Auna Q2 2024 Earnings Report

Auna EPS Results

• Actual EPS: $0.03
• Consensus EPS: $0.15
• Beat/Miss: Missed by -$0.12
• One Year Ago EPS: N/A

Auna Revenue Results

• Actual Revenue: $292.00 million
• Expected Revenue: $299.17 million
• Beat/Miss: Missed by -$7.17 million
• YoY Revenue Growth: N/A

Auna Announcement Details

• Quarter: Q2 2024
• Date: 8/21/2024
• Time: N/A
• Conference Call Date: Wednesday, August 21, 2024
• Conference Call Time: 5:00PM ET

Auna (NYSE:AUNA), listed on the New York Stock Exchange under the ticker symbol AUNA, is a Peruvian integrated healthcare services company headquartered in Lima. The firm operates a diversified care network that spans hospitals, outpatient medical centers, diagnostic imaging and laboratory facilities, as well as optical and dental clinics. Auna’s organizational structure is designed to support a continuum of care model, offering both general and specialized treatments across multiple touchpoints.

The company delivers a broad range of clinical services, including emergency care, inpatient and outpatient surgery, obstetrics, cardiology, oncology, orthopedics, and other specialized disciplines. Its diagnostic division provides advanced imaging and laboratory testing, while its network of optical and dental clinics addresses routine and corrective needs. Auna also places an emphasis on patient experience, employing digital tools such as online appointment scheduling and telemedicine consultations to streamline access to care.

Formed in 2018 through the consolidation of several regional healthcare operators, Auna has expanded its footprint throughout Peru’s major urban centers. Headquartered in Lima, the company continues to invest in facility upgrades and technology enhancements to meet growing demand for private healthcare services. Under its executive management team, Auna has prioritized the integration of healthcare delivery systems and the development of digital health platforms to support long-term growth and operational efficiency.

Auna Q2 2024 Earnings Call Transcript

Key Takeaways

• On a consolidated basis, second-quarter adjusted EBITDA rose 25% year-over-year on an FX-neutral basis, with margin expansion of 2 percentage points and operating income up 29%.
• In Peru, adjusted EBITDA nearly doubled year-over-year to a 21% margin, driven by 15% revenue growth, ~72% occupancy and continued strong demand for high-complexity services.
• In Mexico, the pilot of Onco Mexico oncology insurance launched in Monterrey, physician recruitment initiatives boosted high-complexity volumes, and the region sustained a 33% adjusted EBITDA margin despite modest revenue growth.
• In Colombia, revenue grew 18.3% and adjusted EBITDA rose over 10% on higher high-complexity mix and 81% occupancy, but an extra COP750m bad-debt provision underscores regulatory and collections risk.
• The company reaffirmed 2024 guidance of at least 20% adjusted EBITDA growth on a constant-currency basis, aims to reduce net leverage to 3x EBITDA, and highlights only 1% market share in Latin America as an opportunity.

Presentation

[Operator]

Good morning, and welcome to Auna's second quarter 2024 earnings conference call. My name is Rob, and I will be the 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 Maria Mora, Head of Investor Relations. Please go ahead.

[Ana María Mora, Head of Investor Relations at Auna]

Thank you, operator. Hello, everyone, and welcome to Auna's conference call to review our second quarter 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 two. Before we begin, we 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.

[Ana María Mora, Head of Investor Relations at Auna]

Investors should read carefully 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 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.

[Ana María Mora, Head of Investor Relations at Auna]

For a description of these risks, please refer to our Form F-1 filing with the U.S. Securities and Exchange Commission and our earnings press release. Slide three, please. 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 second quarter performance, as well as discuss our performance outlook. We'll then open the call for your questions. Suso, please go ahead.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you, Annie, and welcome, everyone. Let's begin our review on slide four with a few highlights on the quarter. First of all, our growth momentum accelerated in the second quarter as we continued to scale our vertically and horizontally integrated healthcare platform, as well as benefit from various synergies that we achieved through regional integration and scale. We continued to grow consistently and more predictably. Auna's adjusted EBITDA increased 25% on an FX neutral basis, while our margin expanded two percentage points. Growth reflects the consistently strong performance of our operations in Peru and Colombia, and it validates once again the strength of our diversified and scalable healthcare platform, as well as the effectiveness of our growth strategy. Implementing The Auna Way at our healthcare network in Monterrey is gradually beginning to bear fruit.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

