Auna SA

Good morning, and welcome to Elna's fourth quarter 2024 earnings conference call. My name is Rob, and I will be your operator for today's call. At this time, all participants are in a listen-only mode, and please note that this call is being recorded. There will be an opportunity for you to ask questions at the end of today's presentation. Now, I would like to turn the call over to Anna Maria Mora, Head of Investor Relations. Ma'am, please go ahead.

Thank you, operator. Hello, everyone, and welcome to our UNAS conference call to review our fourth quarter and full year 2024 results. Please note that there is a webcast presentation to accompany the discussion during this call. If you need a copy of the presentation, please go to our investor relations website or contact our UNAS investor relations team. Please note that when we discuss variances, we will be doing so on a year-over-year basis and in FX neutral, or local currency terms. with regards to Mexico and Colombia, unless we know otherwise. Let's move to slide two. In addition to reporting financial results in accordance with international financial reporting standards, we will discuss certain non-IFRS financial measures and operating metrics, including foreign exchange neutral calculations. Investors should carefully read the definitions of these measures and metrics included in our earnings press release of yesterday, to ensure that they understand them. Non-IFRS financial measures and operating metrics should not be considered in isolation as substitutes for or superior to IFRS financial measures and are provided as supplemental information only. Before we begin our remarks, please also note that certain statements made during the course of today's discussion may constitute forward-looking statements which are based on management's current expectations and beliefs and we are subject to a number of risks and uncertainties that could cause actual results to materially differ, including factors that may be beyond the company's control. These include, but are not limited to, our expected adjusted EBITDA growth, the expected impact on revenues and profitability of certain initiatives we are pursuing in Mexico, and long-term financial position and flexibility as a result of certain initiatives we are pursuing related to payers in Colombia and our target leverage level. For a description of these risks, please refer to our Form F-1 and or Form 20-F filing with the U.S. Securities and Exchange Commission and our earnings press release. Slide three, please. On today's call, we have Suso Zamora, our Executive Chairman and President, Giselle Remy, our Chief Financial Officer and Executive Vice President, and Lorenzo Massal, our Executive Vice President of Strategy and Equity Capital Markets. They will discuss AUNA's consolidated and segment financial and operating results for the fourth quarter and full year, and will also provide updates on our various strategic growth initiatives. After that, we will open the call for your questions. Tulsa, please go ahead.

