits of that.

Happy to announce that we've had a couple of very significant wins in that land-and-expand strategy over the last couple of quarters, and I'll talk a little bit about those in the financials. Then for the other two markets, which is the rural and community market, obviously, the go-to-market eventually will be a comprehensive integrated system of action and system of record.

Then for the independent medical group and for the mid-sized health systems, that's where we're seeing more and more appetite for platform-based deals. Those will be very clearly stratified GTMs for those three market segments that our business is focused on from here.

Needless to say, perhaps any deal that has strategic rationale still has to work financially. Happy to note that we have our plan laid out for getting back to our early to mid-30 EBITDA margins after our pro forma will drop post-consolidation of TruBridge initially to the 26%-27% range.

Obviously, we've built out our plan to get back to that early to mid-30s, which is also reflected in our true north goal that we've laid out for everybody for FY30. That is achieved through both continuing to evolve our model from tech-led human-in-the-loop to appropriate level of autonomy by feature, leveraging generative, explainable AI, but also then transforming the TruBridge operating model to appropriately leverage the technology that we already have and the technology that we are building, and then combine that with the appropriate human-in-the-loop from an offshore or global execution perspective.

Then obviously, there's going to be some natural other operating and SG&A synergies as we combine these two organizations of significant size into a business that's just short of about $700 million in revenue. As a combination of those three levers, we feel confident about our ability to get back to our regular cadence of margins here in the next couple of years.

Then all of this eventually is predicated on the operating culture that we drive. I know many people have heard the cliche of culture eats strategy and execution for breakfast.

The reality is we've experienced that already significantly through our past transactions and acquisitions. Our commitment to building a single institutionalized culture that is really driven around outcomes.

I think one of the things that's coming out as this whole AI hype cycle flushes itself out is that the AI is great as a technology, but if it can't improve outcomes from a cost and quality perspective, then that's not going to be worth it, right? Luckily for Ikedas, we've constantly always had an outcome-oriented culture, which is also reflected in our pricing.

We obviously have to institutionalize that culture across the one integrated Ikedas, the combination of TruBridge and Ikedas that starts off with north of 16,000 employees globally and now close to 2,000 clients that are going to be our clients across the two organizations as they come together. We're also in the process of consolidating the leadership team, and I think there are some very complementary strengths that we are discovering across legacy TruBridge and legacy Ikedas leadership.

Bringing all of that together into one complementary leadership team is a big dimension of culture, and then last but not the least, continue to drive the value behaviors that have made Ikedas what it has been over the years. These are the five strategic pillars of execution.

I will continue to report progress against these five pillars, some of which will be reflected directly in our quarterly financials, others will reflect over the medium to long term. It's always good to receive some recognition for all the good work that's happening.

There's several out there for you all to read, but the ones that are I think most important are two. The first one is we're very happy to report a patent that has been approved for our industry path-breaking AAW model, which is a model that basically predicts patient behavior across various dimensions.

One of them is we have a scheduling optimization feature within our patient engagement hub that we've built out, and that scheduling optimization feature enables providers to achieve maximum fixed cost utilization of their time as well as improve access to care. All of that is done through this propensity to show or no-show algorithm that is based on a composite score of patient's awareness of when exactly their appointment is, their ability to show up—some older patients run into logistical issues to show up—and then of course their willingness to show up for the care that they are scheduling even.

Based on that propensity to no-show, we have differential nudging algorithms that ensure that patients show up, but then also we schedule for providers intelligently to make sure that for the patients that have the highest propensity to no-show, we are perhaps doing things like double booking the slots so that at no point does a slot for a provider go waste because a patient doesn't show up. Also, this has had already a huge impact in one of the very important drivers of healthcare reimbursement.

As the patient component of healthcare reimbursement, generally healthcare reimbursement for healthcare providers consists of the patient pay and the insurance pay. The patient component of the reimbursement typically is increasing over a period of time as copays and deductibles keep going up in these insurance plans.

Generally, collecting from the patient is a difficult endeavor. Our AAW algorithm also predicts patients' propensity to pay, and based on their propensity to pay, which is a composite score of their awareness, ability, and willingness, we can differentially nudge them on making sure that they actually pay before the care is delivered, because collecting from patients after the care is delivered typically has a very high write-off ratio.