We are seeing productivity starting to rise among new and existing physicians, along with increases in certain high-complexity services. OncoMexico is another pillar of our growth plan for Mexico, and we have launched in Monterrey the 2024 pilot of this integrated cancer insurance. This is the country's first monoline oncology insurance, fully integrated into our network of healthcare services in Monterrey and will potentially grant access to many families to full healthcare solutions. With that context, let's take a closer look at our second quarter performance, beginning with our consolidated results on slide 6, please. So our top-line growth of 12.5%, combined with improving operation efficiencies, drove operating income 29% higher versus last year's quarter.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

And our adjusted EBITDA, EBITDA margin expanded two percentage points, helping drive adjusted EBITDA 25% higher on an FX neutral basis, along with an improved services mix and higher occupancy levels. As such, we remain on track to achieve our 2024 guidance for adjusted EBITDA growth of 20%, also on a constant currency basis. Peru and Colombia continue to perform strongly, underpinning our growth, while we deploy our business model in Mexico, where we expect to replicate our success on a much larger scale, given the size of Mexico's healthcare market, of course, and the low penetration levels of private healthcare in the country. The implementation of the Monterrey is a gradual and a deliberate process of skill building that will result in improved engagement with physicians, that will produce increased volume, and more so of high complexity procedures.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

We are beginning to see the results of our engagement with physicians and as well with payers. Our future success in Mexico is a function of our capacity to replicate the consistent and predictable performance of our Peruvian and Colombian operations over many years. As you can see in the bottom left of this slide, occupancy across our healthcare platform increased 3.7 percentage points as we ramped up new and expanded care facilities. The vertically integrated model in Peru continued to deliver strong results, demonstrating again the value of our business model at maturity and at scale. Now, let's review our second quarter performance on each of the business segments that comprise the Auna diversified and integrated healthcare platform. Can we go to slide eight, please?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

So here, our healthcare business in Mexico, in the fast-growing Monterrey area, is steadily delivering better results, thanks to improving productivity and higher surgery volumes. This reflects the progress we are making with finding a recruitment and incentive model with physicians. Occupancy levels were flat, and 3% revenue growth was primarily driven by mix, that is, growth in high-complexity services. Adjusted EBITDA was flat versus last year, with a healthy 33% EBITDA margin. Aside from physician recruitment, we also intend to increase capacity utilization through initiatives with our payers, offering tailored products and bundled services. We are creating win-win partnerships with insurance companies and employers as we do in Peru and Colombia. Longer term, OncoMexico will be another growth driver. During the remainder of 2024, we are establishing the necessary operational capabilities in clinical and commercial areas, as well as risk underwriting and other key functions.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Let's move to slide nine, please. So, with respect to Peru, our fully integrated operations there saw Adjusted EBITDA almost double from last year's second quarter, as well as a continued margin expansion. Revenue grew 15%, mainly on a sustained occupancy level of nearly 72%, as well as the growth in plan membership and revenue mix across both segments. All of this reflects the harvesting of growth investments made in prior years, focusing on high-complexity and capacity utilization, as well as synergies achieved across the platform. We've maintained the gains in EBITDA margin seen in last quarter, with our consolidated Peru margin at 21% for this second quarter. Our healthcare services business benefited from an improved mix of high-complexity services across our healthcare footprint in Peru.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

In our healthcare plans business, in addition to member growth, sales increased on higher revenues from our integrated hospitals, including co-payments and non-covered expenses. Revenue also benefited from price adjustments to our healthcare plans. In addition to top-line growth, Adjusted EBITDA benefited from a decline in SG&A, while member acquisition costs decreased on higher efficiency levels. Our oncology MLR is at 54.7% year to date, increasing versus 51.5% from last quarter, mainly impacted by an increase in intercompany fees between our Oncosalud insurance company and our integrated oncology hospitals. Given that the intercompany effect is eliminated at the gross margin level in our healthcare plan business, gross margin remains flat in healthcare plans versus the first quarter of 2024. Lastly, on Peru, we continue implementing a number of strategic growth initiatives related to our healthcare network.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

We're seeking to convert more of the outpatient services we perform by cross-selling adjacent services. We are strengthening our B2B relationships nationally to increase patient referrals through this channel. And on the high complexity front, we are recruiting new doctors in the field of neurosurgery and traumatology. In the healthcare plans business, new growth initiatives include increasing the productivity of the direct sales channel by improving the sources of new leads and referrals, acquiring more B2B customers, and we continue to capture more of the healthier, lower-risk, respected customers who have a history of good health. If we move to page 10, we can do a little dive into Colombia. In Colombia, driving the 18.3% growth in revenue was a greater mix of high-complexity services and occupancy, which increased six percentage points to 81%.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

The more profitable mix of high-complexity services, coupled with higher occupancy, drove a more than 10% increase in Adjusted EBITDA and also helped Colombia maintain healthy margins. Additionally, we kept levels of SG&A expenses in check, thanks to efficiency initiatives and post-merger synergies we have achieved. Given the current regulatory environment in Colombia, we will continue prioritizing working capital and profitability. With that, I'll turn the call over to Gisele for a more detailed review of our second quarter results.

