Auna - Q1 2024

Transcript

Operator (participant)

Good afternoon, and welcome to Auna's first quarter 2024 earnings conference call. My name is Krista, 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 Ana María Mora, Head of Investor Relations. Ma'am, please go ahead.

Ana María Mora (Head of Investor Relations)

Thank you, and hello, everyone, and welcome to Auna's conference call to discuss our Q1 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 contact Auna's Investor Relations team. Before we begin, I would like to remind all participants that our comments today will include forward-looking statements.

In addition to reporting unaudited 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 today 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 prepared 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 which 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, expectations and assumptions related to the integration and performance of the businesses we acquire. For a description of these risks, please refer to our filings with the US Securities and Exchange Commission and our earnings press release. Speaking on today's call is Suso Zamora, our Executive Chairman and President, who will discuss Auna's consolidated and segment financial and operating results, as well as provide updates on our various strategic growth initiatives.

Gisele Remy, our Chief Financial Officer and Executive Vice President, will follow with a more detailed review of Auna's consolidated financial results. After that, Suso will provide a wrap-up of our first quarter performance, as well as discuss our performance outlook. We'll then open the call for your questions. Suso, please go ahead.

Suso Zamora (Executive Chairman and President)

Good afternoon, everybody. Thank you very much, Annie. Welcome, everyone, to our earnings call, our first as a public company, and definitely an exciting moment in our journey. Let's begin our presentation, and please turn to slide 4. So our regional, vertically and horizontally integrated healthcare platform delivered strong top-line growth, and we're reporting an Adjusted Net Income basis of PEN 22 million. So from top to bottom, it's been a good quarter.

These results reflect the growing scale advantages and increasing synergies of our regional platform. Peru's outperformance strengthens our conviction in Mexico, for our larger market, where we are deploying the same business model and implementing our own standards at OCA, the business we acquired in Monterrey, Mexico, in the second half of 2022. Excuse me.

Our continued growth in Mexico indicates that our strategy is gaining traction in healthcare services, while the launch of Onco Mexico is proceeding according to our plan. Our aim is to scale Mexico with a high degree of predictability. Let's take a closer look at our first quarter performance. Please turn to slide 6, operator. So starting with our consolidated results, focused and consistent execution of our growth strategy drove top-line revenues across our geographic segments.

Key performance drivers were a growing proportion of more profitable, high-complexity services. Of course, increased capacity utilization and improving our operational efficiencies. Our strong performance reflects a growing scale and returns from past investments in Peru and Colombia. And in addition, we made further progress deploying our business model in Mexico. A key highlight of the quarter was Peru, where EBITDA margins surpassed our internal 20% EBITDA target.

We expect to continue to replicate the business practices that we had in Peru that have produced growing scale and the benefits thereof in Mexico. Adjusted net income, which excludes extraordinary non-recurring items, rose to PEN 22 million, as operating results more than covered financial expenses and taxes. Debt leverage, a key metric for all of us at Auna, fell further, and we expect will continue to decline as we gain additional traction in the latter half of the year.

In healthcare services, our organic and inorganic investments in Peru and Colombia are paying off. As we have further implemented The Auna Way, this obsession with our patient-centric model of high medical resolution, with great patient journeys and standardization that scales with high predictability and delivers growing financial results.

We have been ramping up capacity utilization in Mexico through a physician relationship and incentive model, and at the same time, we have been developing referral, referral initiatives with insurance companies and brokers. The strong growth in top line and average revenue per patient reflects a greater mix of high complexity services. Our focus on oncology, cardiology, neurology, and trauma shock.

At Oncosalud, we continue to attract new customers to our oncology and general healthcare plan memberships. Combined with higher average monthly revenue per customer, this drove revenues 15% higher. 15% higher. While intercompany price increases impacted Oncosalud's cost of revenue, our very stable oncological MLR at 51.5%, also produced stable gross margins. Can we flip to slide seven, operator? Now, let's move on to our four segments to review specific segment results.

In order to be consistent with the FX neutral metrics provided on a consolidated basis, variances for Mexico and Colombia will be provided on a local currency basis, while the financial charts remain in our functional currency, the Peruvian sol. Please turn to slide 8 to discuss the results of our healthcare segment in Mexico.