Thank you, Annie, and thank you, everyone, for joining our results call. We are pleased to have achieved all of the 2024 milestones at AUNA, including our patient experience, medical resolution, and our 20% FX-neutral EBITDA growth target for 2024. We expected the second half of the year to outperform the first part, given the seasonality effect on surgical volumes principally. We remain excited about AUNA's future as we maintain our growth momentum going into 2025. AUNA's vertically and horizontally integrated regional platform delivered 28% of FX-neutral adjusted EBITDA growth in the fourth quarter. with the margin expanding 3.1 percentage points versus last year's quarter and 1.4 percentage points for the year. This is as expected for the last quarter of the year. In Peru, our fully integrated healthcare and plans business remains strong as we reap the returns on earlier investments we made to build, integrate, and scale our business. Peru continues to demonstrate the consistent earning powers of AUNA's business model when it is operating at scale. With that in mind, we continue the deployment of our model in Mexico, where the business opportunity and potential is even greater, given the size of the country's private healthcare market and how under-penetrated it is. As we further implement the AUNA way across our hospital network in Monterrey, we've been driving operating efficiency and profitability driving growth from new service offerings and our focus on higher complexity offerings. We are also learning what works well in Mexico and not so well, as we always continue to refine our business model across our markets. In Mexico, we were pleased to announce an agreement with the physicians of the most prestigious oncology practice in Monterrey. On March 7th, we have signed a five-year exclusivity period with eight of Monterrey's leading oncologists and radiation oncologists who will bring their practice to own. This will position us as the oncology player of reference in Monterrey with a sizable practice and stellar results. Near-term challenges remain in Colombia with additional provisions this quarter. Accordingly, we are limiting our risk exposure in the country by calibrating growth and focusing on preserving cash flow. As we announced yesterday in our earnings report, We are lowering our exposure to Nueva EPS and replacing those volumes with other payers under risk-sharing models to prioritize cash generation. That said, we are still bullish on Colombia, given its medium and long-term growth potential. It also remains integral to our maintaining our own scale and achieving medical excellence across our platform. We believe 2025 will continue to be a challenging year in Colombia, but expect 2026 to have an important increase in volume and complexity mix. Turning briefly to our balance sheet, our debt leverage fell again to 3.6 times at year end. That's almost a full turn below our leverage last year. Q4 was also the fourth consecutive quarter of positive adjusted net income. And for the year, we reported net income of 124 million soles That is a 238 million soles gain from the net loss of 214 million soles in 2023. So now on slide five, revenues grew 11% on an FX neutral basis across our regional platform to about 1.1 billion soles led by Peru and Mexico. That brought full year revenue to almost 4.4 billion soles, which was 12% higher than 2023. also on an FX neutral basis. Among our healthcare facilities, capacity utilization increased 2.6%, this points to 66%, but our focus remains on growing high complexity services that carry higher margins rather than merely increasing capacity utilization. That focus is what drove our growth in Mexico once again this quarter. At OncoSalud, our health plans business in Peru, plan memberships continued growing. For the year, plan memberships increased 7.4%, while oncology memberships increased 1.6%. Lastly, on this slide, our oncology MLR decreased 0.7 percentage points to 53%, a very healthy level, very much in line with our expectations. Let's move to slide seven to take a closer look at the Mexican component of our regional platform. The implementation of the AUNA way continues to bloom in Mexico, where the addressable market for us is a high multiple peruse. In Mexico, we maintained our growth momentum with revenues growing 9% versus last year's quarter, while adjusted EBITDA increased 30%, also in local currency terms. Driving both was higher volume and improved ticket mix in hospitalizations and ICU therapies. Also driving revenue was strategic pricing across payer tiers in our network. The sequential decline that you see in the revenue and EBITDA charts mainly reflect the seasonality we typically see at the end of each calendar year. The continued investment in the implementation of the NOA in our Mexico operations has paid off with adjusted EBITDA, increasing 30% in local currency and a margin expansion of 5.7 percentage points. Our model continues driving physician engagement and productivity higher while raising operating standards, enhancing medical protocols and improving skills at our healthcare facilities. OncoMexico entered a new phase in 2025 After a successful pilot phase, we have started developing the B2B and the B2B2C segments to gain scale in 2025. In addition, to be able to give access to policyholders outside of Monterrey, we're developing arrangements with a network of service providers in the major cities in Mexico that will serve our policyholders outside of Monterrey while we develop our physical footprint in those cities. In parallel, as I mentioned earlier, We signed a five-year exclusivity agreement with Monterrey's top oncologists and radiation oncologists who serve today about 30% of the private market in Monterrey. Eight leading physicians will join us and together we will continue positioning AUNA Mexico as the best alternative in oncology and the high complexity player of choice. Let's turn to slide eight on Peru. The fourth quarter revenue of our most mature fully integrated platform in Peru increased 10% as it continued capturing more of the payer population, optimizing pricing, and growing plan members. These dynamics, along with the network synergies and efficiencies that we have been achieving, drove a 33% increase in adjusted EBITDA, which increased 51% for the year, also compared To 2023, Peru's margin expanded 3.8 percentage points in the quarter and 5.4 percentage points for all of 2024. These margin improvements were despite increases in cost of goods sold and SG&A, the latter increasing in support of growth. Now let's move to Colombia on slide nine. Our fourth quarter revenue in Colombia increased 14% in local currency. mostly because we have been gradually implementing risk-sharing models in Antioquia, an area that includes Medellin. Examples of these are cardiology and chemotherapy for breast cancer. Also increasing revenue was the addition of 14 ICU beds in Barranquilla. Together, these additional high-compensity services improved Colombia's revenue mix with larger tickets. Adjusted EBITDA increased 23% in local currency, primarily due to price adjustments from previous quarters agreed upon in the fourth quarter and procurement rebates, as well as adjustments to a technical loan and a risk-sharing contract. These items, many of which typically fall in the fourth quarter of the year, also accounted for the large increase in EBITDA. Conversely, EBITDA was negatively impacted by additional provisions for impairment losses related to outstanding receivables with payers, especially Nueva EPS. The situation with the intervened payers in Colombia has deteriorated since our last earnings call, but we remain cautiously optimistic that a resolution is forthcoming. The current state of healthcare in Colombia cannot be ignored by the government nor any political party in Colombia as frustration within the population is high. And it relates to a universal healthcare system that offers high quality of services, mostly from private companies like Auna. The government interventions have impacted all healthcare providers in the country, not just Auna, although we believe that Auna, given its high complexity focus, is in a stronger position than most. We expect a sector solution in 2025. Until then, we remain cautious and continue to monitor our exposure closely with a disciplined focus on maintaining a positive and predictable cash cycle. Our cautious stance in Colombia has not curtailed our attempts to continue to grow in volume and arrangements that require upfront payment for services. And these initiatives may deliver some upside during the latter part of the year. For now, I repeat, We remain cautious, and this stance is reflected in lower total and operating capacity in Colombia during the quarter. Emphasizing cash flow overgrowth in Q1, we began phasing out services that we deliver for Nueva EPS in Antioquia. We are also diversifying and reprioritizing our basic payers by reallocating service volumes to other payers. Overall, though, Our underlying business remains strong in Colombia. As our most recent quality results there make clear. With that, I'll turn the call over to Gise who will provide a more detailed review of our quarterly and full year results.

