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Auna S.A. (AUNA)

Q4 2025 Earnings Call· Wed, Mar 11, 2026

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Transcript

Operator

Operator

Good morning, and welcome to Auna's Fourth Quarter 2025 Earnings Conference Call. My name is Ellie, and I will be your operator for today's call. [Operator Instructions] Please note that this call is being recorded. [Operator Instructions]. Now I would like to turn the call over to Ana Maria Mora, Head of Investor Relations. Ma'am, you may now go ahead, please.

Ana Maria Mora

Analyst

Thank you, operator. Hello, everyone, and welcome to Auna conference call to review our fourth quarter and full year 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 Auna's 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 regard to Mexico and Colombia, unless we note otherwise. Let's move to Slide 2. 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 yesterday to ensure that they understand them. Non-IFRS financial measures and operating metrics should not be considered in isolation as a substitute 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 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. This includes but are not limited to, our target leverage ratio, the expected resolution of the issues with physicians, suppliers and information systems in Mexico, the results of the key initiatives we're implementing in Mexico, Colombia and Peru, the expected capacity and market of Torre Trecca once built, the execution of our strategic plan, including the recovery of our growth levels and the…

Gisele Ferrero

Analyst

Thank you, Suso. As the graph show on Slide 12, the diversity of Auna's regional platform enabled us to deliver 6% revenue growth in the quarter and 4% for the year. Looking at the quarter, the 11% growth in Peru and 6% growth in Colombia, offset the 3% decline in Mexico, where we have achieved steadier results in operations. And although demand in the country remains soft, our business there has established a strong foundation for profitable growth this year and beyond, as Suso explained earlier. Now let's please turn to Slide 13. Fourth quarter adjusted EBITDA decreased 14% in FX neutral to PEN 220 million with the margin contracting 4.5 percentage points to 19.5%. Margin expansion and EBITDA growth in our Peru business was more than offset by Mexico's margin decline related to the mix of services and specialties, our previous healthcare plan to cover ISSSTELEON and our efforts to improve the operation in Mexico through the adjustments to our leadership and new IT systems. Also contributing to our EBITDA decline in the quarter was a higher proportion of risk-sharing contracts in Colombia as well as the rebates recognized in the fourth quarter of last year in Colombia, which created an unfavorable year-over-year comparison. When excluding extraordinary impacts in both periods, Colombia's EBITDA would have been relatively flat in the fourth quarter 2025 versus the fourth quarter 2024. Slide 14, please. For the year, adjusted EBITDA remained relatively flat, decreasing 3% in FX neutral to PEN 917 million, with margin decreasing 1.7 percentage points to just under 21%. The trend in EBITDA was largely due to the same reasons that I explained for the fourth quarter. Let's now move to Slide 15. Our adjusted net income increased more than 3x in the fourth quarter, aided by noncash FX gains.…

Operator

Operator

[Operator Instructions] Your first question comes from the line of Artur Alves of Morgan Stanley.

Artur do Amaral Alves

Analyst

We wanted to explore a little bit more your guidance. And if you're able to break down a little bit more by region or by business line, what are your growth and EBITDA expansion in each line? We would assume that Mexico recovery is what drives most of this improvement year-on-year. But if so, shouldn't we expect a little bit more on the margin side, especially since revenues and adjusted EBITDA guidance imply flat margins. But if Mexico is recovering, and this is a fixed business segment of the company, shouldn't we expect a little bit more in the EBITDA growth versus the revenue growth? And a second question also on the guidance, what are the risks to your 2026 guidance? Where do you think things could potentially go wrong? And how are you assessing that? Jesús Zamora Leon: Good morning, everybody, and thank you for the call. Let me -- it's a long question and it's a long response. Let me address it in the following way. First of all on Mexico, Mexico is off to a solid start for the year, in line with our expectations and the part of everything that we've done in 2025. So I see January and February 2026 versus 2025 metrics improved in various different lines. I mean surgery is up single-digit growth [indiscernible] are up double-digit growth. And of course, in oncology, radiotherapy and chemotherapy, in the double to triple-digit growth. And of course, extremely high in comparison to last year because we did not have Opcion Oncologia. We see occupancy utilization in Mexico also trending up. I see it in February, reaching 41%. So overall, results in Mexico, revenues are up on high single digits versus the same last period. Of course, ISSSTELEON is just kicking up its volume. So I'm…

