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Jesus Leon

Thank you, Anna, and thank you everyone for joining our results call. We are pleased to have achieved all of the 2024 milestones at Auna, including our patient experience, medical resolution and our 20% FX neutral EBITDA growth target for 2024. We expected the second half of the year to outperform the first part, given the seasonality effect on surgical volumes. Principally, we remain excited about illness future as we maintain our growth momentum going into 2025.
Auna's vertically and horizontally integrated regional platform delivered 28% of FX neutral adjusted growth in the fourth quarter, with the margin expanding 3.1% points versus last year's quarter and 1.4% points for the year. This is as expected for the last quarter of the year. In Peru, our fully integrated healthcare and plans business remains strong as we reap the returns on earlier investments we made to build, integrate, and scale our business.
Peru continues to demonstrate the consistent earning powers of Auna's business model when it is operating at scale. With that in mind, we continue the deployment of our model in Mexico, where the business opportunity and potential is even greater, given the size of the country's private healthcare market and how under penetrated it is.
As we further implement the Auna way across our hospital network in Monterrey, we've been driving operating efficiency and profitability, driving growth from new service offerings and our focus on higher complexity offerings. We're also learning what works well in Mexico and not so well as we always continue to refine our business model across our markets.
In Mexico, we were pleased to announce an agreement with the physicians of the most prestigious oncology practice in Monterrey. On March 7, we have signed a five-year exclusivity period with eight of Monterrey's leading oncologists and radiation oncologists who will bring their practice to own. This will position us as the oncology player of reference in Monterrey with a sizable practice and stellar results.
Near-term challenges remain in Colombia, with additional provisions this quarter. Accordingly, we are limiting our risk exposure in the country by calibrating growth and focusing on preserving cash. As we announced yesterday in our earnings report, we are lowering our exposure to [NSA] and replacing those volumes with other payers under risk sharing models to prioritize cash generation.
That said, we are still bullish on Colombia, given its medium- and long-term growth potential. It also remains integral to our maintaining scale and achieving medical excellence across our platform. We believe that 2025 will continue to be a challenging year in Colombia but expect 2026 to have an important increase in volume and complexity mix.
Turning briefly to our balance sheet, our debt leverage fell again to 3.6 times at year end. That's almost a full turn below our leverage last year. Q4 was also the fourth consecutive quarter of positive adjusted net income. And for the year we reported a net income of PEN124 million. That is a PEN338 million gained from the net loss of PEN214 million in 2023.
So, now on slide 5, revenues grew 11% on an FX neutral basis across our regional platform to about PEN1.1 billion led by Peru and Mexico. That brought full year revenue to almost PEN4.4 billion, which was 12% higher than 2023, also on an FX neutral basis. Among our healthcare facilities, capacity utilization increased 2.6% points to 66%. But our focus remains on growing high complexity services that carry higher margins rather than merely increasing capacity utilization.
That focus is what drove our growth in Mexico once again this quarter. At OncoSalud, our health plans business in Peru, plan memberships continued growing. For the year, planned memberships increased 7.4%, while oncology memberships increased 1.6%. Lastly, on this slide, our oncology MLR decreases 0.7 percentage points to 53%, a very healthy level, very much in line with our expectations.
Let's move to slide 7 to take a closer look at the Mexican component of our regional platform. The implementation of the Auna way continues to bloom in Mexico, where the addressable market for us is a high multiple peruse. In Mexico, we maintain our growth momentum with revenues growing 9% versus last year's quarter while adjusted EBITDA increased 30%, also in local currency terms, driving both with higher volume and improved ticket mix in hospitalizations and ICU therapies.