[Gisele Remy, CFO and EVP at Auna]

Thank you, Suso. Good afternoon, everyone. Let's move on to our consolidated results for the quarter, starting with revenue on slide 12. As Suso mentioned, we delivered solid revenue growth in the quarter. We grew 18% in soles year-on-year, or 13% in FX neutral terms, as our mature segments in Peru and Colombia continued to drive growth, and our Mexican business steadily positioned itself to replicate the same success. All our businesses have shown consistent growth on a year-on-year basis. Let's move on to slide 13. Adjusted EBITDA growth for the quarter was 31% year-on-year in soles, or 25% on an FX neutral basis, with the margin expanding to 22.1% off the back of strong margins in the three geographies. Strong revenue growth, coupled with efficiencies across the local and regional levels, drove EBITDA growth and margin expansion.

[Gisele Remy, CFO and EVP at Auna]

Operation in Peru maintained the margin gains that we saw in the first quarter of this year, with an Adjusted EBITDA margin of 21%, while our operation in Mexico sustained a 33% Adjusted EBITDA margin, despite investments and increases in costs and SG&A, given the local and regional capabilities that we continue to build. Colombia had a 15.3% margin. Finally, across the region, we continue to be very disciplined with our SG&A. Let's now move on to slide 14 to talk about net income. Auna maintained a positive adjusted net income in the quarter. Just a comparable period last year, adjusted net income in the second quarter of 2024 was favorably impacted by an increase in operating profit as well as a deferred tax benefit.

[Gisele Remy, CFO and EVP at Auna]

However, these benefits were offset by the FX variance for the quarter, mainly due to the accounting impact of the movement of the Peruvian sol below the floor of the call spread hedges in place in Peru, generating an FX loss for the quarter versus an FX gain for the comparable quarter in 2023. Let's now move on to slide 15 to look at cash flow generation thus far in 2024. Year to date, operating cash flow generation remains solid, off the back of growing operating results, coupled with a stable cash conversion cycle. Organic CapEx also remains stable versus 2023 levels. This investment cash flow for the quarter had an extraordinary impact related to the 47 million soles payment of our IMAT Oncomédica earn-out obligation. Let's now move on to slide 16 for an update on our balance sheet and debt position.

[Gisele Remy, CFO and EVP at Auna]

Leverage continued to fall, according to plan, to 4.13 times net debt to Adjusted EBITDA in the second quarter of 2024. We continue to maintain steady deleveraging on the back of solid growth. Debt levels remain stable to what we saw in the first quarter of 2024, and we continue to maintain a healthy debt structure and maturity profile in support of our growth strategy. Finally, we continue to focus on cash flow generation and deleveraging, with the objective of reaching our medium-term target of 3 times net debt to EBITDA. This concludes our discussion on the consolidated financial results. I will now let Suso wrap up our presentation with his final remarks before we move on to Q&A.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thanks, Gisele. Before we open the call for questions, I would like to end the remarks with our outlook and near-term priorities. Please turn to slide 17. First, we remain on track to deliver Adjusted EBITDA growth of at least 20% in FX neutral terms in 2024, as the fundamentals of our operations remain strong. Peru will continue to have a very material and positive impact on 2024 growth, while growth in our operations in Mexico will be more back-ended towards the second half of the year, as the aforementioned initiatives mature into the second half of the year and in 2025. Finally, in the case of Colombia, we will grow moderately within the context of prioritizing cash flow.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Mexico will become another key growth driver in the coming years as we leverage our 35 years of experience with Oncosalud, and leverage Integra, now Auna Seguros, capabilities to roll out OncoMexico at scale. Lastly, we remain excited about Auna's future, given that we are only in the early stages of penetrating and consolidating Spanish-speaking Latin America's highly fragmented, inefficient, and underserved healthcare market with our proven operating model and scalable regional platform. For perspective, despite our size and scale, we only have 1% market share today, so our growth runway is quite low. As always, patient centricity and value-based care are at the heart of what we do each day, with a focus on providing long-term patient care and excellent medical outcomes through prevention, detection, and treatment. With that, I conclude my remarks. Operator, please open the call for questions.

[Operator]

At this time, we will open the floor for your questions. As a reminder, you can also submit your questions online by using the Q&A function of the webcast platform. Your first question comes from the line of Samuel Alves from BTG. Your line is open.

