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Fresenius Medical Care AG & Co. KGaA (FMS)

Q4 2015 Earnings Call· Wed, Feb 24, 2016

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by. I am Patrick Wright, your Chorus Call operator. Welcome and thank you for joining the Fresenius Medical Care Earnings Call on the Fourth Quarter 2015. Throughout today's recorded presentation, all participants will be in a listen-only mode. The presentation will be followed by a question-and-answer session. I would now like to turn the conference over to Oliver Maier, Head of Investor Relations. Please go ahead, sir.

Oliver Maier

Head of Investor Relations

Thank you very much, Patrick. We would like to welcome all of you to the Fresenius Medical Care earnings call for the fourth quarter and full year of 2015. As always, I would like to start out the call by mentioning our cautionary language that is in our Safe Harbor statement as well as in our presentation and in all the material that we've distributed today. For further details concerning risks and uncertainties, please refer to these filings, including our SEC filings. With us today is Rice Powell, our CEO and Chairman, and Rice will give you a general business update and go through some of the highlights of the quarter and for the full year. And of course, we have with us Mike Brosnan, our Chief Financial Officer, who will cover with you the financials and the outlook. So that was the easy part for me. Rice, the floor is yours.

Rice Powell

CEO

Thank you, Oliver. Hello, everyone. Thank you for joining us. A warm welcome from my side. And as we traditionally do, I think we'll start on slide five with my prepared remarks. My headline for you today is this should have come as a no surprise announcement for you this morning. Given that the big change in the quarter we announced last week on February 18 with the GranuFlo settlement, I think that what you've seen today has a little more detail obviously than we gave you on February 18, but generally, everything is consistent with what we told you back a week ago. And hopefully, today, we'll be able to give you as much clarity as you might like on any questions that you have. Starting with slide five, we continue to see excellent business development in North America, doing very well, nice job, really getting things done in a way that we appreciate. Our Care Coordination organic revenue growth, again, is very strong and, I believe, 23% in the quarter, 25% on the full year basis. Our International business was driven by very good constant currency revenue growth in Asia-Pacific. We'll touch on that and the other regions in a few slides. You obviously have seen the improved cost structure due to the GEP program and our lower cost for health care supplies, and that is code for the success that we're having with Mircera and the conversion to Mircera. Not on the slide but I would comment that as you go through the investor news, you will find that both on the fourth quarter basis and our full year basis, you see that our revenue per treatment in U.S. is increasing and our cost per treatment going down. So we are heading in the right direction on…

Michael Brosnan

Management

Okay. Thank you, Rice. Hello, everybody. Glad you joined today. I'm on chart 13, looking at the fourth quarter and the fiscal year. So, starting with the left hand side of the chart and moving down, we'll talk a little bit about the quarter. Our reported operating income was virtually unchanged compared to last year. That's the $662 million versus $663 million. But as you can see on the chart, we've adjusted for a few special items. These are detailed in the Attachment 3 that was posted within the presentation this morning. But in short, we're adjusting for GranuFlo, the sale of the European market rights to our joint venture with Vifor and for the plants that we closed in 2014, consistent with our past discussions. So based on this, our operating income increased $35 million or 5% for the quarter. Following this through to the margins, our reported margins year-over-year decreased 20 basis points. Our adjusted margins improved to 16.2%, or 70 basis point increase. We'll come back to talk about the margins in a bit more detail in a moment. Net interest expense decreased $29 million. About half of this decrease was due to lower average debt levels. A small amount comes from translating our euro debt, and the rest of the decrease comes from interest income associated with the repayment of an interest-bearing note that we had with a provider in the U.S. Moving to the tax line, the tax rate shows an increase from 26.2% to 31.4%. Q4 this year is in line with our guidance, and we benefited in 2014 from a favorable court decision we had with regard to an old civil settlement. Our non-controlling interest, as you all know, is a North American story. The other regions combined have only a minor $2…

Oliver Maier

Head of Investor Relations

Great. Thank you, Mike; thank you, Rice for the presentation. That was great, lots of detail. So, Patrick, I think we can now open up for a Q&A.

Operator

Operator

Thank you. Ladies and gentlemen, at this time, we'll begin the question-and-answer session. And our first question today comes from the line of Tom Jones of Berenberg. Please go ahead.