Also driving revenue with strategic pricing across payer tiers in our network. The sequential declines that you see in the revenue and EBITDA charts mainly reflect the seasonality we typically see at the end of each calendar year. The continued investment in the implementation of the Auna in our Mexico operations has paid off with adjusted EBITDA, increasing 30% in local currency, and a marginal expansion of 5.7% points.
Our model continues driving physician engagement and productivity higher while raising operating standards, enhancing medical protocols, and improving skills at our healthcare facilities.
Onco Mexico entered a new phase in 2025, after a successful pilot phase, we have started developing the B2B and the B2B2C segments to gain scale in 2025. In addition, to be able to give access to policyholders outside of Monterrey, we're developing arrangements with a network of service providers in the major cities in Mexico that will serve our policy holders outside of Monterrey while we develop our physical footprint in those cities.
In parallel, as I mentioned earlier, we signed a five-year exclusivity agreement with Monterrey's top oncologists and radiation oncologists who serve today about 30% of the private market in Monterrey. Eight leading physicians will join us and together we will continue positioning Auna, Mexico as the best alternative in oncology and the high complexity player of choice.
Let's turn to slide 8 on Peru. The fourth quarter revenue of our most mature fully integrated platform in Peru increased 10% as it continued capturing more of the payer population, optimizing pricing, and growing plan members. These dynamics, along with the network synergies and efficiencies that we have been achieving, drove a 33% increase in adjusted EBITDA, which increased 51% for the year.
Also compared to 2023, Peru's margin expanded 3.8 percentage points in the quarter and 5.4 percentage points for all of 2024. These marginal improvements were despite increases in cost of goods sold and SG&A, the latter increasing in support of growth.
Now let's move to Columbia on slide 9. Our fourth quarter revenue in Colombia increased 14% in local currency, mostly because we have been gradually implementing risk sharing models in Antioquia, an area that includes Medellin. Examples of these are cardiology and chemotherapy for breast cancer. Also increasing revenue was the addition of 14 ICU beds in Barranquilla.
Together, these additional high complexity services improved Colombia's revenue mix with larger tickets. Adjusted EBITDA increased 23% in local currency, primarily due to price adjustments from previous quarters agreed upon in the fourth quarter and procurement rebates as well as adjustments to the technical note in the risk sharing contract/
These items, many of which typically fall in the fourth quarter of the year, also accounted for the large increase in EBITDA. Conversely, EBITDA was negatively impacted by additional provisions for impairment losses related to outstanding receivables with payers, especially [nueva epe] .The situation with the intervened payers in Colombia has deteriorated since our last earnings call, but we remain cautiously optimistic that a resolution is forthcoming.
The current state of health care in Colombia cannot be ignored by the government nor any political party in Colombia, as frustration within the population is high, and it relates to a universal healthcare system that offers high quality of services, mostly from private companies like AUA. The government interventions have impacted all healthcare providers in the country, not just the owner.
Although we believe that Auna, given its high complexity focus, is in a stronger position than most, we expect a sector solution in 2025. Until then, we remain cautious and continue to monitor our exposure closely with the discipline focused on maintaining a positive and predictable cash cycle. Our cautious stance in Colombia has not curtailed our attempts to continue to grow in volume arrangements that require upfront payment for services, and these initiatives may deliver some upside during the latter part of the year.
For now, I repeat, we remain cautious, and this stance is reflected in lower total and operating capacity in Colombia during the quarter. Emphasizing cash flow overgrowth in Q1, we began phasing out services that we deliver for [Nuepesa] in Antioquia.
We are also diversifying and reprioritizing our basic payers by reallocating services volumes to other payers. Overall, though, our underlying business remains strong in Colombia, as our most recent quality results there make clear. With that, I'll turn the call over to Gisele who will provide a more detailed review of our quarterly and full year results.