This is a path-breaking algorithm. It's already been deployed in our MyCare Hub patient engagement technology that has already proven significant upsides in patient collections as well as optimizing the schedule for our customers.

Then the second one I want to point out, Saransh, if we move to the next slide, is this case study that we published recently with Axia Women's Health, where through our optimized coding, we actually delivered a $12 million cash impact in a fully compliant manner with 96% coding accuracy, reducing coding denials. I think this is a very, very important demonstration, again, of the power of the system of action that we have built in terms of its actual ability to deliver tangible value, not just provide technology.

I just want to point out quickly, if you can go back, Saransh, one slide, to the features of our system of action. This is the comprehensive system of action that we have built over all these years.

This system of action applies both to our traditional large group, large health system setting in the urban and semi-urban markets, as well as to now being adapted to the rural and community markets. As you can see, earlier, we used to track, by feature, the automation potential.

Now, we are starting to track, by feature, the autonomy potential of each of these features. That autonomy potential, obviously, is driven by, like I was saying, the deterministic versus the non-deterministic nature of each of these tasks.

We'll continue to do that and report our progress in this journey to autonomy. Again, autonomy being in healthcare meaning there'll always be some human-in-the-loop, although the humans might go from doers of task to auditors of task over a period of time.

How does all that add up into our Q1 financials? Happy to report another strong quarter of financial performance in which we've delivered 21% year-on-year growth for fiscal Q1, 12% in constant currency, resulting in revenues of about ₹893 crores.

While doing that, we've been able to deliver 33% EBITDA at ₹294 crores. It's really important to recognize, though, that that EBITDA would be approximately 200 bps higher if you adjust for that one-time exceptional cost associated with the TruBridge acquisition.

Actually proud to say that we were able to accomplish this TruBridge acquisition at an unprecedentedly lower cost than most of these transactions come in at. I think we were just north of a little about over 1%, and some of that 1% is about 20-odd crores is reflected in the costs in this quarter.

When you adjust for those ₹20 crores, that ₹294 crores basically becomes ₹314 crores, and the 33% pretty much comes back to that north of 35% operating EBITDA. Just wanted to call that out, which then also takes care of the quarter-on-quarter EBITDA growth, if you would, going from then 300-odd crores to ₹314 crores, which would make it a healthy quarter-on-quarter growth.

Wanted to call that out very clearly. Strong growth, strong, continued performance in operating margins that results in appropriate growth in PAT, which is reflected at about 28% year-on-year, coming in at ₹193 crores, which again, if you were to adjust for the one-time exceptional acquisition cost, it goes even higher.

All of that, obviously, on the back of very strong, continued operating and free cash flows that the business continues to generate, which were on a cash basis affected by one-time Niva payment that we had associated with a customer, which is why it's not reflecting in the net debt, but continued strong operating and free cash flow performance that is reflecting the strength in the business. All in all, pretty strong quarter.

Also want to highlight some very, very exciting client wins for the quarter. One we're not able to name, but it's a very, very large and visible health system in California where we are actually helping them as they are taking most of their regions to Epic.

We then made a partnership with us where we are helping them succeed on Epic. That is also good for our overall relationship with Epic and continues to strengthen our partnership with Epic in our traditional market.

If you remember, one of our concerns, or some of your concerns was, as we integrate TruBridge, will Epic get perhaps competitive with us? The reality actually is, both in our traditional market through partnerships like the big California health system, we continue to get closer to them, we continue to integrate more and more features.

Then also, there are things happening between TruBridge and Epic independent of us that are taking TruBridge closer to Epic as well and collaborating with each other in that rural market. More to follow on that, but I think, knock on wood, our relationship with Epic seems to keep getting stronger and stronger.

Another very significant win with a national musculoskeletal leader. They are a very, very large national aggregator in the musculoskeletal space that is starting with a significant RCM relationship and a commitment to explore other dimensions of the platform.

Then I think our flagship relationship with Advocate Health Care. We have, in this quarter, two examples of really strong momentum starting to emerge in our cross-sell endeavor.

Remember, we had pivoted our cross-sell strategy from a platform-based approach for large health systems to a land-and-expand approach. Both this California-based system and Advocate are very, very strong examples of this approach now really starting to work.