So in Mexico, we continue to advance strategic initiatives and the implementation of The Auna Way. Our progress in the first quarter of 2024 is reflected in the 6% increase in healthcare services revenues versus fourth quarter, 2023. Patients treated increased 4.7% with a range of services. Occupancy was stable at 41%.

Due to a temporary decrease in operational volume related to an earlier Easter holiday that fell in the first quarter versus in the second quarter in 2023, and physicians also attending two medical congresses that distracted many of them, which also occurred in the first quarter of this year versus in other quarters last year.

Integra grew 38%, driven by growth in B2B plans, while Integra is a small percentage of our revenues, it serves as a platform for launching Onco Mexico. In addition to its nationwide insurance license, Integra gives us an established and extensive insurance distribution network in the country. Integra will be rebranded to Oncosalud in the future.

Mexico's healthcare services adjusted EBITDA decreased versus the first quarter of 2023 on higher SG&A as a product of investments in regional, commercial, and operational capabilities necessary to deliver growth in the medium to long term, along with local administrative capabilities that had not yet been implemented in the first quarter of 2023 after the acquisition.

However, in a better measure, adjusted EBITDA grew 23% versus fourth quarter 2023. You know, and margins remain at a very healthy and stable level of 34%. I must highlight, we're solidly building our Mexican capabilities, and these replicate those in our business model that, that have years of proven results. During 2024, our organizational focus has been, and will continue to be, Mexico, and our progress in integrating Mexico to The Auna Way seems promising.

We are gradually bringing The Auna Way standards and top talent to OCA, and gradually scaling this business in Monterrey, one of Mexico's fastest-growing healthcare markets, benefiting, of course, from the nearshoring phenomenon. Again, we remain sharply focused on the implementation of our proven capabilities and thus, to shift revenue mix towards standardized, more profitable, high complexity services, and on increasing occupancy by attracting and retaining top-tier, high-yield physicians with incentives and other benefits that reward productivity within the Auna network.

Additionally, we are rolling out tailored packages and bundles for insurance and broker referrals, and these also attract out-of-pocket payers. We are on track for the launch of Onco Mexico this year. Our, our other key initiatives during the quarter are the implementation of SAP and our hospital information system, for which we had a great all-hands launch of these projects in Monterrey early in the year.

We expect Mexico to perform well, definitely during the rest of the year, with a higher impact in the second half of the year as we start harvesting the benefits of our Auna Way strategy. Now, please turn to slide nine to discuss the Colombian healthcare network. Revenue in Colombia increased 15.3% year-over-year.

This growth was primarily driven by a 22% increase in average revenue per patient, due to a better service mix, with a higher participation of oncology services and a decrease in certain ambulatory and in-home hospitalization services during the second half of 2023. The latter resulted in a 5% decrease in patients versus the first quarter of 2023. So growth is being facilitated by investments, such as increasing the number of ICU beds at our hospital in Monterrey.

Outpatient consultations increased 46% in Colombia, while the number of patients we treated decreased 5%, as we reallocated resources away from low complexity areas such as ambulatory and in-home services. This is our strategy: to direct high complexity services to more expensive and specialized hospital units, and service low complexity through digital channels, at-home deliveries, and/or large volume facilities that benefit from scale.

Occupancy levels grew significantly year-over-year to 79%, and this includes Clínica del Sur in Medellín, a relatively new facility that is ramping up. Adjusted EBITDA for the segment increased a strong 16% on top line growth, while margin was stable. Costs of services were up 19%, reflecting investment to support the delivery of high complexity services. However, SG&A was also stable during the quarter.

In Colombia, we continue to develop new competencies in high complexity areas like oncology and neurosurgery, and orthopedics, and cardiology, such as our recent inauguration of the Center of Excellence for Pulmonary Oncology. We expect the SAP implementation to be completed this year for Barranquilla and Medellín. This was a complex endeavor, one in which we've learned a lot, given the need to consolidate many operations with different and older legacy systems.