[Samuel Alves, Associate Partner at BTG]

Thanks. Good evening, Suso, Gisele. Good evening, everyone. Two questions here from our end. The first one, regarding the deceleration top line in Mexico. What do you guys believe that drove the deceleration? If it was caused mostly by a point comp effect versus 2023 in the second quarter. That's the first question. And the second question, regarding Colombia, you guys comment on the press release about an increase in the impairment for PDAs. Just as a clarification, if you guys could provide like the amount of PDAs that jeopardized second quarter results, and how do you guys are monitoring this situation? Thank you very much.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you, Samuel. With respect to Mexico, I'm not concerned. There is some seasonality as we discussed in the first quarter. No, but we are working in high complexity. And the shift to high complexity, you know, has certain impacts that you will see very positive in the second half of the year. So I see and I can of course see how high complexity is penetrating the revenue mix, and how our physician hunting is delivering the right doctors and the right incremental volume, and what we want to be doing in Monterrey. So, I'm not concerned. It's in line with what we expect, Samuel. With respect to Colombia, I don't know, Gisele, if you want to respond to Samuel.

[Gisele Remy, CFO and EVP at Auna]

Yeah, sure. Samuel, could you repeat the Colombia question, which I couldn't hear that well on this end?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

It's related to the impairment.

[Samuel Alves, Associate Partner at BTG]

The question was regarding... Yeah-

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Go ahead

[Samuel Alves, Associate Partner at BTG]

The comment that you guys are making, the press release about the increase in the impairment for PDAs for doubtful accounts. Just if you guys could provide the amount of PDAs that are jeopardizing the second quarter results, and also if you guys see risks for higher PDAs in the coming quarters.

[Gisele Remy, CFO and EVP at Auna]

Yeah, sure. Of course, so the impact of the additional impairment reflected in the second quarter is approximately $750,000 in the second quarter, and this is due to the fact that we have increased the impairment recognition, given the current market context in Colombia. We see that accounts receivable, as you've seen in the press release, are stable versus what we saw last quarter. We think that there will be a slightly higher recognition of impairment in the year to go, probably consistent to what we're seeing in this quarter, but this is mainly just reflecting the higher risk situation of the market currently.

[Samuel Alves, Associate Partner at BTG]

Thank you very much.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you, Samuel.

[Operator]

Your next question comes from the line of Leandro Bastos from Citi. Your line is open.

[Leandro Bastos, Equity Research Director at Citi]

Hello, guys. Good evening. I have two questions as well. First one, if you could just comment a little bit, the early impressions of OncoMexico, the launch in July, how you're seeing kind of, how the product is kind of evolving in the region. And that will be the first one. And then the second, if you could talk a little bit about margins. In Peru, there was a big increase, year-over-year, especially in hospitals. So just to understand whether there was any one-off last year, and what were the main levers to increase margins at both hospitals. Also, Oncosalud, despite kind of a rising MLR. So if you can just kind of provide some color on this, year-over-year, I think would be helpful. That will be it. Thank you so much.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you. Thank you, Leandro. Gisele, let me take the first one and maybe half of the second one, and maybe you can complement. So, on OncoMexico. And thank you for the question. Our goal, of course, in OncoMexico, is to lead in the long-term private oncology market in Mexico. And to do that, we're deploying a set of initiatives now. As you mentioned, as of July first, we launched our Oncosalud B2C insurance product for direct sales in our hospital floors. We have launched it in a pilot mode to test product market fit and to learn about the commercial channels and how they are performing. This is for us a critical stage for a predictable future escalation of the commercial efforts of OncoMexico.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

We have put a small sales team in each of our hospitals to start creating awareness of the product. We have achieved some sales, a lot of leads, and we feel enthusiastic as we are opening new channels in the weeks to come. New channels, we're opening, I think a week from now, or two weeks from now, digital sales. After that, a couple weeks after that, telemarketing sales. And also we're working with a large broker for B2B employer negotiations. We are convinced that this product represents a new era in insurance and mono risk insurance in Mexico. It is clearly a disruptive product that doesn't exist in Mexico, and engagement with our sales force is really rich.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

In addition, when we see OncoMexico, we are in different stages as well of negotiations with two large payers in Monterrey, offering solutions to their challenges. For example, a breast cancer value-based contracting model that we are leveraging, of course, from Colombia and Peru. This is the first of its kind in Mexico. This would allow Auna to build the capacity to serve payers and position Auna as a value-based oncology organization that is part of the solution to the rising health spending in oncology in the world, but in particular in Mexico, of course, now. And in addition to that, very much related, we are also in the advanced stages of a physician practice association model with the most reputable oncology group in Monterrey.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Now, this association will boost our local oncology activity, and of course, help us build a local oncology center of excellence that we have planned now. I wanna. I love the question, Andrew, because we are very much focused on this, and I love it that the market is focused on this as well. This is the highest priority project we have, you know, given that it does not consume capital until later stages, for we are, of course, using the installed capacity in Monterrey for the deployment, and it promises a total addressable market of at least ten times what we have already developed and harvested in Peru. So that's on OncoMexico, you know. And on Peru, I would just like to introduce the response from Gisele.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

It is, again, what we have done and, what we know how to do and how scale works in our favor and Peru is harvesting this very, you know, successful integrated model, vertically integrated model of care and, you know, the more we penetrate our sales with that or revenue to that, you know, the more scale it grants, the higher margin is also delivered there so, Gisele, can you complement this?