Advocate is of particular note because it's one of the top five health systems in the country with north of $35 billion in annual revenue. They've significantly expanded their partnership with us both in revenue cycle and in the coding dimensions, and we're still only scratching the surface even with this expansion.

Very, very excited about this relationship and to be able to reveal it. Then we've also partnered with one of the largest vascular and vein surgery organizations called StrideCare, which again, I think is the leading national integrator in that space.

Healthy amount of wins both from a cross-sell perspective, a couple of new customer acquisitions in the independent single specialty space, continue to demonstrate growth momentum that we should be able to take advantage of going forward. With that, what I will do is turn it over to Nithya to provide some additional remarks on our financials, a little bit more detail, and then we'll bring it all together with a medium-term outlook on the business.

Thank you, Sachin. Good morning, everyone.

Thank you for joining us today. If you can stay back on the previous slide, Saransh.

EPS came in line with the profit growth that Sachin had already commented upon. It was a very healthy 30% year-on-year growth.

If you look at return on equity, it is again at a very healthy 26%. The decline quarter-on-quarter is largely due to the one-time acquisition cost that Sachin called out, as well as an increase in the valuation of Abridge, which is one of our strategic investment.

We had to mark-to-market the asset at a higher valuation. If you can go to the next slide.

A few additional details on the financials. Revenue, of course, grew at a very healthy 12% constant currency.

If you look at forex gain, it was rather neutral this quarter compared to Q4, where we had substantial support from forex gain. If you look at employee benefit expense and other expense together, there are a couple of drivers that I want to call out quarter-on-quarter.

One is while we had fewer number of employees, which, of course, helped in reducing cost, however, we also integrated senior technology resources from ThinkDTM as well as RIAI in the quarter. In addition, there were also one-time acquisition costs across both the quarters.

In Q4, we had about ₹25 crores of acquisition expenses, and in Q1, we had about ₹20 crores of acquisition expenses. We do expect a little bit of integration expenses going into the next quarter as well.

It's likely to remain in a similar range. We'll, of course, talk to you about it when we talk to you about Q2.

Adjusting for both the one-time acquisition expenses as well as currency, while the reported EBITDA is at 33% in Q4, the adjusted EBITDA, adjusting, as I said, for currency as well as acquisition expenses, is actually at 35%, which is in line with the Q4 number as well. If you look at finance and depreciation and amortization expenses, they came largely in line with previous quarter.

Tax rate was higher this quarter. This is something we had discussed last quarter as well.

Tax expenses were in the range of 22.4% this quarter. For legacy Ikedas for the rest of the year, this is likely to remain in the 22% to 23% range.

We will, of course, talk to you about the combined pro forma tax rate when we speak to you next quarter. Net net, the profit for the period stood at ₹194 crores, or 22%.

If you can go to the next slide. These are key KPI metrics that we talk to you about every quarter.

Very happy to report, again, that the adjusted EBITDA per employee continues to grow at a very healthy pace, given the technology transformation and the continuous deployment of automation that we're able to achieve across our platform. Revenue from top 10 customers as well as top five customers, again, grew very healthy.

In terms of contribution, it remained rather flat compared to Q4. Again, very happy to report that our vintage and our relationship with these top 10 customers and top five customers remained very strong.

Top 10 vintage is at approximately six years, and top five vintage is at approximately seven years. FCF yield continues to be very healthy.

Again, adjusted for that one-time expense, FCF yield came in at 90% in this quarter. Sachin, I'll hand this over back to you.

Great. Again, strong financial performance for the quarter.

I think this is our seventh quarter of being public and reporting performance as a public company. Our first quarter was the quarter ending December 31st, 2024 as a public company.

It's our seventh quarter. I thought it'd be good for us to just take a step back and just reflect on where our journey's come to and where it's taking us.

I'll start off with the journey for shareholders that have been with us even prior to the IPO. If you look at a 10-year horizon historically, it's been a healthy growth journey of about 29% revenue and, very importantly, non-linearity between revenue and PAT demonstrated over a 10-year period.

Then I thought it's important to recognize where our journey is taking us, where it has been. I thought let's benchmark the period from when we went public, and let's look at it about six years out, to which I think we have some decent amount of visibility from an earnings perspective and where I can say with a good amount of confidence that this is a true north objective that we really should be able to meet.

Just to put that in perspective, when we went public in December, the trailing 12-month EBITDA of the business was about ₹647 crores, give or take, right? That's the trailing 12-month as of September 30th, 2024, just before we went public.