Now, please turn to slide 10 to discuss our healthcare Peru segment. The results of healthcare services in Peru are a product of leveraging the expansion of the network, increasing the mix of high complexity and high ticket services, and monetizing our Auna network referrals as a result of our proven strategy of deploying our urban healthcare ecosystems.

These drove average revenue per patient, as did adjustments to Auna's healthcare plan, in order to align rates with the highest payer within our network. We are also harvesting growth from other organic investments as well, such as a Clínica Chiclayo hospital. We've also expanded Clínica Vallesur in Arequipa, and increasing the emergency services capacity at Integra. Another revenue driver in Peru was a 2 percentage point increase in occupancy.

And again, this takes into consideration Chiclayo and Vallesur expansions, which are new and are ramping up. This mainly resulted from the implementation of our model, by which specialties and services are directed to the most appropriate Auna facility, principally in terms of cost of treatment. This is our operational model, and by which we continue to scale certain facilities for certain treatments, and thus gain the efficiencies of these, of this particular operational scale.

All of the revenue drivers I've covered drove operating leverage in the quarter, with an Adjusted EBITDA increase of 70%. Now, please turn to slide 11 to discuss Oncosalud's Peru segment. At Oncosalud, our healthcare plans business, we grew revenues 60%, reflecting the strength of this business and its ability to rapidly implement new growth initiatives.

A key driver was increased third-party revenue from Oncosalud's integrated hospitals, which included co-payments, non-covered expenses, and medical grants from some international pharma labs. Other drivers included a 4% increase in the number of oncology plans. Our oncological MLR remained stable at 51.5%. Top line growth drove the 24% increase in EBITDA, with underlying operating leverage reflected in SG&A as a percentage of revenue, which fell three percentage points to 29%.

Lower customer acquisition costs and deliberately slower growth as a result of price increases for general healthcare plans, also contributed to EBITDA growth. With that, I'll pass it on to Gisele. Gisele, if you can, please continue with the presentation.

Gisele Remy (CFO and EVP)

Thank you, Suso. Good afternoon, everyone. I'll pick up the presentation now with slide 13 to talk more about consolidated revenues. Let's take a step back and focus on the key growth drivers in the quarter. As you can see in the chart at the right of the slide, consolidated revenue grew a little bit over 20%... or 11% on FX neutral basis.

As Suso pointed out earlier, the growth was across our business and all of our segments. Importantly, our consolidated gross margin in the quarter was 38.5%. We drove much of the top-line revenue growth by leveraging prior investments that expanded our healthcare facilities in Peru and Colombia, coupled with a higher mix of high complexity and oncology services. Let's now turn to slide 14 to discuss cost of sales and services and SG&A expenses.

Revenue growth drove a 26% increase in gross profit with a strong margin. I'd like to draw your attention to the points under the chart on the left. As we explained in our earnings release, there were a number of one-time accounting effects that make comparisons between the reporting periods of the first quarter of 2023 and the first quarter of 2024 difficult.

First, our cost of sales and services included 11 million PEN in headcount costs that were reclassified to SG&A, beginning in the second quarter of 2023. Also, versus the first quarter of last year, depreciation decreased 11 million PEN in the first quarter of this year, due to the purchase price allocation method used at OCA.

When excluding these accounting changes, our cost of sales and services increased 11% year-on-year on an FX-neutral basis, which was consistent with the revenue growth in the quarter. Moving on to SG&A, as we note under the chart on the right, when excluding the reclassification of PEN 11 million in headcounts, costs, and impacts, which I just mentioned, SG&A increased 17% year-on-year on an

FX-neutral basis, reflecting the previously mentioned investments in regional, commercial, and operational capabilities necessary to deliver growth in the medium to long term, along with local administrative capabilities implemented in Mexico after the acquisition. Now, let's move on to slide 15, please. On this slide, we break down adjusted EBITDA by business segment. In total, EBITDA grew 14.3% year-on-year, or 7% on an FX-neutral basis.

Although margin decreased on a year-on-year basis due to the growth investments, which I just mentioned, it expanded 1.5 percentage points when compared to the fourth quarter of 2023. In Peru, where our growth strategy is very advanced, Adjusted EBITDA increased 40% year-on-year, with the margin increasing 4 percentage points to 20.4%. Let's now move on to net income on the next slide, please.