[Gisele Remy, CFO and EVP at Auna]

Yes, of course. Thank you, Suso. Margin for the consolidated Peru business will be at the approximately 20% level for Peru this year. And you guys already saw us at 20% in the first quarter. So the 21% that we're seeing this quarter is just basically consistent with that, and maintaining the gains that we had already seen in the first quarter of the year. Growth versus last year, as far as the EBITDA in Peru, does have a slight seasonality impact in the base of last year because of some SG&A seasonality last year. However, the 20% margin levels for this year are sustainable, and that is what we should be seeing in 2024.

[Leandro Bastos, Equity Research Director at Citi]

Great, guys. Thank you so much. Very clear.

[Operator]

Your next question comes from the line of Mauricio Cepeda from Morgan Stanley. Your line is open.

[Mauricio Cepeda, Analyst at Morgan Stanley]

Thank you. Thank you, Suso, Gisele, for the opportunity here. So, two questions. The first one, again, about Colombia. We know that the discussions about the healthcare system seems to persist there. How are your risk assessments about future impacts, and notably in terms of the cash flows from the EPSs or from ADRES, or even risks of having to negotiate tickets and other things like that? So a little bit on your risk assessment about the country. And second question about the MLR in Peru. We saw it's kind of varying a little bit, varying up now.

[Mauricio Cepeda, Analyst at Morgan Stanley]

So if you see that is a problem of seasonality or the fact that the mix of the B2B mix, or if there is any influence on freshness of wallet, or lack of freshness of the wallet, if there was differences in designs of policies or health technology pressure. So whatever reason that is making this MLR oscillate. Thank you.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Great. Thank you very much, Paul. So, I'll try to give introduction to both, and maybe you can complement Gisele as well. So in the first one, Colombia, I think we've seen the worst of it. A lot of discussion on the reform that didn't pass, a lot of pressure. Yes, an intervention of a large payer, but with the agenda that this intervened payer should perform better than, you know, when it was not intervened. So in terms of a hospital group like us, we do not see, you know, our accounts receivables growing in number every day. So, and, notwithstanding that, of course, you know, we're risk-averse, and we've taken a position to make sure that our revenues, you know, do not have risk of collection.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

You'll see us. I think we could, if we didn't have that consideration, we could grow very fast in Colombia. But we are now being very, very conservative and saying, "Listen, let's make sure that everything we deliver, every service that we deliver and issue in our account receivable, is because we're gonna collect it within the days that we have as a policy, and not anything more than that." You'll see us growing, but we can grow faster, but we want to make sure we don't take any more risk. In general terms, I see Colombia and the whole discussion in the healthcare sector, I think, being directed to an important infrastructure solution in 2025.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

You know, as I like to recall everybody, 85% of the hospital and hospital groups in Colombia are private. All of us depend, you know, on the payment system working well. That has been a very big concern of the central government, as well as many regional governments, and that puts pressure on all the different stakeholders to make it work. You know, and so that's what I would say as an introduction to Colombia. Gisele, do you wanna add something else?

[Gisele Remy, CFO and EVP at Auna]

Yeah. What I would add, Suso, as we mentioned earlier, accounts receivable days have been stable versus last quarter, as well as the net cash conversion cycle. So, basically, as far as our risk assessment, given the market context, we are, of course, prioritizing cash flow, and we will be maintaining our accounts receivable days, and we will be managing the business as a function of maintaining those days stable.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Yeah. And on the MLR, Paul, so first of all, clarifying, we calculate our MLR for our healthcare plan business on a standalone basis for the insurance subsidiary. Therefore, if our hospital subsidiaries increase intercompany fees, this, of course, is reflected in MLR. So the increase in our oncologic MLR versus first quarter 2024 is primarily due to higher intercompany fees charged to the insurance subsidiary. And we made an internal policy change, where we used to charge the insurance company the cost, the average cost of treatment of a third-party payer, and now we're putting a higher hurdle to the insurance company and putting the highest private payer for that service. So it's a higher threshold. It does not affect it at all.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