Just in the last, call it, 18 to 20 months, with no dilution, we have basically taken that business of ₹647 crores to ₹1,148 crores on a standalone basis pre-TruBridge, right? That is about nearly a 40% CAGR when annualized in terms of growth between TTM September 2024 and TTM June 2026.

Like I had said when we were doing the TruBridge acquisition, we had said that there was going to be a true north objective for FY30 for ₹3,000 crores. I just want to reiterate today that as we have now closed TruBridge and are starting to get our arms around it, I wanted to reset everybody's expectation on how I'm seeing the future.

I want to reiterate that we are continuing to maintain our true north objective of getting to at least ₹3,000 crores in EBITDA by fiscal year '30, number one. Number two, I also want to provide that we will be able to do that again with very marginal dilution, perhaps associated with ESOPs to incentivize our people.

Outside of that, that objective is to achieve that without any further dilution to shareholders outside of ESOPs and getting back to that net debt position that we had prior to the TruBridge acquisition, right? Without dilution or without significant dilution other than marginal dilution for ESOPs, as well as without expanding our debt, we will be back to the pre-TruBridge debt number and ₹3,000 crores of EBITDA.

Just to put that in perspective further, what have we learned about TruBridge in the few days that we've had after close or from the period when we spoke last to now, what are we, about a month into close, give or take? I think there's two highlights.

It's a generally good news. The big good news is we had said when we completed the transaction that it looked like TruBridge was in the $68-odd million annualized EBITDA range.

I think we're happy to confirm that that is the operating EBITDA that we are essentially inheriting through the TruBridge acquisition. Very happy with that.

However, I think on the revenue side, that EBITDA margin, that $68 million is coming off a lower revenue base. We actually believe that the operating revenue that, once translated into Ikedas on a steady-state basis, will be about $300 million a year.

Again, we'll produce the same $68 million in EBITDA margin starting out at the $300 million a year than the $340 million a year that we were anticipating pre-close. What are the drivers of this $10 million-odd a quarter or $40 million a year annual reset?

There are actually three or four key drivers. First is the way they used to recognize revenue for RCM deals.

I think there's a good give or take, $2 to $3 million a quarter just from a rev rec perspective that we are much more conservative in how we recognize revenue from RCM customers. They've been a little bit more aggressive where they estimate the revenue that will be collected for their customers, and then they estimate the revenue based on that.

We take it based on actual revenues. As we adjust that, I think on an ongoing basis, we'll see that adjustment.

Second, there were two services or lines of service that I had said earlier that are not profitable and that eventually we will look to eliminate. Those two lines of service are basically around small IT management services for these rural community hospitals and some early out-type services, and those itself were about $8 million a quarter.

The reality is, when you take those services out, it doesn't affect profitability at all. In fact, it helps profitability a little bit.

We had encouraged them to think about that. Of course, we had no control over it pre-close, but happy to report that they're already on their way to doing that, and that will reset the base over a couple of quarters by as much as $8 million a quarter.

Then obviously, in order to rapidly accelerate the transformation of their operating model, we're anticipating some customer discounts, etc., over the next few quarters, which will be about $2 to $3 million a quarter. Again, I think the way to think about the combined business is, as Ikedas is at a run rate of about $97 million a quarter, which is about $388 million annualized.

TruBridge has a run rate of about $75 million a quarter, $300 million annualized. Together, it's about a $688 million revenue business with a combined EBITDA of about ₹1,150 crores on the Ikedas side and about $68 million on the TruBridge side, which is about ₹650 crores.

That's what the starting point is. Again, I want to reiterate, we're feeling excited about the true north objective that we've laid out for ourselves for FY30.

That's sort of the overall state of the union. Again, if I put all that in perspective from our December 2024 timeline, which will be basically about even less than six years, in 5.5 years, we will have taken combined EBITDA of the organization from ₹647 crores to ₹3,000 crores if we hit our true north.

Of course, there's an if there, but I'm putting us out there saying that I think we have a really, really good line of sight to that. That's the overall state of the union.

Again, I'll round up by saying very exciting quarter, strong performance. The cross-sell land-and-expand strategy is starting to work in large health systems on the legacy Ikedas side.