In the first quarter of 2024, we have introduced the concept of Adjusted Net Income to give the market a clearer picture of our net income when adjusting exclusively for the non-cash and extraordinary expenses generated by the refinancing exercise that was carried out in the fourth quarter of last year.

We expect these adjustments will provide further clarity on the impact the refinancing had on the fourth quarter 2023 net income, as well as one remaining impact in this first quarter of 2024's net income. On this slide, we show you the variations in Adjusted Net Income for the first quarter of 2024 versus the first quarter of 2023. As you can see, Adjusted Net Income reached a gain of PEN 22 million in the first quarter of this year, up from an Adjusted Net Income of PEN 1 million in the first quarter, 2023, and an Adjusted Net Loss of PEN 6 million in the fourth quarter, 2023.

I'd like to draw your attention to the PEN 30 million non-cash extraordinary financial cost adjustment being made to net income in this quarter, which corresponds to an extraordinary item related to the mark-to-market valuation of a legacy derivative, which has now been extinguished in April, related to the retired 2028 notes.

You can find more information as to the adjusted net income in our earnings release. Similarly, the PEN 38 million increase in finance costs versus the first quarter of 2023 is also primarily explained by the same extraordinary impact just described. Now, let's move on to slide 17 to talk about cash flows for the quarter. Operating cash flow increased 2% year-over-year to PEN 154 million. This was mainly due to the growth of our Peruvian operations, as discussed.

As you can see in the cash flow bridge, cash used during the quarter was mainly PEN 45 million in taxes, PEN 31 million of CapEx, mainly maintenance CapEx, and PEN 89 million in interest expenses related to our 2029, to our, excuse me, to our 2028 term loan. During the quarter, we also reduced PEN 13 million in debt.

Moving to the right of the bridge, you can see that of the PEN 1.3 billion in net proceeds from the IPO, PEN 1.2 billion was used to acquire the non-controlling interest of Oncosalud, and most of the remainder of the proceeds were used to pay costs related to the IPO, as small, as well as a small reduction in debt in line with our deleveraging strategy. Now, I'd like to discuss our debt structure and leverage on slide 18.

Since acquiring OCA and EPS in 2022, we have been steadily deleveraging our balance sheet. As you can see in the chart on the bottom of the slide... furthermore, we remain committed to reaching our target ratio of 3x leverage. As you can see in the pie chart at the right of the slide, more than half of our debt is in direct local currency funding.

The balance is in U.S. dollar-denominated debt, of which 90% is hedged to Peruvian soles. We finished the quarter with a very strong cash position of $92 million, which equates to 8% of our revenues in the last twelve months. The other pie chart on this slide breaks down our debt structure, while the bar chart on the bottom right of the slide shows our amortization profile over the next years.

Summing all of this up, we are maintaining a very healthy debt structure and maturity profile in order to support our growth strategy. That concludes my review. I would like to pass it back over to Suso, who will wrap up our presentation.

Suso Zamora (Executive Chairman and President)

Thank you, Gise. So I'd now like to end today's presentation with some final comments, and of course, open to Q&A. Now, comments regarding our vision of the company. So quarter results, they clearly demonstrate our ability to disrupt, modernize, integrate, and consolidate healthcare in these under-penetrated and underserved Spanish-speaking Latin American geographies.

We have been succeeding with a healthcare platform that is more and more regional, vertically and horizontally integrated and scaled. Also driving our success are standardized best practices and protocols, as well as state-of-the-art equipment. These distinct competitive advantages also bring higher predictability to our insurance business.

As a long-standing healthcare services and oncology plan provider who has grown in the market and accompanied millions of patients in their healthcare journeys, we are able to deliver a long-term approach to patient health by focusing on prevention, detection, and of course, treatment.

As per usual, our performance demonstrated this quarter, once our operations reach a certain level of capacity utilization, we start to generate significant returns, and we always harvest the benefits of diversification. As one country, one site, one business performs over expectations, it increases our predictability. We remain very excited about Mexico, given the promise of The Auna Way in that market.