Gisele Ferrero

Analyst

Sure, Suso, thank you. Thank you for the question. Perhaps, what I would complement there is kind of what's that mix behind the guidance from a country perspective? And what are we expecting from margins is that I think normally, when we set out our growth targets, it's very well balanced across the 3 geographies. So we are expecting solid growth from all 3 geographies off the back of all the strategic initiatives that we mentioned in the call. And in the case of margins, specifically when we talk about Mexico, as we noted in the call, the fourth quarter, the impact -- had an impact on the fourth quarter margin. But we will see that margin recovering in the case of Mexico going into the first quarter of 2026 and the rest of the year from that fourth quarter level, right? So we will see both a mix of EBITDA growth across the 3 geographies as well as all the strategic initiatives that we're taking in the case of Mexico also to contain costs and to finally increase volumes, which obviously will have a favorable impact on margins as well. Jesús Zamora Leon: And I think just to finalize, we're not giving guidance by country. At the same moment, we might consider that definitely. But right now, just directionally, as I project the company 5 years out, I think Mexico and Peru will be the [ motors ] of the company. Colombia will be diminished because of the growth of Mexico and Peru. Now it's a critical part of our strategy in Colombia. But because of the scale, the cost efficiencies it has that we take them to the other 2 countries, but the growth opportunities in Mexico and in Peru as well continue to be the most important sources for growth in the next 5 years.

Operator

Operator

[Operator Instructions] Your next question comes from the line of Giovanni Vescovi of JPMorgan.

Giovanni Vescovi

Analyst

My question in regards to Torre Trecca, which have seen some updates recently. But I wanted to know more color and more details in terms of margins, revenue contribution? And if the company already has like a set date for the opening of the project, maybe third quarter, fourth quarter of 2028, if I'm not mistaken. And in terms -- just to recap on the ISSSTELEON price increase, you guys are expecting the double-digit price increase for 2026. Is this correct? That's it. Jesús Zamora Leon: Thank you very much, Giovanni. So going with the last question first, yes, it is for all of 2026. It's a much better award than we've had in the past. It allows us to control also prescription and devices. So I'm seeing qualitatively and quantitatively, it's a much improved contract. I think we're going to deliver great service to them, and we're going to also have attractive margins from a large contract -- largest contract you can get with respect to a counterparty like the state -- in the state of Nuevo Leon. So yes, it is for all of 2026. And then with respect to Torre Trecca, so this has to be viewed as a very attractive opportunity for Auna. I want to step back and make sure the investor community understands. Auna is a healthcare player that has been very successful in B2B relations with an insurance company, of course, large collective employers or groups, and then in Peru, particularly within B2C. The biggest market when you project out the next 10 years, it is the B2G segment, state being the large payer for certain services. You have that everywhere in the world, and you have it as a very attractive segment in Peru and particularly in Mexico as well. So this…

Gisele Ferrero

Analyst

No, Suso, I think it's very clear. I would just reinforce the point for the audience's benefit, that construction expenditures are reimbursed through progress certificates, paid by EsSalud, which significantly reduces any capital risk that Auna is exposed to. So it's fully funded. Jesús Zamora Leon: And we're not the first public private partnership in Peru that has this system. So this is something we're taking on that works and has been working, as I indicated before, for years in Peru.

Operator

Operator

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

Ana Maria Mora

Analyst

Thank you, operator. Good morning, everyone. Let me begin with the questions from the webcast. Some of them have already been answered. I would still like to acknowledge them. So -- and in case Gisele and Suso would like to mention something else regarding the questions, the answers, please go ahead. Otherwise, I can move on. So the first one is from [indiscernible] and his question is, can you guys please detail more into the Torre Trecca project? Financing, operating, what is your view there? And the second one is related to Trecca well, comes from [ Julio Lam ]. He is a graduate from Universidad de Piura. I have a question related, if you have expected CapEx that you will invest in Torre Trecca this year and the next one? And if it exists, is it possible to watch it? Jesús Zamora Leon: So maybe just quickly to reiterate, given that there are 2 questions. Again, Centro Ambulatorio Trecca, it's structured under a concession framework. So predictable revenues supported by minimum guaranteed payments from EsSalud. As Gisele said, the construction expenditures, they're all reimbursed by these progress certificates you mentioned. This reduces the capital risk. This is very much related to the large unmet demand for outpatient services in Lima. So we're taking a huge chunk of these unmet demand for outpatient services in Lima and in a very de-risked way. Of course, as we make progress, we'll be happy to share milestones that we're reaching. And with respect to -- and if it exists, is it possible to watch it? I mean, of course, it's a tower that exists already. It hasn't been finished, and we will be refurbishing and finishing it. So yes, of course, we'll make sure that we post some photographs and some images of the inside and outside of what as we progress and maybe some virtual tours as well. Let's jot that one down, Annie, please. Thank you.