Gisele Remy

Franc Jesus, I will now begin my review with the breakdown of revenue on [Fly 11]. In local currency terms, fourth quarter revenue increased 9% in Mexico, 10% in Peru, and 14% in Colombia. An improved services mix along with strategic pricing across payer tiers drove Mexico's sales in the fourth quarter.
In Peru, healthcare services, we continue to optimize the flow of hospital services and better allocate capacity towards high complexity services, while Oncosalud expanded group memberships. Finally, in Colombia, revenues were mostly driven by the implementation of risk sharing models in high complexity services.
Let's move to Evea on slide 12. On this slide, we break down the 28% FX neutral growth in adjusted EBITDA between fourth quarter 2023 and fourth quarter 2024. This, as well as the 23% EBITDA increase reported in the third quarter, are the back-ended growth that we had previously communicated, which led to us meeting our 2024 annual guidance as Jesus previously mentioned.
Above the bridge are the corresponding margins for each of the segments. As you can see, each of our segments delivered strong levels of profitable growth and also maintained excellent margins through operational synergies and improving efficiencies. On a consolidated basis, adjusted EBITDA margins expanded to 3 percentage points to nearly 24%.
In Peru, our most mature segment, EBITDA increased 33% year-over-year, while its margin expanded 3.8 percentage points. In Mexico, we continue diligently implementing the own way, achieving an improved mix of services across its hospital network and tickets that reflect our focus on high complexity. As a result, EBITDA increased 30% while margin expanded 5.7 percentage points to 34.7%.
In Colombia, EBITDA growth was impacted by certain price increases and procurement rebates that reflect full year performance but were agreed in the fourth quarter. The quarter's consolidated EBITDA growth was partially offset by the provisions and risk mitigation measures that we implemented in Colombia, and also by the investments that we have been making to build out our local and regional capabilities in Mexico.
Let's turn to slide 13, which presents an EBITDA bridge for the full year. For the year, our regional operations delivered PEN993 million of adjusted EBITDA, 20% higher than 2023 and in line with the guidance we had given. Peru and Mexico led the way with stellar EBITDA growth in the case of Peru, our most mature business, showing once again that our vertically integrated model of scale delivers incredible value.
Peru's adjusted EBITDA dot increased 51%, while its margin expanded 5.4 percentage points. Mexico's EBITDA increased 10% in FX neutral terms, and despite Colombia's setbacks with payer interventions and related provisions affecting the P&L, the segment managed to grow EBITDA, which increased 6% for the year also in FXN.
Let's move on to adjusted net income on Fly 14. Adjusted net income was a positive PEN36 millions in the fourth quarter versus PEN6 million in last year's fourth quarter. It was our fourth consecutive quarter of positive adjusted net income. Behind the year-over-year improvement, operating profit increased 46% or PEN60 million, while our operating margin expanded just over 5 percentage points to nearly 18%.
Keep in mind this includes a PEN9 million in impairment provisions in Colombia. The PEN73 million FX loss variants that you see in the bridge is the product of a non-cash FX loss of PEN24 million in the quarter compared to an FX gain in the comparable period last year, mainly related to the depreciation of the Peruvian soil relative to the US dollar during the quarter, outside the levels of the call spread hedges that we have in place.
Moving across to net interest expenses, these fell 63% versus last year's quarter, mainly due to the fact that the fourth quarter, 2023 included PEN215 million of refinancing costs related to the 2023 refinancing exercise. Let's please move on to the next slide. Adjusted net income for the year was PEN146 million, Up from PEN14 million in 2023. Our operating profit increased 40% or PEN223 million.
This increase included the PEN44 million reversal of the holdback obligation from our 2022 acquisition of Auna in Mexico. This was partially offset by the PEN26 million of impairment losses in Colombia that we incurred during the year. The PEN118 million FX variants versus last year includes a negative non-cash impact of PEN42 million in 2024, which compares to a positive FX gain of PEN76 million in 2023, when the Peruvian soil appreciated versus the dollar.
For the year, net interest expenses decreased 26% compared to 2023, due to last year's refinancing that I explained earlier. Income taxes in 2024 decrease pen30 million or 34% as our effective tax rate has normalized in 2024, given the recognition of deferred tax benefits, which we should be able to capture in cash flows in the following years.
The PEN203 million variants in non-cash extraordinary items and adjustments for the year include again, mainly the refinancing effects from fourth quarter 2023. Let's now please turn to Cash on slide 16. The cash position improved for a second consecutive quarter to PEN236 million at the end of the year and represented an 18% sequential increase from the third quarter of 2024.
Net tasks from operating activities increased 15% year-over-year, or PEN86 million to PEN668 million in 2024. Cash generated from operating activities during this period increased PEN161 million, or 24%, partially offset by an PEN80 million increase in tax payments in Mexico and Peru due to higher profits. Regarding the PEN160 million of CapEx shown in the bridge, this was mainly maintenance CapEx, which represented 3.7% of 2024 revenues.
It was mostly related to infrastructure, medical equipment purchases, and the implementation of SAP throughout our regional platform. The PEN77 million of earnout and holdback obligations refer to the extraordinary earnout payment of the [Ema Ogomena] obligation and the holdback obligation for the Onca acquisition.
In 2024, we generated PEN432 million of free cash flow. In the case of organic free cash flow, which excludes the earnout and holdback amortizations, we generated PEN509 million, which was 18% higher than 2023. It is important to note that organic free cash flow rose above interest payments in the second half of the year. Interest paid was PEN503 million, down 19% from 2023, and also includes interest and hedge premiums.
Please move on to slide 17. We insured 2025 with a substantially improved credit profile. As the bar chart at the bottom of the slide shows, we continue steadily deleveraging our balance sheet with the leverage ratio falling for the ninth consecutive quarter to 3.6 times consistent with our commitment to deleveraging.
Additionally, and as duly communicated, last December, we extended our one's maturity profile with the full reduction of the outstanding amount of the notes due, 2025. This was funded through a private reopening of the existing notes due, 2029. The new a amount of the outstanding 2029 notes is now $310 million.
As shown in the ring chart on the right of this slide, more than half of Auna's debt is in direct local currency funding, while the portion in US dollars is mainly hedged to the Peruvians. To conclude, our credit profile gives us the financial strength and flexibility needed to continue supporting our growth initiatives and achieve our strategic goals.
Further, through the EBITDA trajectory that we have established and through debt amortization, we continue to track to achieve our medium-term target of three times leverage ratio in the medium term. I'll now hand the call back to Jesus, who has a few remarks before we open the call for questions.