Tom M. Jones

Analyst · Berenberg. Please go ahead

Good afternoon. I had a couple of questions. The first was on the Care Coordination business. I was just wondering if you could give us a bit more of a sense of the outlook for 2016. I guess we can continue to expect some fairly robust revenue growth, but I was thinking more specifically on the margin side. On that note, I think the Q4 margins came in a little bit light of what we were expecting in the Care Coordination business and certainly below what I was looking for. I was just wondering if you could shed a bit of light on that whether there was any kind of one-off spending that went on there or anything else? And then final question just a quick sort of housekeeping one for Mike really. I was wondering if you might be able to give us some kind of guidance or at least some thought based on your current earnings guidance and your CapEx and acquisition spending plans, where you think interest expense might go for 2016.

Michael Brosnan

Management

Tom, I'll take both. Relative to Care Coordination, what I would tell you is we'd expect a top line growth in the area of 25% to 35% in 2016, which I think would put you kind of in the mid-$2.5 billion to a little bit more than that, $2.5 billion to a bit more $1 billion in revenues for Care Coordination.

Tom M. Jones

Analyst · Berenberg. Please go ahead

Sure.

Michael Brosnan

Management

On the margin side, I think what you're seeing in the fourth quarter is a little bit more of investment, particularly as we got ready with the C-SNPs and the spending that needed to take place before we went live on that, on January 1, additionally investing in our ESCOs and the BPCI, in particular. But I think that puts us in a position when we look at 2016, I would say from a margin perspective, we'd be looking for margins in the range of 3% to 5% in fiscal 2016 because we're going to continue in investment mode in that business, so a good strong revenue growth and 3% to 5% in margins. Relative to interest expense, we – against the guidance, I would say, we'll have slightly higher interest expense after you adjust for the interest income associated with the paid-off note. So just simple numbers, if you take this year's, add about $10 million, I think we'd see something slightly higher than that. That is without the financing costs associated with the acquisitions. So given the $750 million we've guided to, I would say you'd probably want to add another $15 million to $20 million to cover the cost of acquisitions assuming that we close on average at the half year mark, at the $750 million.

Tom M. Jones

Analyst · Berenberg. Please go ahead

Okay. That makes perfect sense. And then just one follow-up maybe for Rice. Just on the ESCOs and the BPCI, I mean I think we've all kind of mentally put the ESCOs on the backburner given the scale of that project. But the BPCI does seem to be a much bigger project that's gained a lot more traction in the U.S. Where are we with that new and what are your thoughts over the next sort of 12 months to 24 months for the BPCI program?

Rice Powell

CEO

Yeah. Tom, I would – I think you're right, the way you're parsing that out, I think it's correct. We are looking and expecting that on BCPI (sic) [BPCI], we'll have a better idea of revenue and what's going to happen there in the back half of this year. We think it's going to take us some time as we talked about back to November. So we're thinking that's a back half of 2016 opportunity for us to get our arms around and give you some more definition about what we think it's going to be worth and what that revenue opportunity is going to look like. And I think you're right with ESCOs, it's going to be 2017 before we really have a good handle on that. But I will take a moment just to tell you that on the ESCOs, we're at about 8,000 patients at this point. If you recall, we had thought we could do maybe 9,000 patients or 10,000 patients knowing that in some months you could be up to 8,000 patients and that could drop a little bit because you do have washouts periodically. But we're pretty much tracking to playing on that, so we feel good about that. But it's going to be a 2017 exercise before we can really see what the shared savings which is going to look like and what the medical loss ratio might be.

Tom M. Jones

Analyst · Berenberg. Please go ahead

Sure. I mean just on the ESCOs since you mentioned it, I mean one of the so great hopes with that was that you'd be able to get a lot dual-eligibles into that program, and of that 8,000 patients, how many if you can share that with us are dual eligibles and how many are not?

Rice Powell

CEO

Tom, unfortunately, even if I wanted to tell you, I don't have that answer. I can get it before the day is out. So let me come back to you on that. I just honestly haven't thought to ask somebody about that.

Tom M. Jones

Analyst · Berenberg. Please go ahead

No, that was a fairly picky question. So I'll get back in the queue.

Michael Brosnan

Management

Thank you.