We continue to expect that it will deliver substantial growth and value creation, both in the near and long term. This year, we expect consolidated Adjusted EBITDA to increase at least 20%, with much of the growth in the second half. Please refer to our earnings press release for the assumptions behind this guidance. Reaching this goal is, of course, subject to risk and uncertainties inherent in our business and in the countries where we operate.

This is also further described in our filings, but we remain optimistic in our ability to achieve it. We believe that as more investors recognize the strengths and merits of our business model and strategy, as well as the growth potential of our market, this will eventually be reflected in Auna's share price. With that in mind, we intend to invest substantial time in meeting investors in the weeks and months ahead to bring Auna to the attention of a wider audience.

Thus, I've committed myself, I've committed Gisele and the rest of the team to frequent roadshows, so that we can be close to shareholders and future investors. For those of you who are current investors, thank you for your ongoing support of Auna and our mission.

As a final word, I'd like to thank the doctors, nurses, technicians, and many other colleagues for their hard work and dedication to our mission of transforming healthcare in Spanish-speaking Latin America. All of us are highly patient-centered, steadfastly committed to the highest standard of care, quality, and safety. With that, I conclude our presentation. We, of course, appreciate your attention, and would like to now open the session to any questions you may have. Operator, please proceed with the Q&A session.

Operator (participant)

At this time, we will open the floor for your questions. If you have a phone question, please press star one on 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 Samuel Alves with BTG Pactual. Please go ahead.

Samuel Alves (Associate Partner)

Hi, Suso, Gisele. Good afternoon, everyone. Actually, Samuel from BTG. Our first question is about the monthly performance throughout the first quarter in Mexico. In local currency, the adjusted EBITDA declined 10% year-over-year during the first quarter. In the presentation, in comment that some calendar effects jeopardized the year-over-year comparability in March.

So just to understand, if the EBITDA performance in January or February was better in year-over-year terms. That's the first question. And the second question is about the 2024 guidance. That is also related to the first topic. Considering the 20% EBITDA growth outlook for this year, do you believe that this figure will be equally split among all the three geographies, or Mexico should lag the others, as happened in the first quarter? Thank you very much.

Suso Zamora (Executive Chairman and President)

Gisele, do you want to take the first one, and I'll take the second one?

Gisele Remy (CFO and EVP)

Yes, of course. Hi, Samuel, how are you? Just to answer the first part of the question as to EBITDA growth on a year-on-year basis. As we mentioned in the call, impacting comparability was not only the seasonality effects, which were different this year versus the first quarter of last year, but also the incremental SG&A, which we already saw on our P&L in the fourth quarter of last year.

That's why it's also important to note that for the OCA Monterrey operation, EBITDA increased 34% when compared to the fourth quarter of last year. You mentioned the 10% decline in adjusted EBITDA, which was in reference to the first quarter of last year, which was before we had made those investments in the regional and local capabilities in SG&A.

As far as the month-on-month performance, basically, you know, obviously, while there were impacts, comparing March to March because of Holy Week, there was also other impacts in the other months, due to the congress, as mentioned. So I think from a revenue perspective, the quarter is pretty much spread out between the three months as far as performance and growth versus last year.

Suso Zamora (Executive Chairman and President)

Sorry, with respect to the second question, I think that we feel very comfortable on the 20% guidance in EBITDA growth. And I wouldn't want to represent how it will come out, but it will—it's not gonna come out very different to what we are planning with respect to Mexico, Peru, and Colombia. It is a fact that.

You know, building the capabilities in Mexico that produce predictable results takes a little longer time, you know? So I always wanna at least give myself some cushion that we will deliver the 20%, but there might be, you know, some differences, not substantial, some differences as to how the countries are producing the results.

I think Mexico is an amazing market made for Auna, you know? And I don't wanna hit it right quarter by quarter. I wanna hit it right year by year, and in the five-year metric, I think we will be, I think, the most significant player, you know, in oncology, at least, no? So I think that I would leave it there somewhere.

Gisele Remy (CFO and EVP)

Moving to complement-

Suso Zamora (Executive Chairman and President)

Thank you, Gisele.