Thanks, Fuso. I will now begin my review with the breakdown of revenue on slide 11. In local currency terms, fourth quarter revenue increased 9% in Mexico, 10% in Peru, and 14% in Colombia. An improved services mix along with strategic pricing across payer tiers drove Mexico's sales in the fourth quarter. In Peru, healthcare services, we continue to optimize the flow of hospital services and better allocate capacity towards high-complexity services, while OncoSalud expanded group memberships. Finally, in Colombia, revenues were mostly driven by the implementation of risk-sharing models in high-complexity services. Let's move to EBITDA on slide 12. On this slide, we break down the 28% FX neutral growth in adjusted EBITDA between fourth quarter 2023 and fourth quarter 2024. This, as well as the 23% EBITDA increase reported in the third quarter, are the back-ended growth that we had previously communicated, which led to us meeting our 2024 annual guidance, as Susil previously mentioned. Above the bridge are the corresponding margins for each of the segments. As you can see, each of our segments delivered strong levels of profitable growth and also maintained excellent margins through operational synergies and improving efficiencies. On a consolidated basis, adjusted EBITDA margins expanded three percentage points to nearly 24%. In Peru, our most mature segment, EBITDA increased 33% year over year. while its margin expanded 3.8 percentage points. In Mexico, we continue diligently implementing the ONAway, achieving an improved mix of services across its hospital network and tickets that reflect our focus on high complexity. As a result, EBITDA increased 30% while margin expanded 5.7 percentage points to 34.7%. In Colombia, EBITDA growth was impacted by certain price increases and procurement rebates that reflect full-year performance that were agreed in the fourth quarter. The quarter's consolidated EBITDA growth was partially offset by the provisions and risk mitigation measures that we implemented in Colombia, and also by the investments that we have been making to build out our local and regional capabilities in Mexico. Let's turn to slide 13, which presents an EBITDA bridge for the full year. For the year, our regional operations delivered 993 million soles of adjusted EBITDA, 20% higher than 2023, and in line with the guidance we had given. Peru and Mexico led the way with stellar EBITDA growth in the case of Peru, our most mature business. showing once again that our vertically integrated model at scale delivers incredible value. Peru's adjusted EBITDA increased 51%, while its margin expanded 5.4 percentage points. Mexico's EBITDA increased 10% in FX-neutral terms, and despite Colombia's setbacks with payer interventions and related provisions affecting the P&L, the segment managed to grow EBITDA, which increased 6% for the year, also in FXN. Let's move on to adjusted net income on slide 14. Adjusted net income was a positive 36 million soles in the fourth quarter versus negative 6 million in last year's fourth quarter. It was our fourth consecutive quarter of positive adjusted net income. Behind the year-over-year improvement, operating profit increased 46%, or 60 million soles, while our operating margin expanded just over 5 percentage points to nearly 18%. Keep in mind, this includes a 9 million soles in impairment provisions in Colombia. The 73 million FX loss variance that you see in the bridge is the product of a non-cash FX loss of 24 million soles in the quarter compared to an FX gain in the comparable period last year, mainly related to the depreciation of the Peruvian soles relative to the U.S. dollar during the quarter outside the levels of the call spread hedges that we have in place. Moving across to net interest expenses, these fell 63% versus last year's quarter, mainly due to the fact that the fourth quarter 2023 included 215 million soles of refinancing costs related to the 2023 refinancing exercise. Let's please move on to the next slide. Adjusted net income for the year was 146 million soles, up from 14 million in 2023. Our operating profit increased 40%, or 223 million soles. This increase included the 44 million soles reversal of the holdback obligation from our 2022 acquisition of OCA in Mexico. This was partially offset by the 26 million soles of impairment losses in Colombia that we incurred during the year. The 118 million soles FX variance versus last year includes a negative non-cash impact of 42 million soles in 2024, which compares to a positive FX gain of 76 million soles in 2023. when the Peruvian soil appreciated versus the dollar. For the year, net interest expenses decreased 26% compared to 2023 due to last year's refinancing that I explained earlier. Income taxes in 2024 decreased 30 million or 34% as our effective tax rate has normalized in 2024 given the recognition of deferred tax benefits, which we should be able to capture in cash flows in the following years. The 203 million solid variance in non-cash extraordinary items and adjustments for the year include, again, mainly the refinancing effects from fourth quarter 2023. Let's now please turn to cash on slide 16. Cash position improved for a second consecutive quarter to 236 million soles at the end of the year and represented an 18% sequential increase from the third quarter of 2024. Net cash from operating activities increased 15% year-on-year or 86 million soles. to 668 million soles in 2024. Cash generated from operating activities during this period increased 161 million soles, or 24%, partially offset by an 80 million soles increase in tax payments in Mexico and Peru due to higher profits. Regarding the 160 million soles of capex shown in the bridge, this was mainly maintenance capex, which represented 3.7% of 2024 revenues. It was mostly related to infrastructure, medical equipment purchases, and the implementation of SAP throughout our regional platform. The 77 million soles of earn out and hold back obligations refer to the extraordinary earn-out payment of the IMATs Olga Medica obligation and the hold-back obligation for the OCA acquisition. In 2024, we generated 432 million soles of free cash flow. In the case of organic free cash flow, which excludes the earn-out and hold-back amortizations, we generated 509 million soles. which was 18% higher than 2023. It is important to note that organic free cash flow rose above interest payments in the second half of the year. Interest paid was 503 million soles, down 19% from 2023, and also includes interest and hedge premiums. Please move on to slide 17. We entered 2025 with a substantially improved credit profile. As the bar chart at the bottom of the slide shows, we continue steadily deleveraging our balance sheet with the leverage ratio falling for the ninth consecutive quarter to 3.6 times, consistent with our commitment to deleveraging. Additionally, and as duly communicated, last December we extended L1's maturity profile with the full redemption of the outstanding amount of the notes due 2025. This was funded through a private reopening of the existing notes due 2029. The new aggregate amount of the outstanding 2029 notes is now 310 million dollars. As shown in the ring chart on the right of this slide, more than half of Aona's debt is in direct global currency funding, while the portion in U.S. dollars is mainly hedged to the Peruvian soil. To conclude, our credit profile gives us the financial strength and flexibility needed to continue supporting our growth initiatives and achieve our strategic goals. through the EBITDA growth trajectory that we have established. And through debt amortization, we continue to track to achieve our medium term target of three times leverage ratio in the medium term. I'll now hand the call back to Susu, who has a few remarks before we open the call for questions.