Rice Powell

CEO

And yes, you were picky.

Operator

Operator

And our next question comes from the line of Lisa Clive of Bernstein. Please go ahead.

Lisa Bedell Clive

Analyst · Lisa Clive of Bernstein. Please go ahead

Good afternoon. A few questions. First, just sticking on the ESCO topic. So my understanding in this was one of the reasons for the change in revenue guidance that you did at some point last year. With the ESCO accounting, it's now not a about capitated amount, it's shared savings. So it's going to be retrospective and so effectively you won't get to book any revenues until I suppose 2017. But if you do, I assume it will be sort of 100% EBIT. Could you just walk me through the math on that and the mechanics on that and whether that's roughly right? Second question, you've talked about the progress of switching patients onto Mircera. But I'm just wondering the patients who are left on Epogen over this time period. My assumption was – my understanding was that you were getting very significant volume rebates for having so many patients on Epogen, I mean potentially something up to sort of 35%. And if you've been massively decreasing your numbers of patients on Epogen, have those volume rebates been going down and therefore have most of the savings from Mircera kind of been washed out up until this point and when do we actually start seeing the savings coming through? And then the third question is, at your Capital Market's Day in 2014, I believe you talked about something like $2 billion of incremental cash returns over the 2015 to 2020 period. I think you had talked about potentially share buybacks, potentially special dividends, potentially just de-levering. Could you give us an update on what your thoughts are on how you may do that and when you may do that?

Rice Powell

CEO

Sure, Lisa. It's Rice. Mike if you would take three and I'll take a stab at one and two. On the ESCOs, you're exactly right. Lisa, it's a shared savings program. So it will be in 2016 or 2017, I'm sorry, before we get a sense of where that stands and obviously, we've got to get data from the government, we've got to look at that figure out what the medical loss ratio is to be able to compute that. So it will take us into 2017 to get that. It is not a revenue play if you will under that scenario. Anything you want to add to that, Mike?

Michael Brosnan

Management

Yeah, I might just add couple of things, Rice. I don't disagree at all with you, Lisa, that ESCOs were in the mix when we talked about this mid-year or last year, but it was also BPCI and in particular what we had said because the ESCOs hadn't even started yet. But what we said having just started BPCI a month or two prior was that probably best case. BPCI would be first half 2016. The ESCOs weren't even on the map yet, because they didn't get started until Q4. So, I think with Rice's comment earlier as we've seen the BPCI develop, we're now thinking that's probably more or like the back half 2016, ESCOs pretty clearly are going to be 2017. And I can't resist when anybody talked about 100% profits. We're very anxious to get started and we're very anxious to get the savings that we think we can achieve with good management of patients and their outcomes from a value based care perspective. But we are making investments in that business. We do have real people. They are doing real work. So there is a cost base that that savings will go against.

Rice Powell

CEO

Yeah. And so Lisa, on Mircera, a couple of things. So yes, we have only kind of put in perspective for you, if you consider 180,000 patients in the U.S., 25,000 of them really get no ESA or they maybe get a odd dose through the course of the year that gives us a population of patients that we can affect of a 155,000. So at 95,000, by end of Q4 of last year, we've converted about 62% of our patients. If we get to 110,000 patients by March 31, we'll be at about 71%. So what I'm trying to get you a little sense of is yes, we do have a pricing arrangement with Amgen. Obviously, they're not altruistic enough to continue to provide us big rebates given where this is going but what should give you some comfort is that the guidance that we are giving you has factored all of that in. So we are getting the benefit on the one hand from one supplier. There is somewhat of an offset, yes, but that's a dwindling population of patients is the way I would leave that. And then at this point, Mike, I will turn it over to you on the CMD.

Michael Brosnan

Management

Thanks, Lisa. Thanks, Rice. Lisa, relative to the expectations of the incremental cash flows, you're absolutely right. I'd indicated that we'd spend about $11 billion in CapEx and acquisition over the planning period which was 2014 though 2020. If you look at where we are in 2014 and 2015, we've spent just a little over $2 billion in acquisitions, most of that in 2014, as you know. And I would say, CapEx of about $2 billion. So think of that as $4 billion out of a potential $11 billion spend. I believe, we have dry powder. I think that we've ticked up the acquisitions a bit in 2016, because we're very focused on continuing to strive towards the aspiration that we shared with you last April. As we get farther into the planning period, if we're continuing to see that we have available cash, then we can consider some of those other alternatives.