Gisele Remy (CFO and EVP)

And reinforce Suso's point, because we see that this question is coming up, on the chat from several participants. Our guidance is on a consolidated basis, and we think given the synergies and the regional footprint that Auna has, it is most appropriate and predictable for us to provide it always on a consolidated basis and not by region.

Suso Zamora (Executive Chairman and President)

Thank you.

Operator (participant)

Your next-

Samuel Alves (Associate Partner)

Thank you so much.

Operator (participant)

Your next question comes from the line of Alejandro Zamacona from HSBC. Please go ahead.

Alejandro Zamacona (US Equity Research Senior Analyst and Head of the Mexico Equity Research Team)

Thank you. Hi, Suso, Gisele, thank you for taking my questions. Couple of questions here. The first one is, can you comment on the status of, this plan of recruiting doctors in Mexico? I mean, any color, in terms of timing, challenges, strategy, should be helpful. And then, my second question is on the occupancy rates in Mexico. I mean, during the quarter, we saw a flat year-over-year growth. What can we expect, going forward? Thank you.

Suso Zamora (Executive Chairman and President)

Thank you very much. So, I think, I think we're, we're on track on attracting the doctors that will produce some high yield. But qualitatively, our focus on high complexity also has a timing issue. So it's not about just filling up the hospital with doctors that deliver any type of practice, but qualitatively, we need to make sure that what we're building, you know, is an institution that has the best standard in this high complexity.

So, Onco Mexico, Onco Mexico is a project that's made that it has two. It's a two-pronged strategy. One is a market share strategy in terms of hospital services related to oncology, and the other one is the insurance business. Both require, you know, a distinguished, you know, number of physicians that align to the Auna Way. You know, and I think the conversation we've had, I was in Monterrey last Tuesday and Tuesday before that, only meeting with doctors, you know?

And now here in Mexico City as well, we've been meeting with some doctors, and we'll be meeting some doctors next week. You know, I think that, we are very well known in Peru and Colombia, I must admit. We are less known still in Mexico. So our strategy to be a significant player in oncology and in other high complexity diseases is one that, that has many, many, diversity of actions, you know, including, clinical trials, research, relating ourselves to some of the other players in oncology, prevention, campaigns.

These again will produce the attraction that we've achieved in Peru and Colombia in the physician world. You know, our offering is distinct, you know. But once it's implemented, as it has in Peru and Colombia, it delivers, you know, predictability and the Auna Way that is this high medical resolution and high patient experience and great financial returns.

But it needs to be built over time. So I would say that 2024 is a very important year as we invite and retain key doctors into our network. That's happening at the right pace, you know, but we still have a substantial opportunity to complete what we want to achieve here.

Alejandro Zamacona (US Equity Research Senior Analyst and Head of the Mexico Equity Research Team)

Thank you.

Operator (participant)

Your next question comes from the line of Mauricio Zapata with Morgan Stanley. Please go ahead.

Mauricio Zapata (Analyst)

Hi, Suso, Gisele, and María, thanks for the opportunity. Two questions from our side. The first one about Colombia. I understand, I saw in the release that you are now receiving direct payments from ADRES. But if you could detail a little bit how it has been interfering with working capital. We saw the receivables going up a little bit, so if there is any kind of relation there, what you were foreseeing in terms of this financial relation now directly with ADRES.

But also, if you could also talk about the patient flow after the intervention in the EPSs. And I understand that you are focusing on high complexity oncology, if this kind of administrative control of the EPSs may change somehow the way you get the patient flow. So, my first question is about Colombia. The second question, a little bit about Mexico.

So we saw that you were increasing patients, but not necessarily the ones that increase hospital occupancy. If you somehow perceive a different ramp up there in terms of hospital occupancy or it somewhat has a kind of a competitive reaction there, as you know, we were trying to capture more volumes there, if there was any competitive reaction in the hospital business. Thank you.

Suso Zamora (Executive Chairman and President)

Thank you. Thank you very much, Mauricio. So I'll start with the last one, and then I'll go into the Colombian. I think we're good at building up hospitals. But in our promise of value-based care, we're actually measuring the number of days patients, you know, go back to their families. So beds is not the perfect metric for us. We still believe that in Mexico, we can double up in the next five years without any investment, you know, to reach our 80% standard in hospital utilization. I don't want to diminish that effort at all, you know? But I think that... I don't think there's a delay.