Thank you, Jise. We are carrying strong momentum into 2025 and remain committed to transforming and modernizing healthcare in Spanish-speaking Latin America with our unique and proven operating model, as well as value-based care. In addition to increasing access to advanced healthcare and improving medical resolutions, we are driving sustainable long-term growth. The Peruvian and Mexican segments of our regional healthcare platform are expected to be the primary drivers of Iona's growth going forward, with a focus on continually improving synergies and operating efficiencies, as well as increasing access. Peru will continue our performing, given the maturity and scale of this business. We expect Mexico's performance to continue strengthening this year through a greater mix of high complexity services, targeted physician recruitment, and increasing physician productivity. Longer term, it will gradually become a far larger contributor as we scale in the country's much larger healthcare market and vertically integrate our operations. Colombia remains a strategically important market for us in terms of scale and best practices in medicine. In the near term, we will continue taking a conservative approach that helps ensure reliable cash flows and operational stability. That includes diversifying and re-prioritizing AUNA's mix of payers in the country. This year, we will also continue developing OncoMexico into a disruptive insurance product, leveraging our many years of experience with OncoSalud and aiming to replicate the success that we've had with this product in Peru. As a reminder, the initial focus of its launch is on the B2B and B2B2C segments of Mexico's insurance market. Additionally, agreements such as the one with the oncologist physicians will further position us to expand our footprint across Mexico. Finally, Aona remains strongly positioned with a clear path to higher levels of growth and profitability. In addition to our proven business model, We have the right growth strategy to address the unique context of each market and capitalize on the many growth opportunities within them. And as always, patient centricity and value-based care will be at the heart of what we do. That concludes our prepared remarks. Operator, let's open the call for questions.

At this time, we will open the floor for your questions. If you would like to ask a question over the phone, please press star one in your telephone keypad As a reminder, you can also submit your questions online by using the Q&A function of the webcast platform. Your first question comes from the line of Mauricio Cepeda from Morgan Stanley. Your line is live. Please proceed with your questions.

Hello. Thanks for the opportunity here. I have two questions. The first one about seasonality. If you could please explain the seasonality in health services in Mexico and Peru. So typically, what would be the distribution of volumes across quarters in the year for Mexico and Peru? So we can understand a little bit this kind of quarterly variation effects that you live on. And the second question is about the demand in Monterrey. If you see that there are enough policyholders in Monterrey, if your strategy from now will be to conquer share from this pool, I understand that you're increasing complexity, but if you have a strategy to conquer share from this pool, or if you have any kind of strategy to partner with insurers there, and try to increase the number of policies in the city. And by policies, I mean not your own policies. I'm referring to policies that can be offered by general insurers that somehow can bring you volumes. Thank you.

Great. Thank you, Mauricio. Great set of questions. And the first one, I can only comment more conceptually and maybe directionally on seasonality. What we see is, of course, at the end of the year, people delay their procedures, as everybody knows, at the beginning of the year, especially in the southern hemisphere, also because of the summer season. So we see that In addition to that, we see, particularly in Mexico, a more pronounced growth of volume in the second semester, notwithstanding that December is slow and January as well is slow. I must forewarn investors, January is also slow. We see that because of distant patients and doctors as well deferring procedures now. I'll ask Gisele when I finish the second question. Maybe she has the numbers or she wants to complement the view on seasonality. We don't have much more than that. Maybe in the future we can share something else in an earnings release, but we would need to be a little more diligent and just respond to something out of the cuff. In demand in Monterrey, I would say a couple of things. We're working with insurers. to expand the size of the market. We're working with insurers to take on some of the high complexity risk and the attached volume of that. We're working with employers also to expand the market that has some kind of coverage, sometimes covered by employers through insurance companies or not. We think we will be very deliberate in conquering high-complexity share, and I think we're very excited about these are not transactional relationships. We're working with important payers to partner in important relationships. with respect to high complexity procedures, you know, curtailing the cost for them and for us increasing the volume and the predictability of that business. So we are excited in that. We are not, you know, I want to repeat this, you know, we're not just another provider of healthcare services, you know, and I think I'm very convinced about that yesterday I was visiting and insurer, one of the leading insurers in Mexico. And clearly, no one sees us as another provider of healthcare services in Mexico. Our model is unique and transformative. It's not easy to digest, I must say that. It's not easy. It does take a bit more time to ground and expand in a country like Mexico, but I think we're getting great traction. The relationship with payers and insurance companies in general is very promising, very promising. Jesus, do you want to compliment on the seasonality? Do you have any view on that?