Lisa Bedell Clive

Analyst · Lisa Clive of Bernstein. Please go ahead

Okay. Thanks very much.

Rice Powell

CEO

Thanks Lisa.

Operator

Operator

And our next question comes from the line of Gary Lieberman of Wells Fargo. Please go ahead.

Ryan Halsted

Analyst · Gary Lieberman of Wells Fargo. Please go ahead

This is Ryan Halsted on for Gary. Follow-up question regarding Mircera. If I look at the, sort of, the change in the profitability per treatment, sort of just revenue per treatment minus the cost per treatment, I'm looking at about a little over 200 basis points I guess of margin expansion in North America dialysis. I was hoping you can maybe reconcile that with the 300 basis points that you noted in our comments. And how much, I guess – is there some other place where the transition to Mircera might show up outside of the cost per treatment?

Rice Powell

CEO

Yeah. So Ryan, well, a couple of things. I'm not sure about the 300 basis points. We talked about $300 million is part of what the GEP say we should generate or you....

Michael Brosnan

Management

Yeah.

Rice Powell

CEO

Fair enough. Well, go ahead. I'll let you answer Ryan, on the first piece of that and since you're one that laid out.

Michael Brosnan

Management

Yeah. No, I mentioned a couple of things about – I said largely due to the healthcare supplies, so I think lion's share of that was related to it. But then I also mentioned a favorable impact associated with our mix of payers and that that was partly offset by some higher personnel cost. So I typically wouldn't get more granular than that, but there were some other things contributing to the 300 basis points margin performance.

Rice Powell

CEO

Yeah. I would say Ryan, we're seeing nice performance on our commercial book, guys are doing a good job with improving the number of commercial treatments, et cetera, so that works to our advantage in addition to what we're seeing with the move to Mircera, probably the best way to characterize it.

Michael Brosnan

Management

Yeah. I mean and I would say, because I'm sure you've kind of poked at this and someone else will ask on the call as well. So just relative to 2016 to make sure we started off the year with the right context, I'd just make a couple of remarks, not surprisingly given that Medicare, the reimbursement increase is going to be something on the order of 0.2%, if you do the math, so extremely modest. On the cost per treatment side, we'll have the usual labor increases that will be buffered by our cost management and that will include some of the actions we've taken this year with regard to healthcare supplies. So I think in total, cost per treatment will be slightly lower in 2016 versus 2015. We will have some seasonality. But nevertheless we do think that it will be slightly lower in 2016 versus 2015 on the cost side.

Ryan Halsted

Analyst · Gary Lieberman of Wells Fargo. Please go ahead

Okay. That's helpful. Maybe just a modeling question. The corporate expenses was a little bit higher than what I had modeled and I guess a little bit higher than recent quarters. What was included in that?

Michael Brosnan

Management

The corporate spending you're looking at is, the spending in corporate headquarters here in Bad Homburg and some of the corporate activities, including R&D and some of the overhead spending in our manufacturing organization, so that's based here in Bad Homburg. As I commented, it was a little bit higher than I would have liked to, just a bit, I think that mid-year I've guided to about $360 million. So if that's in your model, you can blame me, and we finished a bit higher than that. When I think about 2016, I would say, you should probably plan that flat at around $400 million, and that reflects an increase spend in R&D and the continued spending on the compliance investigation that we mentioned earlier as well as some of the investments we've made particularly in legal and compliance that we'll assess as we go forward.

Rice Powell

CEO

Yeah. Ryan, it's Rice. We've got a couple of new products that are coming out. And so we're spending a little more as we get on the eve of that. We've got a new in-center dialysis machine. We've got acute care or ICU machine coming out. And then we've got a newer version of our CRIT-LINE which is the actual device which used to be separate, is now going to be integrated into the machine. So we've got a couple of these things that will roll out over the next 12 months, 13 months, 14 months. And so, that's a little bit of hot spending that you're seeing there. And I think Mike mentioned this earlier, but just to remind you that the GranuFlo expense was sitting in North America because that's where this all really occurred. So, that's not part of that, Bad Homburg, Germany, if you will, expense.