Ana Maria Mora

Analyst

Thank you, Suso. The next question then will come from [ Christian Tesi ]. What is the expected CapEx for 2026 and for 2027 and 2028? I recall you have mentioned an expansion of the business. What would be the expected CapEx there?

Gisele Ferrero

Analyst

Thank you, Annie. Yes. So to give you a little bit more color on CapEx. As Suso already mentioned, our guidance for the year is approximately 4% of revenue. So very much in line with what we've seen in previous years, and that CapEx will be allocated to maintenance investments, both across medical equipment as well as infrastructure. It also includes our technology investments as we continue with systems implementations across Mexico as well as Colombia, and the rest of our recurring CapEx investments. We're not giving any specific guidance further on into '27 or '28. But as was mentioned in the question, we should expect investment for the expansion of our Lima network to begin in 2027. And we will give the market more information into that as the year progresses. Jesús Zamora Leon: Maybe, Annie, important with respect to Gisele's last comment. So Lima is reaching high levels of occupancy. And as you can tell with that, we see ourselves considering certain options to expand urban ecosystem health care in Lima in '27 and '28.

Ana Maria Mora

Analyst

Thank you. Suso. The next question comes from [ Christian Tesi ]. When do you expect to happen that Mexico total occupancy rate reached 40%? Jesús Zamora Leon: Yes. Thank you very much for that question. So as I mentioned in the previous answer, I believe, we're already at 41%. I've seen certain days, especially in Doctors Hospital, our main higher complexity facility in Monterrey at much higher rates of that. So again, I'm optimistic we are already above 40%. We're at 41% and we continue to see some potential for growing that, of course, during the whole year.

Ana Maria Mora

Analyst

Thank you, Suso. The next question comes from [ Gerard Forte ]. Regarding Colombia, what conditions are required for provisions to be reversed? Could this materialize beginning in first half of 2026?

Gisele Ferrero

Analyst

Thank you, Gerard, for the question. As we've previously mentioned to the market, our provisions are based on an expected loss model. And that is the case for all 3 of the geographies. Specifically, in the case of Colombia, within that expected loss model, there is separated methodology for the intervened entities. We continue to provision according to the expected loss model. And we think that even though this does not reflect a view on that we will not be able to collect on those accounts, it does permit us to derisk the balance sheet and derisk future results. We do not expect to have any reversions in impairments of accounts receivable in the first half of 2026.

Ana Maria Mora

Analyst

The next question comes from [ Alexander Louis ]. And also, I'm going to bundle that with the question from [ Temo Tarago ]. And this relates to the Sojitz MOU. Can you provide any update on the Sojitz MOU? Jesús Zamora Leon: Great. We actually have been meeting it in the last few weeks in Mexico and elsewhere with Sojitz on various alternatives. I think we're not ready to inform anything to the market, but I think I'm gaining traction there. I do think that we need to focus in the future as we have in the past to grow inorganically. And Sojitz is offering an attractive potential capital increase in -- that will sustain our growth in Mexico in particular. So we'll bring that back, but it is related to Mexico and had to allocate more dollars to Mexico and grow Mexico. And once we have it a little more built and defined with Sojitz, we'll definitely bring it back to the investor community. That will be [ Cameron Carrago's ] question on Sojitz. I don't know, Gisele, I think that's the situation there. Anything else?

Gisele Ferrero

Analyst

Correct. No, nothing to add on that end.

Ana Maria Mora

Analyst

So moving along. The next question comes from [ Antonio Cardoso ] and it relates to our debt. So what's the all-in cost debt after the refinancing?