Jesus Leon

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

Question and Answer Session

Operator

(Operator Instructions)
Mauricio Cepeda, Morgan Stanley

Mauricio Cepeda

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

Jesus Leon

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

Gisele Remy

Yeah, sure, so I would just kind of reiterate the point that we do tend to see softer volumes across the geographies in Q4 and Q1, specifically for given the holidays and the seasonal impacts of, the end of the year and the beginning of the year where, as Suso mentioned, elective types of procedures are deferred. Okay. Not only effective and not only elected because sometimes, it's just procedures that can be deferred.
There's some procedures in orthopedics, people don't want to have, their hip replaced in December and January. They want to have it in a month that's outside of the sea, outside of those months. So, there are some things that are not elected that can be delayed and they are delayed.

Mauricio Cepeda

That's very clear. Thank you, Suso.

Operator

Samuel Alves, BTG Pactual.

Samuel Alves

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

Jesus Leon

Thank you so much. The second one, the second question I didn't hear perfectly, was it about management or the leverage li?

Gisele Remy

Hi what liability management, yeah.

Jesus Leon

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

Gisele Remy

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

Samuel Alves

Thank you. Suso.

Operator

Leandro Bastos, Citi

Leandro Bastos

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

Jesus Leon

You say you want to start with that one.

Gisele Remy

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

Jesus Leon

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

Leandro Bastos

Okay. Great thank you so much.

Operator

Alejandro Zamacona, HSBC.

Alejandro Urquiza

Thank you. Good morning, Suso. A couple of questions from our side. First one is on the oncology agreement with Oogia. And so how much volume can you bring given that they hold 30% of the market share and what percentage are you assuming this transfer to and then in addition related to this agreement, what are--

Jesus Leon

I think we lost him.

Operator

Joseph Giordano, J.P. Morgan.

Joseph Giordano

Oh hi, good morning everyone. Hi, Suso and Lorenzo, thanks for taking my question. Actually, like, take a different route and discuss a little bit expansion of the network, right? So we do have like some plans to expand network of services in Peru. So if you could update us on that front. That would be great. And then second, concerning [uncomaxis], so now I have like, so very affluent, oncologist, in the northern part of Mexico, the like research center being set up in Mexico.
So my question to you goes like in. How are you seeing accrediting new service providers to roll out to Mexico, particularly when it comes to Mexico City and Guadalajara, which are two major centers that do not have like a direct presence.
Thank you.

Jesus Leon

Great, thank you, Joe. Nice to hear you. So, I say, can you remind me the first part of the question? I remember Mexico, but I jotted something down and I can't--

Joseph Giordano

It was expansion.

Jesus Leon

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

Joseph Giordano

Thank you, Suso.

Operator

Alejandro Zamacona, HSBC.

Alejandro Urquiza

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

Jesus Leon

So I don't want to, forecast some or reveal, margin, of these businesses, but I would say, a couple of things, Alejandro in. So our agreement with them is about the 30% and how it gets channelled into Auna is a question of time, I think it can, with the plans that we have in place, it's not only about the 30%, capacity market share that they have in in oncology in Monterrey. Actually, for us, the spillover effect of a doctor leaving the imaging and the pharma and the labs and the surgery. Remember, these are chemotherapists, which is a critical gatekeeper in oncology is a chemotherapist.
He or she is normally the one that determines where the surgery is going to happen, where the labs are going to happen, where the imaging is going to happen, and even where the radiation is going to happen. No, this is like the primary care in many other diseases. The chemotherapist is the one deciding is the one deciding that, no.
So for us it's not only about the volume that they currently have today they actually channel the surgeries and the other services I just listed out to others, so this is going to be very promising and in line from what we expected to occur. So I would not be surprised that in due time in a couple of years, we would have 30% of the Of the oncology market in Monterrey.

Alejandro Urquiza

And my second question regarding, Colombia in your press release, you mentioned that you have been phasing out selected services to Nueva IPS in and Tokyo.
Can you provide more detail on the facing of these services? I mean, and specifically what would be the next, or the new mix after the competition of this facing strategy?