Ryan Halsted

Analyst · Gary Lieberman of Wells Fargo. Please go ahead

Okay. Got it. Thanks for taking the questions.

Rice Powell

CEO

Sure.

Operator

Operator

And our next question comes from the line of Alex Kleban of Barclays. Please go ahead.

Alex Kleban

Analyst · Alex Kleban of Barclays. Please go ahead

Yeah. Thanks for taking the questions. First one is just for phasing on the quarters this year and just thinking about earnings and growth. Given where we've finished with cost-for-treatment in the Q4 and assuming some of those kind of inflationary increases don't hit until later on in the year. Is it safe to say that we have more of a front-end loaded 2016 relative to what we've seen in the past? Second question is a bit more detail on the modeling, but it's just really around income from investees which I guess is mainly to Vifor and such. Is kind of $40 million to $60 million range about right for that next year, just given where you are with Mircera and with Vifor? And just going to take a stab at this and see if you will answer, but in terms of the trend into 2017, which I know is pretty far at this stage, but you are kind enough to give us two years, last year, how do you see that and how do you see that relative to the kind of high single digit earnings after tax guidance you'd given for the long-term? Are we reverting back to that mean point, or would we still be a little bit ahead of that in 2017 given that some of the GEP and such is going to carry over into 2017? Thanks.

Rice Powell

CEO

So Alex, it's Rice. I think what we'll do is, I'll take that third question. Mike will take one and two. Nice try on 2017, but I think that we just really aren't in a place to try to walk you through that at this point. Obviously, as we look out in the future, we've got to see where foreign exchange and some of those things go. It's just kind of early for us to really try to prognosticate that. And as we had said earlier, two-year guidance is a rarity, it won't become the normal practice. So, I don't think you should expect we'd continue to do that. But – Mike you want to take the phasing question and the investee income?

Michael Brosnan

Management

Sure, yeah. In terms of phasing, I think you'll see a tick-up in Q1 off of Q4 relative to cost per treatment, which is normal. Typically, there is always that bump in the first quarter. But having said that, Q1 of 2016 will be a little bit less than Q1 of 2015, if that's helpful. Income from investees, to be honest, don't typically guide to that level. So, I'll just take a pass on that. Yeah.

Alex Kleban

Analyst · Alex Kleban of Barclays. Please go ahead

Okay. And just for the phasing in terms of the earnings growth, will it be faster than the 20% or 15% to 20% in H1 and then slower in H2? Is that a fair assumption?

Michael Brosnan

Management

I think actually with everything we're doing, I think it would be the reverse.

Rice Powell

CEO

Yeah. We think it will ramp more towards the back half.

Michael Brosnan

Management

Yeah. It will ramp more towards the back. I think – typically our Q1 is never our strongest quarter, so I'd expect that pattern would continue and then as the year progresses...

Rice Powell

CEO

Get better.

Michael Brosnan

Management

...get better.

Rice Powell

CEO

Historically, if you look out, Alex, you will see that's kind of the way it plays.

Alex Kleban

Analyst · Alex Kleban of Barclays. Please go ahead

No, that's why I was thinking this year could be exceptional just because of what we've seen in terms of the step-down in cost per treatment. And I was thinking maybe you'd have some gradual rise in that over the course of next year. But I guess you're saying we'll see the rise in Q1 and then maybe some decrease sequentially through the year. Is that how we should think about it?

Michael Brosnan

Management

Well, I think not focusing on just the U.S. and just taking a look globally, I would say just in terms of what was commented on today, we do think the cost per treatment will be slightly better. We've mentioned the fact that we are continuing to make investments in Care Coordination, and as Rice commented, some of that Care Coordination benefits will be more towards the back half of 2016, and we are also continuing to deal with the headwind of foreign exchange.

Alex Kleban

Analyst · Alex Kleban of Barclays. Please go ahead

Okay. Okay, great. Thanks. I'll get back in the queue. Thanks.

Michael Brosnan

Management

Sure.

Operator

Operator

Our next question comes from the line of Chris Cooper of Jefferies. Please go ahead.