Yeah, sure, Suso. I would just kind of reiterate the point that we do tend to see softer volumes across the geographies in Q4 and Q1, specifically for given the holidays and the seasonal impacts of, you know, the end of the year and the beginning of the year, where as Suso, mentioned elective types of procedures are deferred.

Okay. And not only . And not only elective, you see sometimes, you know, it's just procedures that can be deferred.

That can be deferred or deferred.

You know, there's some procedures in orthopedics. You know, people don't want to have, you know, their hip replaced in December and January. They want to have it in a month that's outside of those months. So there are some things that are not elective that can be delayed, and they are delayed.

That's very clear. Thank you. Thank you, Susu. Thank you, Giselle.

Our next question comes from a line of Samuel Alves from PT Pactual. Your line is live. Please proceed with your questions.

Good morning, Susu, Gisele, Lorenzo. Good morning, everyone. Well, two quick questions here. The first one is about the growth by geography expected for 2025. Last year, the growth in local currencies was largely driven by Peru, right? So for 2025, do you think that Mexico will be the top growth market, with Colombia maybe remaining flattered and somewhere in between. Does it make sense, this breakdown? And the second question is about liability management. Maybe you guys could recall what the main liability management initiatives are recently done by the company and what additional appearance the company might do this year. if you guys in any potential asset to speed up the process. That's it. Thank you very much.

Thank you, Samuel. The second one, the second question I didn't hear perfectly. Was it about management or delivery?

Liability management.

Hi, what?

Liability management.

Oh, liability management. Yeah. Okay, great. You can do that one. And so in general, Samuel, so I have to explain this. I've tried to explain in the past. We run the company, you know, with a 20% EBITDA, you know, EBITDA growth. So all our managers know that is the goal. That is the goal. This is not something for guidance for the market. This is how we run the company. But it is a product, and we run it for the consolidated basis. And we also have the benefit, we believe it's a benefit, of diversification of three countries and the insurance and the healthcare services business. And we run all those businesses to make sure that we're always hitting the 20%. It's very important annually. This is our target. This is an internal target that, of course, coincides with what we declare to the market. This 2025, more generally somewhat, because of externalities, principally payers in Colombia and our decision to limit our growth there, we see that as something that we're acting on, we're aggressive on. but we don't have full control of. So we're saying, you know, let's make sure that internally management has the right incentives, we have the right action plans to deliver the 20%. But we also know that, you know, we might be hit by, you know, some news, you know, that is not under control. And we like to be conservative about what we say. I would say that Mexico directionally given what we're doing and harvesting, especially again in high complexity, again with the doctors we just hired, we're going to do something very similar in orthopedics and cardiology. It takes time. I want to, again, it's not an excuse. I mean, this is what we do. The opción oncología transaction that we actually revealed last week, it took us like two years. It's a great transaction. Great for them, for the doctors, great for us, and great for patients, and great for the system in Monterrey. It's a new standard of what we're doing there. But it took us two years. And we're working in the other practices in the same way, and we'll deliver that in the future as well. But it takes a little bit, it takes some time. I think Mexico will be harvesting more substantial growth this year. I think Colombia, I'm uncertain if it'll be no growth or maybe depending on what might occur in the system. The system right now has a huge demand of services. And we're saying, we're happy to take those services if you pay upfront. And we might get traction on that. So there might be a surprise, you know, and we might see some growth out of Columbia. Peru is a stable growing business with a stable growing business. And we manage it that way. And, um, we think it, um, what approved in 2024, I think was, you know, very high and, and, um, and, and good. And, and as we wanted it to. But it's a product of what we do to always deliver this 20% internally that we also represent as guidance. Again, in this year, we're a little bit sensitive to calling it guidance because of the Columbia uncertainty of these externalities. Do you want to complement and also take the other question on liability management?

Yeah, sure. With reference to the second question, Samuel, from a liability management perspective, what has been done thus far, as commented in the earnings release in the fourth quarter, we refinanced the remaining stub of the 2025 bonds through a private reopening of the 2029 bonds. This was a small refinancing of, you know, the approximately $57 million that we disclosed. And as far as a more structural liability management exercise, we have obviously been analyzing alternatives in the market. Our bond is trading quite well, well above par, which also gives us a view that our current cost of funding is well below what we obtained when we did the 2023 financing exercise. We have also seen our credit profile improve materially as is also demonstrated by what we saw in the leverage and liquidity levels. So we are obviously actively evaluating refinancing alternatives, which as we know are always booked for in local currency. So this is something that we continue to analyze and hopefully we'll have news there in the coming quarters.