Very excited about the new operating system for healthcare that we're building as we combine TruBridge. While we think of this as a multi-decadal journey, if I was to break it down for the next say, 4 to 5 years, I think we have a pretty healthy outlook for the next 4 to 5 years.

With that, I'll wrap up our prepared remarks and turn it over to the operator for helping facilitate questions.

Hi. Am I audible?

Yeah. Thanks for the opportunity.

Actually, I have a couple of questions. Sir, it will be helpful if you could help us understand at an organic level, what kind of constant currency revenue growth you consider healthy or sustainable over medium term?

Actually, I'm not asking for any formal guidance, but rather I'm trying to get a better sense of the level of underlying growth the business is comfortable delivering consistently. Because right now, if I see since we got listed, on an average, we have delivered around 14-odd percent kind of growth.

This quarter being 12%, one of the slowest-growing quarter in constant currency term. Broadly, how do you see going forward?

Also, don't you think most of the operating leverage we are generating, it's coming through currency gains which we are making? At organic level, how you are seeing this going forward?

Not guidance, but more better understanding and clarity if you can share.

Great, great. Thank you for the question, Satyam.

I'll answer the second part of your question first. You said, is all the margin growth coming through currency?

No, not really, to be perfectly honest. For example, our 12% year-on-year growth for this quarter that you have experienced has come on a people cost increase of only 4.2%, right?

Our head count has gone in June '25, we were at 12,300 people; in June '26, we're at 12,889 people, which is basically a growth of 4.2% in people cost versus 12% constant currency growth in revenue. Actually, if you keep looking at it on a year-on-year basis, we have demonstrated constant non-linearity between revenue growth and profit growth, and it is all driven by operating efficiencies.

In fact, right now, our head count is a little inflated simply because we're anticipating integrating TruBridge. There are certain aspects that we need to invest in the TruBridge customer base that are factored in as some additional costs that we are carrying because we want to elevate the performance of some of their customers on the RCM side.

I think that's the second part of your question.

Just to add to that, I think this quarter, where exchange gains were completely neutral, you would see that our underlying EBITDA performance is again very healthy. The 33% reported number, adjusted for the acquisition costs, is actually 35%.

The entire growth in EBITDA has actually been driven by operational improvements and not by currency.

Thank you, Nithya. Satyam, on your growth, look, I've constantly said that the market is growing at 12%, and so I've always said, look, I am not smart enough to predict what will happen every quarter.

Over a period of time, if we are growing faster than 12% on constant currency terms, our market share is growing, not reducing. I'll continue to say that that should be our aspiration, that will be our aspiration.

That is not a guidance. I'm not good enough to predict that.

I can tell you that we will aspire to continue to grow that $388 million book of business at 12% and which is the legacy Ikedas business, and continue to drive non-linearity as it relates to profitability in that growth. That non-linearity will mostly be demonstrated in the gross margin because that's where the juice comes out of.

There might be SG&A investments that offset some of that gross margin, but we'll continue to see some non-linearity there. Then as it relates to the TruBridge book, I have to say that you know what their historical growth pattern has been, and I need at least 2, 3 quarters to wrap my hand around it.

Once I've understood exactly what are the various levers, then I'll understand what the TruBridge growth potential is, and I think we'll be able to have a more better conversation on what our TruBridge book growth aspiration should be in that market. That's as much as I can tell you is retaining that 12%-plus growth aspiration constant currency on the Ikedas book, still wrapping my head around what the TruBridge growth is.

Again, our aspiration will be to be the fastest-growing integrated system of action and system of record in the rural community market. What that number is going to be, I think we need some 2, 3 quarters to understand that, which is why, intentionally, if you see the slide, we've put a true north on EBITDA, but I haven't yet put a true north on revenue.

I have put a true north on EBITDA that we think we'll achieve based on whatever little I do know about revenue. Thank you for your question.

Understood, sir. At industry growth, we'll continue to maintain.

Critically. Sir, second question, if you allow.

My second question is with regards to your AI strategy. Sir, in today's concall also and last call also, you explained in detail about your vision of leveraging AI, small language model, and glass box AI.

Sir, to be precise, just wanted to understand how SLM sits alongside or on the top of LLM and where exactly glass box AI framework fits in? Is it around SLM?

How SLM and LLM will work together and where glass box AI actually fits

in? My second [unclear] No, that's a great great question, Satyam.

