Good morning. Good morning and welcome, everybody. My name is Fabrizio Redavid, the Director of Marketing Communication in the GPI Group. I am really happy to see so many of you here. For so many years, we haven't met in person, and for the first time in a long time, we decided to meet here physically. The online solutions are very practical, but it's also important to meet each other. Today, we're discussing the 2025-2029 GPI Industrial Plan. Fausto Manzana, the CEO, and Matteo Santoro, the General Manager, are here with us. I would like to talk about the agenda, and I'll give the floor to the CEO. The agenda is divided into four sections. First of all, an overview of the GPI state of the art, where we are today and where we want to go, and then I will talk about market overview and opportunities.
The digital market is undergoing a revolution because technologies are a revolution in healthcare systems at them. Matteo Santoro will talk about strategic plan and performance in 2027 and 2029, and then there will be the final Q&A session. You can ask your questions from here, from remote. This is a hybrid event, and on the streaming platform, a form will be made available for the Q&A session, and I would like to start straight away and give the floor to Fausto Manzana.
Good afternoon and welcome. It is definitely a pleasure to see so many of you here, and I think that we should really be grateful to have such an attentive audience here with us today. Now, before we start with our plan, I think we should recap what we've been doing. We have a 2022-2024 plan, which has just been completed.
We increased our capital some time ago, and we organized several investments, which led the GPI Group to acquire a clear leadership and well-established leadership as far as our country is concerned, and at the end of 2024, we became the leader in the field of information technology for healthcare in Italy. And this is something which is well established, and the idea and the intention of investing in products within an international scope has also been clarified, confirmed, and established. What did we do? We confirmed our position in foreign markets, especially in Europe, but also in the rest of the world, in the field of healthcare digital products, so GPI is definitely the first player in our country. It is among the first three, four stakeholders in Europe, and it is a competitive stakeholder also in the rest of the world.
Now, there are so many reflections to be made about the rest of the world market, but we can generally say that our turnover is quite significant. We're talking about EUR 40 billion, some talk about EUR 50 billion. But what we can say with certainty is that the GPI role accounts for approximately 1% of the global figures, and this is quite significant. Today, we're discussing something more simple. We wanted to improve our position. Of course, there are some issues characterizing the Italian market. In the past years, this Italian market was characterized by the concentration of procurement at the regional level. Today, we do not talk about hospital or single facility. Today, throughout Consip, the National Procurement Agency, we have to deal with 22 stakeholders: the regional authorities, the independent provinces, some work in-house, some are completely public, but we're talking about 21 stakeholders, 22 stakeholders, sorry.
And then the digital revolution in procurement completely transformed the sector. And this means that, in very simple terms, the number of stakeholders has further decreased. Your competitor becomes a partner, contexts tend to change, and projects such as the EHR, the regional EHR electronic health record for the Lombardy region, for example, which is something vital for the health and life of each of us, has been a revolution because the digitalization of facilities, the Niguarda Hospital, the Brescia Hospital, we're talking about 25% of the nation's healthcare system has been concentrated in the hands of regional authorities. And today, we'll look at this plan under two perspectives.
First of all, projects and GPI has transformed its way to manage contracts, the related turnover, and this perspective is very different from the rest of the world. It's not the same in Germany, Austria, Germany, it's not the same in France.
There is an Italian context, a European context, and then the rest of the world. We work with 70 countries all around the world, and we have projects that are also products such as blood, digital pathology, the laboratory information systems. We're also working on the EMR, the electronic medical records. We're working on a standard record in a digital format that we can distribute and use all around the world. The target for these products is the same as the target that we have for projects. But, for example, the procurement processes are quite different. In Saudi Arabia, for example, we were asked to extend our contract. We were asked to start a negotiation on contract extension on Christmas Day, and we were able to finish the negotiations on Boxing Day on the 26th of December.
We're talking about a couple of million euros' worth of licenses, and this will allow us to work with an additional 80 hospitals in the blood sector. This is an expansion of our presence all over the world, where very large stakeholders, and I'm talking about stakeholders that bring about the digitalization in hospitals that have hundreds of beds, well, at a much lower price, we bring about the digitalization of healthcare systems in the whole of the Lombardy region. In order to make things easier, we divided the world into Americas, South and North America, Europe, Southern Italy, Northern Italy, and the emerging countries. These are the areas that will generate our profits and loss, and the product lines will be developed according to these areas.