Thank you, Susu. Good morning, everyone. Your next question comes from the line of Leandro Bastas from Citi. Your line is live. Please proceed with your questions.

Hello, guys. Hello, Susu, Gisele. Thanks for taking the question. We actually have two. The first one on OncoSalud, if you could discuss a little bit commercial strategy and the outlook for 2025. I mean, we saw last year very strong commercial growth but not as much in terms of ticket progression. I don't know if it has kind of a mixed component here, or if you could kind of discuss a little bit the strategy for price increases on the health plans. So that would be the first one. And second, just kind of an update on Colombia. You mentioned during the call kind of the increase of the risk sharing model. So if you could kind of elaborate on how margins look under this kind of, with this new model. and also kind of what are our conditions today for working capital in Colombia and what we're currently running in terms of kind of a base of working capital and so on. Thank you.

Disa, you want to start with that one on working capital?

The last part of the question? Uh-huh. Of course. So, thank you so much for the question. So, from a working capital perspective, and as we kind of mentioned in the earnings release, our view specifically in Colombia is obviously to prioritize cash over growth in the short term. And as we've seen from our cash conversion cycle, we've maintained it basically flat in 2024 versus what we had in 2023. Any movements in accounts receivable days have been funded through accounts payable and inventory dates. We continue to work obviously dynamically in the case of Colombia and obviously regionally as far as working capital management. And specifically, and I don't want to also give the answer to the second part of the question, I'll let Suso take the risk-sharing models, but I would comment that they have a better cash conversion cycle given that they are paid up front. And so, obviously, the fact that we're migrating part of our mix to a larger portion of risk-sharing models in Colombia is also beneficial for the cash conversion cycle.

Great. Thank you, Gisele. So two parts of the question still to be answered. On the risk sharing models. So the risk sharing models for us, we manage within the access group, which is the insurance and other plans group. And we see it's a B2B product that we offer insurance companies. We're starting to offer them also in Mexico. And it's some relationships by which we take risk in volume or in frequency of certain types of events for a more complete treatment that includes, you know, it might be, it's not only, for example, with the surgery, it's everything from the diagnosis all the way to including it could be services at home. No, we do it for cardiology, for oncology. We do it for many practices. And we take a risk, especially because we cap normally a price. We say, if you give us this amount of volume of these procedures, all of them included, then we'll take care of your patient, integrate it into our facilities at this price. So we take a risk on the price or on the volume. They're very much aligned with what we do in oncology and other practices. They're very much aligned in what we want to do because they scale. They're standardized procedures that scale very well with high predictability in terms of the revenues we get from them, the cost that we have of them, and of course, the patient journey and the medical outcome. These normally have slightly decreased margins to fee-for-services. But as we scale, I think that is diminished a bit. And they're profitable for us. They're attractive for us because they're scale models, but maybe slightly lower margins than fee-for-service. Now, on OncoSalud... So we have a, as you might recall, we have a strategy of always repricing our policies depending on medical inflation and any new therapies that are included. And we do it constantly and throughout the year. I think I'm uncertain as to the exact number of the 2025 price increases. But I think today the MLR is stable. Remember, it's very much related to MLR. The MLR is stable at 52%, 53%. And I think right now I see the company, including what we have included in the past, which is a price increase related to medical inflation and nothing more specific to that. More importantly, in OncoSalud, we are rolling out new complementary insurance plans. in other practices that we'll talk about in the future, you know, that will complement the oncology healthcare plan.

Okay, great. Thank you so much.

Your next question comes from a line of Alejandro Zamacona from HSBC. Your line is live. Please proceed with your questions.

Thank you. Good morning, Susan. A couple of questions from our side. First one is on the oncology agreement with Opcion Oncologia. So how much volume can you bring, given that they hold 30% of the market share? And what percentage are you assuming is transferred to Auma? And in addition, related to this agreement, what are

I think we lost him.

Hello? We have lost connection with our last analyst. We'll proceed to the next analyst. Your line is from Joseph Giordano from J.P. Morgan. Your line is live. Please proceed with your questions.

Oh, hi. Good morning, everyone. Hi. Thanks for taking my question. Actually, I'll take a different route and discuss a little bit the expansion. of the network, right? So we do have some plans to expand the network of services in Peru. So if you could update us on that front, that would be great. And in second, concerning OncoMexico, now we have Opción Oncología, so very affluent oncologists in the northern part of Mexico, the research center being set up in Mexico. So my question to you goes, how are you seeing and accrediting new service providers to roll out to UNCO Mexico, particularly when it comes to Mexico City and Guadalajara, which are two major centers that do not have a direct presence. Thank you.

Great. Thank you, Joe. Nice to hear you. So, Disa, can you remind me of the first part of the question? I remember UNCO Mexico, but I jotted something down. And it was a little bit of expansion. Oh, yeah.