Without getting too technical and making this a class in AI, I will quickly say that there are basically three SLM models. One is a classic standalone SLM model.

The big advantages of the classic standalone SLM model is it has much lower latency than relying on an LLM, it can often run on CPUs or edge devices, obviously it has lower GPU and cloud costs. The second is an SLM that is distilled from an LLM.

That's another very common approach where you use the LLM only during the training of the model, and then the SLM takes over. Think of the LLM as a teacher to the SLM.

Then the third is what I call a hierarchical SLM plus LLM model, right, where the SLM is used for things like instant intent detection or classification or more simpler Q&A, workflow execution, which is important, routing of tasks, which is important, and then the LLM is only invoked when the task requires deep reasoning. Now, what we will have is we will have all of these three manifests for different tasks.

We'll have standalone SLMs for some tasks, we'll have SLMs that are distilled from an LLM for some tasks, and we'll have hierarchical SLMs and LLMs working together for some tasks. That's the strategy that we're going to deploy.

Together, what that's going to lead to is this construct where we will have much lesser dependency on the frontline LLM model. That's to your question of where do the SLMs really kick in.

I wish I could tell you that based on the combination of these approaches, my token utilization will drop by 60% versus a traditional LLM approach. I'm not smart enough to tell you that today, but over a period of time, that metric will emerge for us.

Second, your question was around where does the explainability come from? The explainability comes from the knowledge graphs that we have acquired through our RIAI acquisition and that we will continue to build.

What is a knowledge graph? Knowledge graph is nothing but a set of relationships between data points that then starts to explain how the AI is arriving at the inference that it is arriving at.

That knowledge graph is really what will enable us to bring the explainability into the AI inferences that we're arriving at. Hopefully, that's enough for this call at least.

Again, I didn't want to make this an AI class, but since you asked, I at least wanted to give you a bit of a

Sure, sir. That's helpful.

I have one more question. I'll get back into the queue.

Hi, Sachin and team Ikedas. Congrats on a solid set of quarter and, again, congratulations on the strategic acquisition of TruBridge.

My question is related to the acquisition itself. Sachin, I would like to understand how long have you been in the market looking for acquiring a company in the EHR who have developed the EHR systems?

Was this you who made an active decision to go out there, look for an acquisition, or was a banker there pitching you the idea? Wanted to understand some thought process over there.

Secondly, Ikedas acquisitions have been very strict and have performed very well from a capital allocation standpoint. From a narrative standpoint, what are the few criterias you look which makes the acquisition fit into the Ikedas story?

Great.

Thank you for the question. Appreciate it.

Look, I think as I've narrated at the time of articulating the TruBridge acquisition, this was a very, very strategic, thematic approach that we had, right? Because we understood that the true operating system of the future would be a deeply integrated combination of system of action and system of record.

Now in our traditional large group market, there were some large EHR vendors that are already firmly installed that are themselves trying to become system of action. With them, we have this cooperative relationship where we are cooperators because we do rely on integrating with them through API, but we are competitors as it relates to our systems of action, right?

The chances of acquiring any of those large EHR vendors were limited. We started thinking, what if we look at an adjacent market where there is still a large EHR vendor, where there is an opportunity for a deep integrated system of action that could bring efficiency to these chores and where that acquisition will not make us overly competitive with the EHR vendors in our traditional market?

It was with that very thematic mindset that we spread the word from our corp dev team around what we're looking for, and I think it took us a good year, 18 months maybe that much to land TruBridge, which, of course, was in an auction process. When we landed it, we were instantly attracted by it for two reasons.

One, the rural market is a very large market. Second, TruBridge had a very significant 30%-plus market share in that rural market as one of the two dominant EHRs.

Third, because the service mix in the rural market is very similar to the ambulatory market, right? When you look at that together, TruBridge became a very, very attractive proposition for us, and that's how we arrived at choosing them and going.

A very thematic strategic pursuit that led to the discovery of TruBridge. They were in an auction process through a banker, and we were able to land the deal.

There was a second part of your question that if you don't mind repeating. Yes.

The question was, acquisitions historically have performed very well from a capital allocation standpoint and an IRR standpoint, but from a narrative perspective, how do you see acquisitions in general fitting into the Ikedas story?