Gisele Ferrero

Analyst

Thank you for that question. First of all, it's important to note that we -- after the refinancing exercise, which we executed last year, we increased the proportion of direct local currency funding, which now leaves us, as was mentioned during the call, with 56% of our total debt in direct local currency funding, and the remaining 44% of the debt is in U.S. dollar-denominated debt. However, that U.S. dollar-denominated debt is 85% hedged to the Peruvian sol via derivatives. As you will recall, our all-in rate, which again obviously reflects a mix of currencies and where those -- where rates are in each one of the 3 geographies. Our blended rate in 2025 was closer to approximately 12.5% with the old debt structure, and as a product of the refinancing and now also including the new derivatives, which have been put in place to hedge the new debt structure that rate has dropped over 100 basis points. And that's from a blended perspective, including all of our debt, both short and long term.

Ana Maria Mora

Analyst

The next question comes from [ Saguno Turkani ] and it's also related to cash flow. [ Saguno Turkani ] says, congratulations on the strong 2025 finish. Now that the company has officially reached a positive free cash flow inflection point and is guiding for USD 45 million free cash flow for 2026. How is the Board prioritizing capital allocation? Specifically, given that the stock is trading significantly below its book value, is there any internal discussion regarding a share buyback program once the leverage ratio hit the 3x target? Jesús Zamora Leon: That's a good question [ Saguno ] and thank you for that. I don't have a precise answer, but at the Board, we've been discussing the best use of capital and the different alternative allocations that we have. I think it's important to note that I think we mentioned in the earnings release, we've had -- the stock has underperformed dramatically we believe because of the selling pressure from a very large shareholder that now is officially no longer a shareholder has sold their position. So we believe that the share, given that there's no significant selling pressure from anybody, I think the stock will trade much better and closer to its book value, certainly. But to be clear, the Board has discussed -- has analyzed share buyback programs. We think that given that this selling pressure has resolved, I'm not certain it would be a high priority. I think a higher priority would be to use the balance sheet once it's below 3 to continue to grow at the rate that we've grown in the past, particularly in Mexico. In Mexico, we have a very rich pipeline of growth opportunities, high complexity, higher margin opportunities, that's where we need to put the money to produce, I believe, more appreciation in the stock price. Would you like to, Gisele, complement my response?

Gisele Ferrero

Analyst

Yes. Just to complement Suso on the first part of the question with reference to free cash flow and what our expectations are. While we have not specifically given any guidance related to free cash flow, as Suso already mentioned, we've given strong guidance with reference to revenues and EBITDA growth, which will obviously have a direct impact in free cash flow generation in 2026. And additional to this, as we continue our disciplined working capital management, as well as I already mentioned around the CapEx numbers, which in 2026 will continue to be close to historical levels and limited to maintenance and IT investments. We expect to see growth in free cash flow, also in line with what we're guiding for revenues and EBITDA. And given that, as I already mentioned, we've materially reduced interest expense. This does generate a virtuous cycle as far as deleveraging. So I do want to emphasize the point that the company already showed in 2025 that we were able to generate free cash flow -- generate cash flow after interest payments, and this will only grow going into 2026 permitting us to continue to delever and get closer to that 3x net debt-to-EBITDA target.

Ana Maria Mora

Analyst

Okay. The next question comes from [ Joaquin Vero]. Thank you for this question. How are you planning the ramp-up in occupancy in Mexico and the margins to come back up to 30%? What is the normalized level of occupancy you're looking for in 2026? Jesús Zamora Leon: Okay. Thank you, [ Joaquin ]. So these 2 levers of occupancy and margins, we managed particularly through mix, higher complexity mix. Of course, one can fill a hospital much faster, but with much lower margins. So we're very careful with that. But to fill a hospital and to maintain higher margins means to have a higher mix of higher complexity. And that's how we plan to manage the ramp-up of occupancy in Mexico and, of course, the recovery of the margins. I think very importantly, I do want to say volume and volume growth is a foundation on which everything else comes, even higher complexity, margins of course. So being in the much larger health care plans throughout Monterrey gives us a huge improvement in the total addressable market with respect to the private policies. That will produce volume growth. And then the mix will produce the margin recovery. We have a very clear plan for 2026 to recover at least a couple of points of the margin contraction that we have implemented to make sure that we are -- we have a growing volume of all our services and treatments in our hospital network. So I don't think we're giving guidance on the occupancy level. Gisele, I definitely think that 40%, 41% that we have today is a really good base. We're going to be growing that. We're definitely going to be growing that. I don't know, Gisele, should we comment on the occupancy in Mexico?