Yeah.

Yeah. Yeah. So I don't like I'm commenting very much about, you know, deployments of capital in the future. They're having really solid and and well grounded. I do see that we're reaching capacity. We know we run our hospitals that once they reach 80, 85 percent, we start I'm talking about an expansion now. And once OncoSalud penetrates into the hospitals that are general healthcare hospitals and they become integrated, that's another trigger. So we see that happening at the end of the year. So most probably you'll see as I'm starting to assess an expansion, most probably Clinica Delgado, which has all the engineering and most of the stuff already done, next year. next year uh most probably to inaugurate maybe 2027. that's um a little bit um a little bit it's a dir i take it as a directional comment not not a not a calendar not a calendar event i know jesus looking at me like her eyes i can see them but anyway yeah so i see ourselves um yes um rolling out a little more capacity um most probably in in at the end of 2026 and 2027. on Uncle Mexico. So, yeah, it's critical for us, given the conversations we're having with many of the payers, as you can imagine, they're saying, yeah, great in Monterrey. What are you doing in the other cities? And and we have been closing agreements in Guadalajara, in Mexico City to deliver services within our plans and also for third parties within our system. So we're agreeing with doctors on the protocols, on the services, on the own way of doing things in agreements that will normally, if we're successful, end up in a much more intimate relationship, maybe in a structural integration of those facilities. So we can do that well for surgery and for chemotherapy stations and as well for radiation services, and we're way ahead of that, making sure that OncoMexico has a national footprint. We're doing the same thing also in Tijuana, also in conversations to deliver the services that we need in that city as well. So yes, we are well ahead of that, and I think we'll be able to show some of that later in the year. Thank you, Suso.

Your next question comes from the line of Alejandro Zamacona from HSBC. Your line is open.

Apologies. That was a great time to get disconnected. My question was regarding the oncology agreement with Opción Oncología. So how much of the 30% of the market share that they currently hold, you are assuming that it's going to be transferred to AUNA? And also, what are the margin expectations for the first one or two years as volume is ramped up?

So I don't want to forecast or reveal margin of these businesses. But I would say a couple of things, Alejandro. So our agreement with them is about the 30% and how it gets, um, channeled into a Luna is a question of time. No. Um, I think it can, um, I think it can, um, without the plans that we have in place, um, it's not only about the 30%, um, capacity, um, a market share that they have in, um, in ecology in Monterrey. Actually, for us, the spillover effect of a doctor leaving the imaging and the pharma and the labs and the surgery. Remember, these are chemotherapists, which is a critical gatekeeper in oncology is a chemotherapist. He or she is normally the one that determines where the surgery is going to happen, where the labs are going to happen, where the imaging is going to happen. And even where the radiation is going to happen. This is like the primary care in many other diseases. The chemotherapist is the one deciding that. So for us, it's not only about the volume that they currently have. Today, they actually channel the surgeries and the other services I just listed out to others. So this is going to be very promising. and in line from what we expected to occur. So I would not be surprised that in due time, in a couple years, we would have 30% of the oncology market in Monterrey.

My second question regarding Colombia. In your press release, you mentioned that you have been phasing out selected services to Nueva EPS and Tokia. Can you provide more detail on the phasing of these services? I mean, and specifically, what would be the next or the new mix after the completion of this phasing strategy?

So, I think that it will be difficult to see on a month-to-month or quarter-to-quarter what will be the stable state of the situation in Colombia. I think that the stresses in Colombia's healthcare systems will produce a nueva EPS at the right time. There will be a payer that has the capacity and not the political agenda. So I think that at the end of the year, it wouldn't surprise me that our business with Nueva Pese is reasonable. We've been disciplined with them, and they have been delivering on the commitments with us. Now, from here to the end of the year, we're playing rough. and limiting services until they, I don't want to use the wrong words, but maybe until they get their full act together. Not today because of the intervention and the politics down there. The act, they don't have it together, but they need to get it together. I see in the last few weeks a dialogue that is the best we've had in the last six to 12 months with them. And of course, it's not only because we're being tough with them, it's because patients are being really, really tough with them. It's seven o'clock. Yes, so I see an opportunity there, but it's difficult to see what's going to happen quarter by quarter. But I think at the end of the year, it wouldn't surprise me. They are a very relevant player, very relevant in our geographies. I think that they'll come back in a very organized and ordered way, and we'll have a strong relationship in the future with them. Jesus, you want to add something to that?

I think very much in line with what you commented, Suso, very much focused on this year, obviously, on cash flow, which leads us to focus the revenue mix on the risk-sharing models. and also diversify payer risk.

And there are no more questions from the phone line, so I will now turn the call over to Ana Maria Mora from ONA, who will proceed with questions from the webcast platform.

Thank you, operator. The first question comes from . Can you please comment on the different dynamics improved, which led to occupancy rates to fall year over year? Can you please comment on adjusted EBITDA growth effect time expectations for 2025? Does the internal goal to achieve 20% adjusted EBITDA growth effect time per year also apply to 2025?