The implicit goal is to confirm the GPI strategy regarding projects, but also paving the way to the creation of a small multinational with a lot of potential for growth. That's the way we view our company for the future. These areas can be further developed in terms of safety and security, not only as far as an increase of perimeter security, but also the security of our applications, and then we can further develop artificial intelligence. I think that there is a direct connection between artificial intelligence and healthcare systems, and I think that one of the areas where the artificial intelligence can play a vital role is supporting diagnosis, supporting decision-making, and pooling digital information so as to support healthcare professionals in their decision-making processes.
GPI has certified an algorithm for a medical device which will support healthcare professionals also for the diagnosis of conditions such as, for example, postpartum depression. This is something which facilitates the relationship between physicians and the patients, and healthcare professionals can, for example, be warned about the risk of postpartum depression. We're talking about 17-18% of women who suffer from postpartum depression. This is a very serious condition which has to be managed carefully and quickly because it could have very serious consequences. Now, this is the context that I would like to describe as an overview, but our marketing director and general manager will talk about the details. Our goal today is to create value from the investments we've made in the last years. We have developed several solutions. We performed several operations such as the GIO acquisition.
We need to optimize our solutions, and my goal is, for example, having, I'm not talking about one solution, but two, three solutions that we can export to other countries all around the world. Haemonetics, as for the donors area is concerned in the United States, allowed us to reach several blood donation centers and made in full TESI. There are also other operations that we carried out. I think that TESI is an excellent example of an excellent acquisition, and this year, we will purchase the minority. With the strength of the group, we were able to grow significantly, and the speed of the delivery and deploy of individual projects is vital, and we're very happy about the results we achieved. We're also very happy about the acquisition of Evolucare, which as a standalone is performing better than the seller case.
So today, we can say that we could extract values, synergies, and economies from a better integration with the Evolucare Group. We have a very successful growth story, but what I would like to illustrate here today is what we can call a plan for building the pillars, the foundations of a small multinational, and we'll talk about it more in detail afterwards, but here you can see an overview of the growth plan. You can see the M&A operations that we carried out in the past, and the results. We have significant development on software, and our growth is much higher than the growth of competitors, especially as far as software is concerned, but I would like to stick to my overview. Our plan is very ambitious. We would like to extend our presence to other parts of the world.
We know the market, we know our competitors, and we think that in the next three, four years, we will have the opportunity to speed up our penetration in the global markets. Although we must be careful, we must be cautious, and we're not talking about skyrocketing figures, we can say today that we will be able to generate more cash and increase our margins over the past year's plans. Here you can see what can be considered our beacon for navigating our future. It is much easier to determine what is lacking in GPI than what we already have. We're not just software suppliers. We supply solutions, partnerships, and accompany our clients, our patients, much more than other contexts. In our country, telemedicine is not probably headed for a significant increase. This does not mean that as a GPI Group, we do not believe in telemedicine.
There are important projects, and GPI has tested a pilot project in a regional healthcare system, and we do believe in telemedicine, but we do not believe in technologies alone. We believe in what I call virtual care. That is a paradigm shift which will see GPI as the only stakeholder able to appropriately meet the needs of this domain in our current context. What can I say about this slide? Well, our care area is vital for our organization, and you can draw your conclusions from here. You can have your own opinion, and all of your opinions, all of your remarks are precious. We think that the future of telemedicine and virtual care will only develop if we do not forget the past of the care SBA. We made a very important investment in the domain of automation, especially as far as infusion therapies are concerned.
We needed a shift in paradigm. We developed a new device, a new robot that took us 12 months in the past year, and it will take us 12 months this year, but at the end of 2025, we will have the first prototype of a product that will be marketed in 2026, which ensures the safety, environmental safety, but also the safety of healthcare professionals which work with these devices. We are talking about chemotherapy medications, which are quite delicate to handle, but also and foremost the safety of our patients. And our first market for this product will be the United States. This is our 2025-2029 plan in terms of strategy and targets. We think that we will be able to achieve these targets. No extraordinary operations in terms of M&A and capital operations are expected for this period. We would like to remain in our perimeter.