I do wanna say that it changes the number a little bit, but this is the way we make sure that the MLR is always, you know, totally manageable, the healthcare network has good margins, you know, and there's no subsidy from one side to the other, no. The other thing that I would like to share is, again, this effect is eliminated at the gross margin level, you know, in the healthcare plans business, and gross margin is flat versus Q1, 2024. We do not expect our oncologic MLR in the low fifties to change materially, because as you might recall, and as we've represented in the past, we continue to adjust our plan prices accordingly.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

You know, so, remember, in Auna, MLR is not a result, but it is, you know, it is baked into it. We make sure that we price according to the MLR that we want, you know? And that flexibility to do that in Peru and in the future, Mexico, is a very, very attractive condition to the market. Do you want to say anything else on the MLR, Gisele, just to complement? Thank you, Paul.

[Gisele Remy, CFO and EVP at Auna]

No, I think that was quite thorough.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Okay.

[Mauricio Cepeda, Analyst at Morgan Stanley]

Thank you, Suso. Thank you, Gisele.

[Operator]

Your next question comes from the line of Josseline Jenssen from Lucror. Your line is open.

[Josseline Jenssen, Head of LatAm at Lucror]

Hello. Thank you very much, Suso and Gisele, for taking my question. Well, I've seen that in terms of consolidated cash flows, the net cash from operating you know activities covered you know the interest expenses. So but still there is the free cash flow is negative. So, my question is regarding CapEx and which amount of CapEx are you expecting for the remaining of the year and for the next year? And when do you expect, you know, to have a positive free cash flow? And regarding M&A activities and dividends payments, are you still thinking of not do any of those activities or pay the dividends until that net leverage reach its three times target? Those are my questions.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Okay, I'm gonna start responding to that with the last part, and then, Gisele, you can explain our cash flow. So we're a growth company, and we have a dividend policy of no dividends, so it's not a question of leverage. I don't think we'll change that policy for the foreseeable future. So we see ourselves as very much reinvesting, you know, our free cash flow in the future when those start to accumulate in growth more than dividends. I think most of the shareholders know that's our policy and that's how we envision ourselves in the future. And Gisele, on the free cash flow, please.

[Gisele Remy, CFO and EVP at Auna]

Yes, of course. Thank you for the question. In the year-to-date numbers, you will note that we have an impact due to an extraordinary payment for the earn-out obligation related to the IMAT Oncomédica acquisition. So that was a non-recurring payment. In the context of the year-to-go numbers, we should see in the year-to-go organic free cash flow covering the interest payments. And furthermore, as far as the annual CapEx numbers and plans, we do not expect annual CapEx to be more than $50 million for the year on a consolidated level.

[Josseline Jenssen, Head of LatAm at Lucror]

Sorry, 50 or-

[Gisele Remy, CFO and EVP at Auna]

I don't know if that.

[Josseline Jenssen, Head of LatAm at Lucror]

Fifty million?

[Gisele Remy, CFO and EVP at Auna]

$50 million for the year.

[Josseline Jenssen, Head of LatAm at Lucror]

Okay. Okay, thank you very much.

[Gisele Remy, CFO and EVP at Auna]

Mm-hmm.

[Operator]

Your next question comes from Alejandro Gomez. Your line is open.

[Operator]

Hi, Suso. This is Alejandro from HSBC. Two questions. First, margin contraction in Mexico, quarter 28. Can you explain, I mean, how relevant the decisions, recruiting process, given the contraction, and are the expectations going forward? Then I'll follow up with my second question.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

I'm sorry, Alejandro, you were breaking out. I think your question is about the physicians, right, in Mexico?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Yes. I mean, my question is regarding the margin contraction for Mexico.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Okay.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

So, the question is, this is, I mean, how relevant is the physicians recruiting process, and what's the expectations going forward?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Okay. Well, first of all, I mean, we see a lot, a lot of, as I mentioned before, some seasonality in Mexico. Our expectation in margins in Mexico is that directionally we are on the right track, gaining momentum in the growth, but in line with our expectation. Now, in terms of physicians, yeah, I think we've rolled out a winning new physician model that is attractive for high volume independent physicians, very compelling for younger physicians looking for, let's call it, a home with institutional capabilities in their practices, where volume, best practice and support are the key offerings. And I think we are delivering that. I'm excited of what we're collecting.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

You know, we've reformulated the offering to physicians, and not only to produce approximately like 300 new hires, you know, but also to produce productivity of the 1,000 doctors that we have already, you know. This has already produced incremental revenues, and of the new doctors, you know. And also on the hunting, we see also really good success. I mean, we're hitting something like 60% of the doctors that we target, we're able to hire. So we're hitting. We have a great, I think a high success factor. And remember, we do this very deliberately, especially in high complexity.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