Well, I think it's important, again, to note, Gisa, you can correct me, We're having difficulty setting a guidance of 20% this year. That's very important that we, I want to highlight that. We work on the 20% internally, you know, and that's what we represent in the past. The uncertainty in Colombia has made us not want to give a guidance of the 20%. Internally, we do work on that. I think we might be able to come back on that point in the next quarter. until we make sure of the certainty of um the columbia situation and and um what's going to occur there um we're we're uncomfortable given that 20 giving that guidance now i think our goal is a 20 i don't know if i want to differentiate that in in that way no jesus you want to do you want to compliment so that you know our investors are are clear in what we're expecting in 2025 and what we're saying we're going to do in 2025.

Yeah, maybe Suso to compliment that point, I think it's important to note that in 2024, we met our annual guidance with 20% FXN growth, despite the headwinds that we may have faced, and particularly in the case of Colombia. Therefore, kind of reiterating Suso's point, as he's already commented, given the continuous uncertainty with payers in Colombia, it is difficult to provide the same certainty of guidance for 2025. However, our internal goal continues to be to grow at 20%. That is our North Star, even though at this point in time, it is a little bit more difficult for us to phrase it as guidance. To tackle the second part of Gayo's question, thank you for the question, Gayo, on occupancy levels in the case of Peru. Specifically in Peru, we had a slight drop in occupancy rates. in the fourth quarter as we continue to optimize pricing and increase high complexity.

Thank you, . The next question comes from . Hi, everyone. I have two questions. Could you provide more details on how these risk sharing models have contributed to the revenue and EBITDA growth in Colombia? And what expectations do you have for the impact of this initiative in the coming quarters? And the second question is, could you provide more details on other income in Colombia and the increasing corporate expenses at OncoSalud and healthcare services through during 4Q24?

Great. So on the first question, for us, for us and the risk sharing model, is critical to our strategy and our nature. It produces what we always are looking for, is predictability on the patient journey, the medical outcome, and of course, the financial results. So for us, it's critical. Healthcare is very complex and very anecdotal, and one can be lost in the variability. by conquering that variability and producing certainty and predictability, the opportunity is much richer and much bigger. So we see ourselves scaling that. I don't remember the exact numbers. In Colombia in particular, we're going something from low teens, I think mid-teens, to maybe... high 20s in terms of the revenue risk represented by risk sharing models. What's very important I want to highlight, this is a competitive advantage. Few players can deliver that. It requires a certain unique way of operating. It's a little of an insurance mentality. and a healthcare service provider merged together. Because there is risk and there is the healthcare service component, of course. So I think this is something that makes Auna very attractive and produces what we mostly seek, which is volume. Volume. We are a growth player in volume, and this is a key component that produces the growth in volume. Lisa, do you want to add on that?

No. I think Sosa expressed it well, and maybe to tackle the second part of the question, vis-a-vis other income and corporate expenses. Specifically in the case of other income, which as we know is a line that reflects non-operating impacts as far as income and expenses. In the case of Colombia in the fourth quarter, the most material impact there would have probably been the reversal of a tax provision, which would no longer come due. And in the case of corporate expenses, nothing too material to report, just basically the same progression that we've discussed in previous quarters as far as the regional and integrated capabilities that we're building, which basically are also bearing material fruit as far as synergies and efficiencies across the board, both in the medical practice as well as in costs and SG&A from being able to operate in a regional manner and have all of our procurement and negotiations and strategies reflect that scale. I don't know if there's more questions from the chat.

Yes. The last question that we have in the chat comes from Omar Avellaneda. Sorry. What is your expectation for debt reduction in 2025?

Great. So, thank you. I can tackle that question. And I think as Susal already noted, we're not giving any specific leverage or balance sheet guidance for the year. However, we continue to be very focused on deleveraging, and as we've seen in 2024, our proven capacity to grow EBITDA and improve liquidity has taken us to 3.6 times net debt to EBITDA at the end of 2024, and we continue to be focused on our medium-term target to take that leverage level to three times net debt to EBITDA.

Thank you, Gitte. At this time, I'm not showing any more questions. I would like to turn the call back over to Suso, who has a few closing remarks.

Thank you very much, Annie. I think, Gitte, I don't know if you feel comfortable, but I think we are managing the company with a little bit over a billion dollars of debt ceiling. And we have no plans to increase the absolute amount of debt. So I think that should give investors a clear view on where we're going in the future. I just want to, again, thank everybody for their support, the analysts and the investors, of course. And I want to repeat, we're not just another provider of health care. Our model is really unique and very transformative. It does take a bit more time to ground and expand in a country like Mexico, for example, but we're getting there. Now, in the medium and long-term view of this, we have not changed a position. In the short term, we might be fine-tuning the model and how we ground it in Mexico in particular, where we're just new. But things are clear that they're coming the way we've planned them. And we see the horizon as very, very promising. Thank you everybody for the support again and thank you operator for the for the support in the in the in the meeting as well. Thank you.

Thank you. This concludes today's conference call. You may now disconnect.