We would like to remain in our garden and have its growth as well as it is possible.
Thank you very much, Fausto, and now we will take a look at what happens on the market, which opportunities we have. A lot of things were already mentioned by Fausto, and I can add that there is a very important topic in terms of digitalization. We said that AI can be a very important instrument enabling us to improve diagnosis, but also in other, but it also has other applications. For example, we can optimize bookings at the booking center, and we can optimize the management of emergency rooms, so artificial intelligence is being used today to create standard models, but it will be used today to develop tailor-made solutions.
We think that EUR 60 billion is what the market is worth, and the growth expected at the global level is quite high. For our target, the value is EUR 25 billion with a growth of 11-12%, which is a little bit higher than the global healthcare market value, and the CAGR will grow less. And we're talking about an expensive market, which is growing a little bit less. We have to take into account the weighted average as well. In our country, we have different levels of maturity. Horizontal applications, what Fausto was referring to as projects have a lot of potential for growth. Italy has quite a mixed situation. Before I show you the figures, let me show you the slide of what people are expecting from digitalization. Well, enabling access to care.
This means having technologies allowing us to understand where the supply is and how to improve access. And then they expect better outcomes. They expect a better patient experience. I can ask for a consult from home and understand whether I have to refer to an emergency room or other facilities. Digitalization is vital for the whole world of care because the patient is not the only stakeholder in the universe of care. And there's the caregivers, the hospital facilities. In Italy, 20% of our resources are wasted because we do not manage care well enough. We need to innovate care, its instruments, and we need to improve the sustainability of the environment because the digitalization helps containing limiting costs. In a world where we have an aging population, without digitalization, we will not be able to ensure healthcare for everybody. So what can we do thanks to digitalization?
Telemedicine, telemonitoring, teleconsults help us empower the patient. And this means to integrate all stakeholders, including hospitals, research and development centers. It simplifies the access to information. We have millions and millions of data available today, but information is something else. Artificial intelligence will help us say that if you want this piece of information, I can consult all data very quickly and give you the piece of information that you need. And then the innovation in biotechnology, the digital twins. We have the possibility to create a digital version of each individual and predict what could happen with this disease, what could happen with the physical conditions of this person. And in order to enable all this, we need to use artificial intelligence in a very smart way. Let me show you the Hype Cycle of Gartner.
So when a new technology is introduced, and you can see it on the left, there is a big enthusiasm for this new technology. And then this enthusiasm tends to become more stable, but a very small amount of stakeholders have, for example, used voice recognition. And for example, artificial intelligence allows us to analyze the emotional content of the patient's voice in order to understand the level of anxiety. Let's look at figures. We see that there's a global market of over 60 million. Our main target countries are France, Germany, Austria, Switzerland, the U.S., and Italy. We have others, but we wanted to focus on these areas. And the market size is over 25. Italy accounts for 1.7% with an 11.3% rate. We are now looking at product areas. Core offering our main projects, so EHR and EMR.
We split it by geography, so we have growth rates between 6% and 8%. We are the third player globally. We are entering the U.S. because it's over half the market. So it's a huge market share. Diagnostics is especially interesting. We have significant growth rate, especially in German-speaking areas. We see that we have also interesting growth rates for critical care. Looking at other areas of diversification, when it comes to automation, the market size is EUR 3.5 million with a 9.2% rate. And this includes the new solution we are developing, and it is worth EUR 135 million initially. We want to focus more on hospitals rather than retail. BPO, so basically the reservation center, and this is specific to Italy, but we want to stay there. We want to focus on this market, but it is quite static, so it accounts for around 3%.
I'd like to leave the floor to our general manager.
Thank you very much. It is very important for me to be here today because we want to share with you our goals for the future. It allows us to feel more confident in what we're doing. A lot has been said already by my colleagues, but I would like to stop and think about why we're here. There is a rationale behind our growth. We've never really explained it before. I would now like to look at the first aspect of this plan. The market analysis was the first step. It was very interesting. It was probably the first analysis we've done because we didn't stop at general data. We looked in detail at a more granular level to understand our positioning on the market because this confirms an intuition we had around 10 years ago.