In high complexity, 27% of those 300 doctors that I mentioned, you know, are in the specialties that we procure, that is in high complexity. You know, and that is producing at least almost 40% of the incremental revenues of the new doctors, so we're excited about what we're seeing. Changing the way doctors are compensated, doctors are hired in Mexico is something we've done elsewhere, but it does take time, and we do harvest gradually, you know, incremental, you know, value from the different way that we relate to doctors, you know. Again, I would like to say we're on track with what we expect, and we're gaining momentum, but this is not a step-up function.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

This is a gradual increase of more and more doctors in what we do well, which is high complexity. More and more doctors also capturing their spillover effects of adjacent services of what they bring to our hospitals there.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Okay. Thank you.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Gisele, you want to say anything about the margin in Mexico? Do you want to complement something, or?

[Gisele Remy, CFO and EVP at Auna]

Yeah.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Maybe there-

[Gisele Remy, CFO and EVP at Auna]

What I would complement, Alejandro, is that margin impacts versus last year are more don't really have anything to do with the physician model. It's more related to the increases in costs and SG&A, given the investments that we're making on the local and regional level that we mentioned last quarter in our release.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Yeah, that's a good point, and I always wanna remind everybody, I mean, there is a step up in all these indirect costs, because The Auna Way is a little more expensive, scales really nicely, very predictably, adds a lot of value to the patient, to the medical community, medical resolution, and good sustainable margins. But there is a little bit of a step up because then most of the, most of the recent assets that we acquired had very different standards to ours. I think that's stable now, Gisele, for the future, I don't, I don't wanna commit to anything, but I think, today, the standards of operations in all our hospitals throughout the regions are the same in terms of compliance, in terms of security of the patients, in terms of the protocols.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

I think, today, all the facilities, I think, have ongoing expenses that are very much related to the Auna Way and the standards we have defined in the Auna Way.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you. Thank you, Will.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you, Alejandro.

[Operator]

Your next question comes from the line of Caio Moscardini from Santander. Your line is open.

[Caio Moscardini, Senior Equity Research Analyst at Santander]

Hi, good afternoon, Suso, Gisele. Good afternoon, everyone. The first question is regarding the SG&A level in Mexico. We'd like to ask if we are already at a more normalized level or if there are further investments to be made in the region, right? And the second question regarding Oncosalud price hikes. What type of price hikes are you expecting for the next cycle? Are you going to reduce the level of medical loss ratio through the price hikes, or you are okay with this current level? So that's it. Thank you.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

I'll start with the second one. We've had 35 years of 50%-55% MLR in oncology. We're not gonna deviate from that. That's why we reprice, so always at 50% and 55%. This is the way we manage the business. It's not, it's nothing that's related to one quarter or the next quarter. No, this is a continuous way we operate MLR. No, there will be no change in the MLR and where we will fall in the future. I don't plan it nor expect it in any other way because of the way we run the business. The first question was...

[Caio Moscardini, Senior Equity Research Analyst at Santander]

About the GNA in Mexico.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

All right, I couldn't-

[Gisele Remy, CFO and EVP at Auna]

Yeah.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Gisele?

[Gisele Remy, CFO and EVP at Auna]

In the case of SG&A in Mexico, we are now at a more stable, absolute level. As you will note, this quarter, second quarter, also versus the first quarter of this year, right? That's on an absolute level. We are more normalized. Growth rates versus last year basically had a little bit more volatility because we still had an impact from the reclassification that we mentioned last quarter. So while you will see it growing less this quarter versus last year, once we clean out those impacts, it was still growing similarly to what we saw in the first quarter, right? So what we should see for the year to go is stable, normalized levels on an absolute level versus what we saw this quarter.

[Caio Moscardini, Senior Equity Research Analyst at Santander]

That is perfect. Thank you.

[Operator]

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

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Annie?

[Ana María Mora, Head of Investor Relations at Auna]

Hi, Suso. Yes, thank you, operator. The first question that we have on the webcast comes from Stella Strano, from JPMorgan. Could you please provide details on how the accreditations and relationships with doctors are evolving in Mexico? Also, what are the company expectations for ticket mix regarding volumes and complexity? Thank you.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Great. I think I did answer a part of this, but maybe I can add a little more color to it. You know, in terms of the physician hunting and the results. And as I said before, we've added 121 new doctors, you know, and almost 30% of them are in high complexity practices. You know, I like trauma. We're growing rapidly in new doctors, general surgeons, of course. We're growing rapidly as well in obstetrics and gynecology, and that's growing very well, as well as cardiology. So you see, again, the coincidence of what we plan to do and what we are actually harvesting, though, in terms of the physician model.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Again, it's a two-pronged approach, the way we relate to physicians. It is about productivity and being demanding and managing, you know, doctors and the value they deliver to our facilities in Monterrey, how much adjacent services we harvest from them. And of course, it's also about hunting for new doctors in the specialties that we want. I think, as I said before, this is coming as we expect, and we'll see. You'll see us harvest this in the coming quarters. Did I miss the other question, Annie? There was a part, a question.