Jesus Leon

So, I think it would be difficult to see on a month to month or quarter to quarter what would be the stable state of the situation in Colombia. I think that the stresses in Colombia's healthcare systems will produce a [Nuevaepees] at the right time.
There will be a payer that has the capacity and not the political agenda, so I think that at the end of the year it wouldn't surprise me that, our business with is reasonable. We've been disciplined with them and they have been delivering on the commitments with us now from here to the end of the year, no, we're playing rough.
And limiting services until they I don't want to use the use the wrong words but maybe until they get their full act together, not today because of the intervention and the politics down there, the act, they don't have it together, but they need to get it together. I see in the last few weeks, a dialogue that is the best we've had in the last 6 to 12 months with them.
No, and of course it's not only because we're being tough with them, it's because patients are being really tough with them. So I see it's 7 o'clock.
So yes, so I see an opportunity there, but it's difficult to see what's going to happen quarter by quarter. But I think at the end of the year it wouldn't surprise me. They are very relevant players are very relevant in our geographies. I think that. They'll come back in a very organized and ordered way and we'll have a strong relations in the future with them.

Alejandro Urquiza

You said you want to add something to that?

Gisele Remy

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

Operator

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

Anna Maria Mora

Thank you, [Freer]. The first question comes from Gallo Muscardini. Can you please comment on the different dynamics in Peru, which led to occupancy rates to fall year over year.
Can you please comment on adjusted EBITDA growth expectations for 2025 that the internal goal to achieve 20% adjusted EBITDA growth per year also applies to 2025.

Jesus Leon

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

Gisele Remy

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

Anna Maria Mora

Thank you, Gisele. The next question comes from (inaudible). Hi everyone, I have two questions. Could you provide more details on how these risk sharing models have contributed to the revenue and IIA growth in Colombia and what expectations do you have for the impact of this initiatives in the coming quarters?
And the second question is, could you provide more details on other income in Colombia and the increasing corporate expenses at [Uncoalud] and healthcare services during 2024.

Jesus Leon

So on the first question for us, and the risk sharing model is critical to our strategy and our nature. It produces what we always are looking. For is predictability on the patient journey, the medical outcome, and of course the financial results. So for us it's critical.
Healthcare is very komplett And very anecdotal, and one can be lost in the, in the variability by conquering that variability, and producing them certainty and predictability, the opportunity is much richer and much bigger. So we see ourselves scaling that.
I don't remember the exact numbers in Colombia in particular, we're going something from. Low 10s, I think mid-10s. To maybe high 20s in terms of the revenue risk represented by risk sharing models. What's very important, I want to highlight, this is a competitive advantage. Few players can deliver that.
It requires a certain unique way of operating. It's a little of an insurance mentality and a health healthcare service provider merged together. Because there is risk and there is a healthcare, the healthcare service component, of course, no. So, I think this is something that makes Auna very attractive, and produces what we mostly seek, which is volume. Then we are a growth player in volume, and this is a key component that produces the growth in volume.
Gisele, you said you want to add on that?

Gisele Remy

No, I think so expressed it well and maybe to tackle the second part of the question, vis a vis other income and corporate expenses. Specifically in the case of other income, which as we know, is a line that reflects non-operating impacts as far as income and expenses.
In the case of Colombia in the fourth quarter, the most material impact there would have probably been the reversal of a tax provision which would no longer come due.
And in the case of corporate expenses, nothing too material to report, just basically the same progression that we've discussed in previous quarters as far as the regional and integrated capabilities that we're building, which are basically around also bearing material fruit as far as synergies and efficiencies across the board both in the medical practice as well as in cost and SG&A from being able to operate in a regional manner and have all of our procurement and negotiations and strategies reflect that scale.

Jesus Leon

I don't know if there's more questions from the chat.

Anna Maria Mora

Yeah. The last question that we have in [Nachat] comes from [Omar Aliyan]. Sorry, what is your expectation for that reduction in 2025?

Gisele Remy

Great, so thank you. I can tackle that question, and as I think as Suso already noted, we're not giving any specific, leverage or balance sheet guidance, for the year. However, we continue to be very focused on deleveraging, and as we've seen in 2024, our proven capacity to grow EBITDA and improve liquidity has taken us to 3.6 times net debt to EBITDA at the end of 2024, and we continue to be focused on our medium term target to take that leverage level to 3 times net debt.

Anna Maria Mora

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

Jesus Leon

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

Operator

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