The fact that healthcare would become an international, a global market. So there are, of course, differences at a regional and national level, but we are convinced and COVID showed that because then healthcare became a political issue, and healthcare became a global market. We were surrounded by players that were the product of huge acquisitions, so we had to make a choice in 2015, 2017. Either we buy or we get bought, and we decided to buy because it means becoming leaders. If you decide to buy, you want to be a leader, and you have to have a big picture of what healthcare would become in the next 15 to 20 years, so we started buying companies with a very specific rationale. Many haven't really understood why we bought 60 companies with EUR 400 million in terms of investment since we joined the stock exchange.
We bought companies that met some requirements. So they either had a product we were missing or that were present on a market we weren't present on. So we were able to create a quality global offer. And we really looked beyond the three to five years term. So we didn't really focus on the national recovery plan or on the Consip targets. So our plan is a natural progression of what we're doing. As our CEO was saying, we had kind of an inertia in our growth. We should be able to attain these results without effort. But while in the past, we were very focused on some business area, on some vertical related to performances in our areas, we are now looking at the world globally because the market will be global. We are global already. Our solutions are sold in 70 countries worldwide.
We sell to Japan, for example, so this plan is based on the bullet points you can see. The first is creation of synergies, and we bought many companies, as I said. We weren't really too stressed on integrating because if you have to integrate every two to three months, it becomes very difficult. Our CEO talked about some thesis, but we wanted to create some synergies, and we attained results that we couldn't even dream of, so we decided to unleash the synergies at an industrial, commercial, and organizational level. We want to be competitive initially because we are leaders here, not only in terms of volume and activity, but we are also leaders in terms of quality. That's what our customer says.
For example, in August of this year, we were called by Regione Lazio because their systems were hacked, and we hosted their systems because ours were safe. Another focus will be internationalization. We are present in many countries worldwide, but we would like to be increasingly global rather than only being an Italian company. We will reorganize our operating model. We are already implementing this new model. Diversification means opportunities to us. Then we have an ESG plan, which is crucial because we believe that the healthcare system should be universal and accessible to everyone. Aside from what the law says, our activities impact on the life of citizens, and we have to really bear this in mind. What are the strategic paths of the GPI Group? What are we expecting? We expect to grow in terms of margin thanks to what we're doing.
We are expecting to see an improvement on the cash flow profile because initially, respecting commitment is quite difficult, even though the procedures were made simpler when it comes to the National Recovery and Resilience Plan. It is not enough, so we would like to work on cash flow and reduction of debt. Of course, we also take into account the possibility of implementing extraordinary operations, so we think this could be successful. We have GPI navigating in different areas, as you see software, which is our core business, and software is segmented into two areas. One is core offerings, solutions that are more client-oriented rather than market-oriented, so we build solutions around the requirements of the customer. Maybe we struggle in the beginning, but we then create a strong relationship that is also very profitable with the specific customer. This is, however, slower.
We cannot be very quick with this. And then we have product-focused solutions. So these allow us to penetrate the foreign market. They can be scalable globally. So what can be released initially, what is released initially can be released elsewhere. And they are also quite quick in their deployment. Then we have diversification, which would be an opportunity. We have care, which is something we struggle in explaining. We have an observatory for product and highly innovative products. For example, products that can create infusions for oncology. So products that involve very risky products in terms of health. And then we also would like to look at how the national healthcare system will evolve. So just treating a symptom with a drug in a hospital is very, very expensive. So we think that telemonitoring is the future, and care is crucial.
In Lombardy, over the course of five days during the COVID period, thanks to ACARE, which is kind of an operational center, we were able to monitor 60,000 patients at once. So this is an opportunity for diversification in terms of innovation of products and new organizational models for care delivery. So the product program is based on these three pillars: core offering, which are basically only related to Italy, so public healthcare or public tenders. The most important aspect, which is the vertical offering on products, so blood, diagnostics, and critical care, which refers to Evolucare. And then we have diversification, care, and telemonitoring, ICT, and cyber defense, which we invest a lot in. And then automation. As I said, we are leaders in Italy. We would like to maintain this positioning and enhancing our offering. But we would like to cover more parts of Italy.