[Ana María Mora, Head of Investor Relations at Auna]

No.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

That was it. Okay. Thank you. Thank you, Estella, and, let's hear the next question, Annie.

[Ana María Mora, Head of Investor Relations at Auna]

Yes. So we have a couple of questions in regards to, to Mexico as well. The next one comes from, Pedro Floriani: "What can we expect in terms of occupancy rate in the Mexico hospital for the second half of the year? How is the first half of the year track in terms of what was budgeted, and how should we see that evolving?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Great. So, I mean, we don't feel very comfortable in giving a lot of guidance on occupancy, especially occupancy on beds, which is such a random, I think, a number when we are such high complexity. We're looking at surgery rooms and chemotherapy and radiation treatment rooms and their capacity, you know. And what we do see is that high complexity occupancy, the services that we deliver, you know, are growing. We see it in surgery. We see it in the three hospitals. We see it in practices as trauma, as I mentioned before, the new doctors. Urology is growing very nicely. Neurosciences is growing at a very high clip as well.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

You know, something we're not as specialists in, but is growing very quickly, is also plastic surgery, you know, and cardiology, as I mentioned before. Again, the practices that we're really good at and that we capture. So we see these treatment rooms, these surgery rooms, you know, and their capacity is growing much faster than bed utilization. Now, I don't want to not answer the question. We do have a plan to increase bed utilization in the hospitals, you know, and we see that in the second half of the year, you will see the increase in how we fill up more all the beds in the three hospitals we have. So I would like to...

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

I don't know, Gisele, do you want to comment on that, or leave it at that?

[Gisele Remy, CFO and EVP at Auna]

What I would add, Suso, is what you've already mentioned. As far as trends for the rest of the year, we continue on track-

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Yeah

[Gisele Remy, CFO and EVP at Auna]

To deliver our consolidated guidance of 20% EBITDA growth, FX neutral.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Yeah.

[Ana María Mora, Head of Investor Relations at Auna]

Thank you, Suso and Gisele. Just one more question. This comes from Saikat Majumder. The question is: "Are you seeing any positive impact from packages and bundling services in Mexico?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Definitely. Definitely, and that's a key element of our growth and high complexity. And I can already see how we're growing in some packages. Some are simpler packages, you know, in terms of obstetrics, and others are a little more complex. That is delivering growth. In addition, something very attractive that we've done in our hospital recently is to put up counters to make sure that we capture any additional prescription, as we call it, cross-selling adjacent services. So in most of the floors, the patients will leave, and before they hit the elevator, we ask them, "What did the doctor prescribe? You know, what, what is the next test?

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

When is it?" And we make sure that those tests, those imaging, those pharma, those labs, get captured within our hospital. And that's also measured on a weekly basis, and that's also having a great impact as well.

[Ana María Mora, Head of Investor Relations at Auna]

Oh, yeah. Thank you, Suso. Well, at this point, I believe all of the questions have been answered. So I will pass the call back over to you, Suso, for your closing remarks.

[Jesús Antonio Zamora León, Executive Chairman and President at Auna]

Thank you again, everybody. We really appreciate everybody who's joining us today, and it's been nice meeting some of you, during recent roadshows and at investor conferences, in the U.S. and as well as Europe. We are keen to continue engaging with our shareholders as well as the prospective investors. Please let us know if we can do anything better in terms of these calls. You know, we trust that our recent financial and operating results make clear the fundamental strength of Auna. Auna is a diversified and integrated healthcare platform, as well as our ability to scale it further in the region. Please do let us know if we can do this better. Thank you very much, everybody, and have a great rest of your day.

[Operator]

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

Participants

Executives

• Gisele Remy, CFO and EVP
• Jesús Antonio Zamora León, Executive Chairman and President
• Ana María Mora, Head of Investor Relations

Analysts

• Caio Moscardini, Senior Equity Research Analyst at Santander
• Analyst
• Leandro Bastos, Equity Research Director at Citi
• Mauricio Cepeda, Analyst at Morgan Stanley
• Josseline Jenssen, Head of LatAm at Lucror
• Samuel Alves, Associate Partner at BTG