Look, I think what Ikedas will not do is acquisitions for the sake of acquisitions. Typically, there is going to be a strategic thesis behind the acquisition.

That has to be the mainstay of the acquisition. Then, the strategic rationale should be the main driver of the acquisition, and then it also has to make financial sense.

If it makes strategic sense, but it totally is a bad thing from a capital allocation perspective or is going to be hugely financially challenging and creates inordinate amounts of risk, then we will be careful about it, right? I think the mainstay is strategic objective, and then it has to be financially viable.

One, it should not create too much leverage on our balance sheet relative to our current EBITDA. That's one thing.

Second, it has to come at a price that is accretive. If you think about TruBridge now, we acquired $68 million of EBITDA for about $550 million, give or take, which is a pretty healthy accretive addition to us, with further upsides coming from the synergies that we are going to drive.

Got you. Thank you very much.

I'll join the queue.

Thank you for taking my question. Am I audible clearly?

Yes, absolutely.

Yeah. Sir, my first question is to Nithya.

I think there was a comment on the higher acquisition M2M price. Could you please clarify a bit on that?

Second,

I'll follow after this.

Happy to. My comment was regarding our investment in Abridge.

It's a strategic investment that we have held the last several years, and this quarter, we had to record it at a higher valuation. That's the reason the denominator, when I'm calculating return on equity, the equity value increased a lot more than my profit increased because there is no impact on the P&L.

It goes through OCI, Mayank, it goes directly into equity, the revaluation. That's why the base increases, but it doesn't show up in the profit.

I was talking about Abridge. It had nothing to do with the TruBridge acquisition.

Sure, sure,

sure. Thank you for clarifying that.

My second question is to Sachin. Considering that there is some revenue rationalization in TruBridge, which was not foreseen before the acquisition, do you still believe that FY27, it will be EPS accretive for us?

Absolutely, because the good news is even with the revenue reduction, the EBITDA is still the same. Absolutely, EPS accretive, perhaps even a bit more EPS accretive than we had imagined.

Sure. Those are my two questions.

I'll get back in the queue. Thank you so much.

Thank you.

Hello, am I audible?

Yes, Aditi.

Yeah. Hi, sir.

Sir, just wanted to clarify that in the future, with the acquisition of TruBridge, the standalone or legacy business is continuing having a 20 to

Aditi, I'm sorry to interrupt. You're breaking up now.

Sorry, Aditi, you're breaking up now, sorry.

Hello, now is it better?

Yes.

Hello?

Yeah. Hi, sir.

Just wanted to clarify that the legacy Ikedas business that your opening comments is that that would be 12% to 13% growth. With TruBridge, I wanted to understand the revenue synergies.

After the TruBridge consolidation and with the revenue synergies, what would be a consolidated pro forma?

Aditi, I'm still struggling to understand the question. If you're asking about medium-term growth outlook of revenue based on TruBridge and Ikedas combined, like I was saying earlier to Satyam's question, the aspiration on the legacy Ikedas side continues to be north of 12% constant currency.

On TruBridge, I still need a couple of quarters to articulate, understand what the right aspiration is there for that rural and community market. Can't really give you that outlook.

Having said that, is there a significant cross-sell opportunity in TruBridge's customer base for Ikedas' system of action? Absolutely.

That'll be one of the drivers of that growth that we will create. We're not in a position to give you a revenue growth outlook for the TruBridge book yet.

I

understood. Got it.

That was my question. Thank you.

I have a couple of questions. The first is on this acquisition.

As you mentioned that, TruBridge's EBITDA margin is close to 22%, 23%, which at this stage is much lower than Ikedas. Like what we had seen in Acuity also, the margin was much lower, but you could achieve a blended EBITDA margin north of 30% in a very short span of time.

If you could just give us some idea, I'm not asking for a guidance, about your expectations and what are the low-hanging fruits to take this margin up? My second question is you have given a medium-term guidance of ₹3,000 crore of EBITDA without equity dilution.

Does this mean that you are not really looking at any big acquisition between now and FY30? Is there any other white space in your line of business that you are looking at where an organic opportunity is possible?

Thank you.

Great. Thank you for the question, ma'am.

Yes, absolutely. As I was saying, one of our five strategic pillars of execution is to get the blended business to the early to mid-30 margins over the next couple of-odd years.