But I think the first quarter was—had these dislocations, had these dislocations of the Holy Week, you know, in which people don't do medical treatment, you know, and other issues. But I think, we're on track to grow occupancy. I do think that in the future, we'll try to help the market understand how we see occupancy and how we see higher complexity procedures as a better measure of our volume, as a better measure of our volume.

Now, we are measuring surgery rooms utilization, ICU utilizations, chemotherapy infusion site utilization. That's the core of our business, not the hospital stay. You know? But still, I do not want to diminish. Right now, we have a very clear strategy to fill up the hospital beds, not with anything the words I just said. And that, and that'll be coming during the course of this year.

You know, in Colombia, I believe that the fragility, vulnerability of these two payers, you know, that were intervened by the regulator based on financial considerations and limits that they were not complying to, will improve our working capital collections in the future, not make them worse. I think there's a transition in which the ADRES and the insurance companies and ourselves and other service providers are learning to work directly with the ADRES, you know, and that might prove a few months of a dislocation.

In general terms, I see the Colombian sector with these interventions. Hopefully, the companies will be back on their, on their own footings and then return to an autonomous and operational standard. I think that does not put us in any vulnerable position.

As you might remember, 84% of the hospital services in Colombia are delivered by private institutions, and the government or the intervening authority does not want hospitals to miss payments, patients to wait for services. I think we're protected there. I think there are issues that the ADRES and the payers have to resolve and make it a little more efficient, but I'm not worried.

There was a lot of uncertainty before that about what was gonna happen because the vulnerability of these companies was well known. This was one of the scenarios that was expected. I think it's not bad for us. We'll be, of course, monitoring the situation, being very much in tune with what's necessary for our patients as well.

I think that, because we are a high complexity player in Colombia, in particular, and most high complexity procedures or diagnostics are delivered in what we call... in packaged, you know, I don't want to call them capitated, but they're not perfectly capitated, but in packaged fashion to the payers, you know, in the B2B fashion, in Colombia, called PGPs and PAVs, and there are other modalities of them.

The fact that those have a higher priority in the system, they normally get paid faster. You know, so I think that we, we had and will continue to have, you know, a better working capital situation than others because of our high complexity offering and credibility thereof. Thank you, Mauricio.

Gisele Remy (CFO and EVP)

And perhaps Mauricio, from my end... Hi, Mauricio, how are you? Perhaps from my end, just to clarify, or complement some of the points you mentioned. As far as cash conversion, you can observe in our earnings release that cash conversion has remained stable, versus both the fourth quarter of last year as well as the first quarter of last year.

As we stated, in our initial, you know, clarifying note on the Colombia situation, and also, reinforced with on our earnings release, payments since the administrative interventions have been consistent with what we had received in previous months. So collections have also been consistent... and this is reflected in the stable cash conversion cycle. And that is on the point of Colombia.

And then, just to complement the point on occupancy levels in Mexico, we continue to maintain a firm view of what we can accomplish in occupancy in Mexico in the medium to long term, and this is why we were working on the aforementioned initiatives as far as, you know, the doctor incentive model, as well as all the other benefits that Suso mentioned.

Also focus on physician productivity as well as, you know, the bundles and packages which we're working on with the different payers, right? The insurance companies and out-of-pocket, et cetera. We suggest looking at occupancy on an annual and multi-annual basis. Tracking it every quarter will be difficult to maybe visualize some of these results.

But we continue to see that we will be able to take the Mexican operations to the long-term levels that we see in Peru, for example, right? Where facilities that are ramped up approach 80% occupancies, right, in the next five years. And finally, as far as the competitive environment, part of your question, no specific disruptions, as far as the competitive environment. And as Suso mentioned, the physician relationship model is one that really does differentiate Auna.

Mauricio Zapata (Analyst)

That's, that's very clear. Thank you. Thank you, Suso. Thank you, Gisele.