Chris Cooper

Analyst · Chris Cooper of Jefferies. Please go ahead

Hi, there. Thanks for taking my questions. I think you may have just covered it, but if I could just clarify please on the corporate EBIT. It sounds as though the strategic investments into the legal and compliance and the R&D functions explains some of that increase there. Should we think about that as a step-up and then from there, it's just incremental increase? Or is this kind of the sort of rate of – the run rate that we should think about going forward? Secondly, on Mircera, it's very kind of you to give the 110,000 number. Should we be thinking that it could get to 135,000 patients over the longer-term? And I'll come back with the third if that's okay.

Rice Powell

CEO

So Chris, let me take number two and Mike can take one. Mike's looking at his papers, so I'll just answer quickly on Mircera. Keeping in mind that I don't really get to control – I wish I did – exactly how many patients are going to convert. I don't think it's out of the realm of possibility that we could be up around the 135,000 patients, but it's hard for me to predict because there's just a lot of different variables that go into that. So I'm just going to kind of leave it sort of that range and say it's possible. We'll probably have better clarity on that as we go through Q1 and we can kind of get a sense of where this is going to play out. It's not impossible. But I can't peg it for you right now. I just don't think it would be appropriate.

Michael Brosnan

Management

Yeah. And I would say, I pretty much covered it for 2016 with flat at about $400 million. I think over time that might moderate a bit. But at this point with the variables we have in there trying to balance one-off legal spending against R&D investments, I'd probably leave it there for a bit and then maybe take it down slightly as we move out in years.

Chris Cooper

Analyst · Chris Cooper of Jefferies. Please go ahead

Sure. Thanks. And just one follow-up, and please more of kind of a bigger picture question I guess. Can you just give us a sense please about homecare and as we stand today what proportion of your dialysis sales makes – is made up of homecare revenues and I guess what your aspiration there might be over the next sort of three years to five years, please?

Rice Powell

CEO

Sure, Chris. It's Rice. I would tell you that we're probably somewhere as a percent of patients on home treatments in the 12% range, something like that. The vast majority of that 12% sits in the PD book of business, if you will. So that's kind of where we are. I've often said I didn't see a reason that we couldn't be somewhere in the mid-teens. I think it's going to take better technology. I think quite honestly, we need some more user-friendly equipment if you will to make that happen and we're working on that now. But I think that's kind of where we sit today. We're not quite yet into the teens, but I think it's doable and we could get there over time.

Chris Cooper

Analyst · Chris Cooper of Jefferies. Please go ahead

Great. Thank you.

Operator

Operator

Our next question comes from the line of Ian Douglas-Pennant of UBS. Please go ahead.

Ian Douglas-Pennant

Analyst · Ian Douglas-Pennant of UBS. Please go ahead

Yes. Thank you very much for taking my question. Just going back to the topic of ESCOs because I'm afraid I disagree with Tom, I do think this is important. Could you give us an update on your – any negotiations that you're having with private providers, or just any commentary you could make there where this is likely that we would see any kind of arrangement come into place either this year or even next year? That would be great. Thanks very much.

Rice Powell

CEO

You are right, it is important. But what I can tell you at this point is that we're still in the process, running the pilot that we have with Aetna, that still continues. I don't really have any clinical data that I can share with you. Beyond that, we have discussions with some other folks, but there is no real change from the last time we spoke about it. I think I would say it's sort of still in a steady state if you will, but if something should change there in the next quarter, we'll certainly let you know.

Ian Douglas-Pennant

Analyst · Ian Douglas-Pennant of UBS. Please go ahead

Okay. And those other discussions you're having at are relatively early stage still or...?

Rice Powell

CEO

That's correct, yes.

Ian Douglas-Pennant

Analyst · Ian Douglas-Pennant of UBS. Please go ahead

Thanks very much.

Operator

Operator

Our next question comes from the line of Veronika Dubajova of Goldman Sachs. Please go ahead.

Veronika Dubajova

Analyst · Veronika Dubajova of Goldman Sachs. Please go ahead

Good afternoon, gentlemen. And thank you for taking my questions. I have three please. I'm afraid they are mostly for Mike. The first one is just on the GEP program, and I appreciate you exited at $200 million. But can you actually tell us the number what was the actual realized saving in the full year relative to the run rate at year end just so we can think about what the progression is through 2016? My second question is just on the Care Coordination margin in the medium-term, I think you previously discussed something in the low-teens. Is that still something you feel comfortable even though obviously, you're making some big investments at this stage, but would you still be comfortable with people thinking of a medium-term low-teens margin for Care Coordination? And my last question is just quickly at tax rate guidance for 2016? Thank you.