Gisele Ferrero

Analyst

I would simply add Suso, both from an occupancy as well as a margin perspective. I would like to remind the market, as Suso already said, that we have successfully been awarded the extension for the ISSSTELEON healthcare plan with very improved economics. We are starting the year with preferred provider status with 2 major insurers. Cost containment strategies have been an integral part of the discussion with payers to secure the preferred provider status, and this will have a direct impact on the increase of volumes in 2026 as well as margin gains. And finally, as Suso already mentioned, in the first 2 months of 2026, we have continued to see growth across several services and utilization normalizing as well as the cost base stabilizing. So therefore, we expect to gradually recover during 2026.

Ana Maria Mora

Analyst

The next question comes from [ Constanta Orbenetta ]. Could you please detail how [ ISSSTE ] hurt your performance in Mexico in the Q4? And how this planned extension will be an improvement for 2026? Jesús Zamora Leon: Great. Thank you, [ Constanta ]. So basically, the improvement on the award of the [ ISSSTE ] contract for 2026 is related to, first of all, we increased prices 30% and we included the agreement that we control the pharma and the device prescription. And that's critical for cost containment and of course for the increases in prices for margin -- for better margins. The end of the quarter on this award -- on the previous award of 2025 was mainly affected by higher complexity volume in that award that, of course, reduce the margins, but at a set price that was set in 2025, of course, it reduced margins. So I think the 30% more than covers a very healthy margin for us with a large insurer -- indirect insurer, we said earlier. So we're very excited about what has occurred and our relationship with ISSSTELEON is every day much more intimate and much more -- and the NPS we're getting from the beneficiaries, ISSSTELEON is very positive. I think that's going to be a growing contract in the future and a growing award in the future.

Ana Maria Mora

Analyst

Thank you, Suso. We only have time for 1 or 2 more questions. I realize the time you have. So the next question comes from [ Joaquin Vero ]. I've noted high impairment losses in trade receivables, not only in Colombia but in Peru. Can you give us more color on this?

Gisele Ferrero

Analyst

Yes. Thank you for the question, Joaquin. I think we talked a little bit about the impairment losses in Colombia in the previous question. So I'll address the ones in Peru. The first thing I'd like to highlight is that it's very important to note that accounts receivable days in Peru have improved in the third and fourth quarter of 2025. And we expect to continue on that trend during 2026 as a product of several process and system initiatives, which we are rolling out, specifically in the accounts receivable cycle. The higher impairment in the case of Peru in 2025 is more related to specific conciliation with some payers from previous years, right, related to services around 2024, where we have had some specific negotiations related to those specific services, especially as a product of technology changes that have occurred in the insurance companies as well as on our end, which led to a lag in recovering those accounts. And that's what impacted the impairment impact in Peru specifically in 2025. It's a much more isolated effect, and we will be basically working on those conciliation impacts during the quarters of 2026. We should not expect to see impairment increase versus the 2025 levels.

Ana Maria Mora

Analyst

Thank you, Gisele. And I do think we have time for one more question. And this question comes from Cesar Piedra. Peru continues to be the main growth driver for the group. How much of the performance do you see as a structural versus temporary whether for pricing mix, ramp-up effects or unusually favorable conditions? Jesús Zamora Leon: So I feel I'm very comfortable in representing that Peru is a very solid and consistent part of Auna. So very predictable for us. So it's difficult for me to put Peru's performance with temporary or any unusual considerations. I think Peru works pretty much like clockwork with a model that is very mature with brands and the medical staff is very well known. And our integrated insurance business, we manage for an MLR. And again, that proves a lot of predictability. So no, besides some upside from Trecca and some other things in the future, I think it's a very stable operation with very few risks for surprises of any sort.

Ana Maria Mora

Analyst

Thank you, Suso. This was our time for the questions. And now I will leave it to you for your closing remarks. Jesús Zamora Leon: Well, thank you very much, everybody. We know it's been a difficult year for -- in 2025 for Auna. We've done the work. It has been a year of introspection. It has been a year of a lot of internal work. We have built the foundation for continued and recovered growth for 2026 and onwards. I want to thank the investment community for supporting us and our mandate to transform health care in Latin America. Thank you again.

Operator

Operator

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