Operator (participant)

There are no more questions from the phone lines, so I will now turn the call over to Ana María Mora, who will proceed with the questions from the webcast platform.

Ana María Mora (Head of Investor Relations)

Thank you, Fraser. Now we will proceed with the questions from the webcast platform. The first question is, what are your plans of expansion in Mexico, and then taking advantage of nearshoring?

Suso Zamora (Executive Chairman and President)

Thank you, Annie. So I don't feel very comfortable. I'm not sure how much I can talk about this, of course. Right now, we're very much focused on delivering that huge opportunity in Monterrey with 40% on capacity utilization and rolling out the Onco Mexico project. The Onco Mexico project, as I described before, and which I've spoken about, and I think we've represented well in the filing, you know, is one in which it starts off in Monterrey and will continue in Mexico City. It is a project that we've devised as asset light, capital light.

Given that the number of patients in oncology that we will be capturing is a smaller number, we don't need to do a major investment, be it CapEx or an acquisition, to deliver high growth in that Onco Mexico project. So we see ourselves being very sensitive about capital allocation for that project, and we see ourselves as we've grown in other countries, not in the necessity to do something large. So we do see ourselves implementing this strategy in the second half of this year, more forthright in the, in 2025. More, much more, in 2025. This year, all the plans.

But definitely, the Mexico City market is the most attractive market, you know, and when we see ourselves delivering a lot of value to a lot of families that don't have cancer coverage in Mexico City. Thank you. Sorry.

Ana María Mora (Head of Investor Relations)

No, it's okay. Thank you, Suso. Now we're gonna go ahead with another question regarding Mexico. This question is from Caio Moscardini, and the question is: Can you please share our expectations for the launch of both Onco Mexico and the hospital operation in Mexico City? How are these projects evolving?

Suso Zamora (Executive Chairman and President)

So again, as we've indicated, Onco Mexico is on track. You know, in July, we'll be launching the policies and the B2B services are being negotiated today, you know, and I think we'll deliver what we expect in 2024. 2025, we'll see a much more significant impact in our total results. You know, again, mostly related to our operations in Monterrey, while we roll out our capabilities in Mexico City, which will produce results later on in 2026. That's the way we should see it, but I think we're on track.

There's a great team involved in this with proven capabilities and I think we confirm over and over again of the need for this coverage and these services and confirm the opportunity that we have at Auna for that, you know? So in Mexico City, again, it's about making sure that we have the facilities, the right number of facilities and capacities to give the services to the population that we grow at a certain pace. This can be done, as we've proven in the past, in an asset-light way, and you'll see us engaging in that way in the next 12 months. Thank you.

Ana María Mora (Head of Investor Relations)

Thank you, Suso. The next and final question, because we're running out of time, is from Jocelyne Jensen, and the question is: Could you provide your CapEx expectations for the year by country? Where do you see net leverage by year-end? When do you expect to resume dividend payments?

Gisele Remy (CFO and EVP)

I can tackle that one. Thank you, Jocelyne. As far as our CapEx expectation for the year, this should be approximately $15 million in 2024. As far as leverage projections for the year-end, we're currently not providing guidance on leverage, given that this, at the end of the day, will also be a resulting factor from the EBITDA, where we have provided the 20% EBITDA growth guidance on an FX neutral basis. As to the dividend policy, currently, Auna maintains a no dividend policy. As you guys know, we're very committed to de-leveraging the company, and obviously, this will be a function of that as well.

Suso Zamora (Executive Chairman and President)

Giselle, just to add on, I mean, we are a growth company, a high-growth company, and as you see our numbers from the past. So we reuse all of the retained earnings and cash flow to continue to grow. So we will not be changing the dividend policy for a while.

Ana María Mora (Head of Investor Relations)

Thank you, Suso. As mentioned before, we have run out of time, so at this time, we are going to close the Q&A session. Thank you all so much for your attention and your interest in Auna. As always, we look forward to hearing from you, and don't hesitate to contact us. Please stay safe and healthy, and have a great evening.

Suso Zamora (Executive Chairman and President)

Thank you very much, Angie.

Gisele Remy (CFO and EVP)

Thank you so much.

Operator (participant)

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