Michael Brosnan

Management

What was the third question?

Rice Powell

CEO

It was tax rate guidance.

Michael Brosnan

Management

Okay.

Rice Powell

CEO

Hang on, one second, Veronika, Mike is going to come back to you. We just held that question for him. Okay.

Michael Brosnan

Management

Let's see, I think on the GEP, we'll look at some stuff and maybe come back to you on that shortly. With regard to the tax rate, I would say 32% to 33% for 2016, so consistent with what I indicated for 2015. On the Care Coordination, I would say that when – at the CMD in April when we were talking about what the behavior of the different parts of our businesses margins might be or business in Care Coordination, we had not closed anything at that point in time in Care Coordination. And then subsequently, what we said is given the nature of the business is that we've now put in Care Coordination. We have the businesses that everyone knows very well that let's say are high-single to low double-digit margins. Then we have the insurance businesses which traditionally are lower margin businesses. So I think where we land on Care Coordination is very much going to be a function of the relative weighting of the growth of those businesses as we go forward. So I tend to think of it myself as maybe eventually – I'll let Rice do the counter-point here, I would say mid to high single-digit. Rice would probably push it into double-digit territory.

Rice Powell

CEO

Yeah. I want to see us get to double-digit. But I think Mike's given you a pretty good scorecard on it. And look at – as you well know Veronika when you look at the set of assets, and I've said this before, the vascular businesses look kind of like the dialysis business does in the core. When you look at the pharmacy is doing a good job, the pharmacy distribution businesses generally are in the mid single-digit. Sales can improve and I think they will. That's where you're really going to see I think the opportunity for improvement. And when you look at the health plan, as Mike said, we don't know exactly what to tell you because we are in such a ramp-up phase and sort of a discovery phase if you will. So, we're not trying to be evasive. We just don't want to get into trying to parse out each one of those, we don't know enough right now to do that. But rest assured given the way we've broken out the segments, we're always going to be talking about this and we'll get better at giving you some kind of prognostication.

Michael Brosnan

Management

Yeah. And I'd just add, we still – coming into 2016, we still had got about five years left in terms of our mid-term plan. So, there is a fair amount of run rate left for us to develop this business along the lines that we'd like to. And we're also looking at the fact that this generally is a lower capital intensity than dialysis business. So, we're looking to improve the ROIC as a consequence of lower margin if you will to balance it out from an investor's point of view.

Veronika Dubajova

Analyst · Veronika Dubajova of Goldman Sachs. Please go ahead

Understood.

Rice Powell

CEO

And then GEP?

Michael Brosnan

Management

We're still looking. We may not be able to get to that number on the call, Veronika. But generally, we feel very good about GEP. We think we're on track for the $300 million. In 2016, nothing really extraordinary to report there other than the fact that we're pleased that we've been able to materialize those savings over the planning period.

Veronika Dubajova

Analyst · Veronika Dubajova of Goldman Sachs. Please go ahead

That's great, Mike. And are you able to comment on whether you'd uncovered further opportunities beyond the $300 million as you've been through the process? And as you'd look beyond 2016 into, let's say, 2017 to 2019, are there other big saving opportunities that might appear during that timeframe?

Rice Powell

CEO

Yeah. Veronika, it's Rice. What I would tell you is, it does get a little harder. We've got some projects that we are definitely working on. Predictability is not as easy as this, what I'd call first phase, which is when you're consolidating purchasing and you're taking four suppliers down to one, et cetera, it gets pretty granular as to what you're going to say. We are not looking at things like, how best to take our new equipment and can we have our equipment drive the lights, gas and water in the clinic; can we get to a point where remotely we can turn on in clinic and get it up and ready to run, so nurses don't come in an hour and a half early, they come in 30 minutes ahead of the shift, things like that. We don't know enough right now. And it's sufficiently difficult, technically to see if this is really going to work for us. I don't want to try to give you a guess, but what I would say is the concept and the focus on improvement is going to continue. And wherever we can find wins we're going to take them. Some of the bigger things we're looking at are going to take us a little more time to try to see what we're going to be able to do.