We have sufficient levers in the TruBridge book to transform their operating margins through the right use of technology that we already have, technology that we're building, and the appropriate use of offshore human-in-the-loop to get the margins to that place. Yes, that is definitely our aspiration, and we are working through that process of getting back the margins to the right place just as we did in Acuity.

Then as it relates to acquisitions, no, I don't think we're saying we won't do any acquisitions. All we're saying is that we think we can get to this ₹3,000 crores without the additional acquisitions.

Now, it's possible we do acquisitions and we get even bigger. Without contemplating an additional acquisition in the mix, we could get to ₹3,000 crores.

We could get an acquisition, do better than ₹3,000 crores, worse than ₹3,000 crores. Obviously, there's a bit of speculation, but as things stand today, we feel like we can get the business to ₹3,000 crores of EBITDA.

We're not saying that our doors are closed for acquisition. We're just saying that we will continue to be disciplined.

The reality is, we have a lot of integration to do right now, and we're heads down in that process. Okay.

Thank you, and all the best.

Sorry to your question of, is there more white space to acquire? There's a lot of white space.

Yes,

yes, yes. I think this space is huge.

There's going to be a lot of opportunity. I am circumspect about what happens to point solution vendors, even RCM-only vendors, traditional back-office RCM-only vendors going forward.

Will there be more opportunity? I think there's a lot of opportunity.

I think the shift from intellectual recognition of full platform to actual buying behavior of full platform is imminent. As all that plays out, there's definitely going to be opportunity, which means we will have to be even more disciplined because we are going to get hit by acquisition opportunities every other day, and we have to be absolutely disciplined about what we pursue.

Got it. Got it.

Hi, am I audible?

Yeah. My question is on this mid-June launch by Abridge of their Clinician Intelligence Platform.

From what I read about their initiatives, they're moving just beyond being an AI scribe and moving into pre-visit, during the visit, and also mediating the relationship between payers and providers. Everything that Ikedas talks about in terms of a capability of a platform, that is what Abridge is also talking about.

Just wanted to get your perspective on how do you see that and the competitive intensity going forward?

Look, I'll tell you that we respect Abridge as an organization, which is why we invested in them and have continued to hold a stake in them. Having said that, I'd say that there are 30 such vendors that are all now aspiring to evolve from point solutions to platform.

Not everybody is going to be able to execute through that. There will be some winners and some losers.

Also, there is a huge time and effort that it takes to expand from an AI scribe business to a pre-peri-post-visit platform. I think all power and my best of luck to Abridge.

We'll obviously carefully be evaluating them, but also many other vendors. The reality is that the competitive intensity in this space is increasing, should increase, and will increase.

When you have a TAM of $200-plus billion that's growing at 8% and outsourced TAM of $35 growing at 12%, the competitive intensity is naturally going to increase. The question is, have we built enough of a competitive moat that allows us to win in that increasing competitive intensity?

We obviously are drunk in that Kool-Aid, but we're also watchful of competition. Abridge is one of those many, many, many point solutions that have now realized that point solution existence is fraught with all sorts of risk, and so they're trying to go upstream and try to build a bigger platform.

How well they do, how well they don't do will be a matter of time.

Okay. Just a follow-up to that, in your renewal conversation with the hospital providers, is the pitch by all this new platform providers on just pricing or any further capabilities that they are trying to sell?

With the large health systems? Or your question is about the large health systems?

Renewal conversations with customers.

With the large health systems mostly.

Oh, pricing impact. No, look, I think with increasing competitive intensity, there is always going to be pricing pressure.

I will say that we're signing deals at a very healthy price. We just signed another deal recently that was a five-year lock-in at a very healthy price.

I will say right now, outside of tasks that are truly non-deterministic in nature that can be reaching a high level of autonomy, pricing is not the biggest issue. The issue is, there is competitive intensity, the issue is for customers to separate the signal from the noise and then be able to make the right decisions about how elaborate a platform approach they want to take.

Yes, is there pricing pressure? I think with increasing competitive intensity, there will be pricing pressure.

We continue to believe that there is continued margin leverage in the business in spite of that pricing pressure based on our value proposition in the market.

Okay. Thank you.

That's helpful.

Thank you, everyone. For any additional questions, please feel free to reach out to us at our investor relations ID.

Thank you, everyone, for attending the call.

Thank you.

Thank you.