Veronika Dubajova

Analyst · Veronika Dubajova of Goldman Sachs. Please go ahead

Understood. Thank you. I'll jump back into the queue.

Rice Powell

CEO

Sure. Thank you.

Michael Brosnan

Management

Thank you, Veronika.

Operator

Operator

And our next question comes from the line of David Adlington of JP Morgan. Please go ahead.

David J. Adlington

Analyst · David Adlington of JP Morgan. Please go ahead

Thanks for taking the questions. Two please. So firstly, just in terms of the one-off costs you recognized last year associated with both the cost savings program and the legal cost on GranuFlo. I just wonder if we toss all those up, how much that would have come to and I'm presuming they mostly drop out during 2016. And then secondly, you also pointed towards the pickup in acquisitions. I would just love to get some color on timing and what areas we might expect those to be? I mean, clearly, Care Coordination is going to be a focus, but I suspect also dialysis services. Just any color you might be able to share with us there, please.

Rice Powell

CEO

Yeah. So David, I'm going to ask Mike to help me on this. What I will say though first is, we really can't give you a sense of the GranuFlo. Having just reached a settlement, I really don't want to get into that kind of detail, because you don't want people to feel like they could have done better in settlement if you will. So I think we're going to have to leave that alone. In terms of acquisitions, if we say anything whatever it is we're thinking about, the price is going to go up considerably between now and the next week, so we probably won't do that, other than to say, we are looking globally. We are looking at care as well as the core business and I think we'll leave it at that. I think anything else probably doesn't help us. And then relative to the GEP cost, Mike in terms of implementation cost, I don't really remember what the – if we had it – what the number was for 2015.

Michael Brosnan

Management

We never separated it out between the two, other than to acknowledge that we had some. In 2014, it was a net cost exercise...

Rice Powell

CEO

Yeah.

Michael Brosnan

Management

...yeah – 2013, it was a net cost exercise. 2014, 2015 we started to show a net benefit. So I think we're well enough into the program that the one-off costs are pretty de minimis. It's more about reaping the – harvesting the saving.

Rice Powell

CEO

Yeah. I think one thing we can just remind you of, back in the very beginning – Mike's right, we said we're going to spend $100 million to try to get at the $300 million. But we're out of place now where it's not a big number in terms of what the implementation costs are.

Michael Brosnan

Management

Right.

David J. Adlington

Analyst · David Adlington of JP Morgan. Please go ahead

Okay. Fair enough. And maybe just a follow-up on the acquisitions, maybe timing and also in terms of your guidance, if you do make any dilutive acquisitions, is that captured within the guidance?

Michael Brosnan

Management

Well, the guidance is without acquisitions. So I think it's our intention to have it accretive. If it's not, then I'll certainly be talking about it, but I can't – yeah, just that.

Rice Powell

CEO

Yeah. And we just don't think it's smart, David. I know you'd like to know. We just don't think we can start to give you a sense of when we think something is going to pop or we're going to do a deal and close because it's just not that easy. So I just don't think we can go there.

Michael Brosnan

Management

Okay. David, I took your question along the lines of, can I have my cake and eat it too.

David J. Adlington

Analyst · David Adlington of JP Morgan. Please go ahead

Nice try.

Michael Brosnan

Management

Am I correct in that?

David J. Adlington

Analyst · David Adlington of JP Morgan. Please go ahead

Fair enough, guys. Thanks very much.

Rice Powell

CEO

Thank you.

Michael Brosnan

Management

Thank you.

Operator

Operator

There are no further questions from the phone lines.

Oliver Maier

Head of Investor Relations

Okay. Great. So thank you very much everybody. Thanks for the questions. Thanks for participating today. Looking forward to seeing you soon and talk to you soon.

Michael Brosnan

Management

Thank you. Thank you for your interest.

Oliver Maier

Head of Investor Relations

Take care. Cheers, bye-bye.

Rice Powell

CEO

Thanks, bye-bye now.

Operator

Operator

Ladies and gentlemen, the conference is now concluded. And you may disconnect your telephone. Thank you for joining, and have a pleasant day. Good bye.