So we are restructuring our areas in a more efficient way. We're adding then more elements such as artificial intelligence. AI enhances the performances of our solutions. We created an AI algorithm that allows us, in a predictive way, so several days in advance with a high accuracy rate, the number of access to the emergency room. And that's very important because knowing how many patients might turn up to the emergency room for what really makes everything more efficient. And looking at telemedicine, it means creating all the infrastructure for the management of the patient, especially for chronic patients, because in the future, 30% of the population will suffer from chronic diseases, and 10% of them will need continuous monitoring. For example, a stable person who is diabetic costs to the healthcare system around 7,000 EUR, while with telemonitoring, it will cost less than 1 EUR per day.
We can really innovate in this space. Looking again at the products, blood is the most prominent investment we had. We are present in over 60 countries. We have so many products, almost 9 platforms. We are present in Italy, in France, in Europe, the US, Arab countries. I think we have over 150 hospitals of Saudi Arabia, over 2,000, okay, 200, pardon. We look at diagnostics, referring to TAS. This growth is limited to Italy, Mexico, and Brazil, but it is a scalable solution that will require us to be quick. We expect to create interesting synergies. We have Evolucare, especially in France. For example, for operating rooms, etc., these products are mainly conceived for the French market, but it can be easily adapted for other markets as well.
One of the strategic elements of the plan would be synergy development model through the reorganization. We will be divided by country. Each country will have a strategic commercial responsibility. So each country will have to sell all products in our portfolio. For example, in France, Evolucare sells products of their own portfolio but not from other brands. So each country will have commercial goals. And then we will centralize factories with industrial synergies. We have nine platforms for blood. We expect to reduce them. This will free many resources, also economic resources, and then corporate functions. We will centralize all the different units, and this will allow for a greater synergy without significant efforts. The other strategic element is diversification. I already mentioned that.
We are highly focused on software, but we cannot forget that the healthcare system is evolving, and it requires highly innovative products and solutions for sustainable care. The healthcare system cannot last for long with this trend because the offer is fixed and the demand grows exponentially. You know the reasons, but we have to find solutions that can offer more care. With telemedicine, you do not treat patients better, but you offer more options. ECG, ESG are very important. I come from the world of social cooperation, and I firmly believe that what we do is important. It matters. Of course, we will abide by all the norms, but we invested in parameters that could represent us. So we thought we should find KPIs that were suitable for our own nature.
The issue here is how to measure the impact of our activities on our collaborators and on citizens and stakeholders, because the real issue here is understanding that we need to create value that can be disseminated and shared by all stakeholders and shareholders. We believe this increases the profitability of our business, so it is not something naive, but it is a really interesting tool for growth for us. I would like to give you some data. I think everyone was waiting for some figures. We'll share some information that, of course, is not complete, but we will see an initial light growth. We will grow more than the markets, but if we want to create worst-case and best-case scenarios, we are in a best case. Of course, we can do much better than this, but we had this projection. In 2027, we'll have EUR 600 million revenues.
In 2029, it will be over 700 with 25% EBITDA, so the growth is slow. We haven't considered here extraordinary operations. This is a natural growth that will stem from reorganization and creation of synergies. One of the crucial issues was the increase of cash flows and the reduction of debt, so with what we described in the plan, you can see that the ratio between debt and EBITDA will improve. We will be below 2.6 in 2027 and below 2.5 in 2029. This is the expected average data with a stable standard policy of dividend share, so to make it a bit simple, as I said, 1,600 to 1,700 million between 2027 and 2029. CapEx will maintain the standard value, and here we have CapEx for standard products and extraordinary operations such as simplification of platforms, etc.
We expect to see an increase in ROIC, so from 11% to 15% by 2029. We've also looked at the PFN ratio. What will be the shape of this company in 2029? We're looking even more far ahead, but this company will be focused on the foreign market, so we will go from 18% to 30%. This is the minimum results we expect to obtain, and we will be a software-focused company. You know that up until a few years ago, software didn't reach 50%, but by 2029, the core business would be software, and it will account for 68% of revenue by product. This is a small synthesis of this plan. This is something we built with a very clear vision of where we want to go, but this will not require many efforts. We could do better.
I'm sure the CEO will settle for these results. We can do better, as I said, but this is a plan that doesn't involve extraordinary operations, but of course, we do not rule them out.
Okay, thank you very much. So we'll open up to Q&A. We'll, of course, give priority to those who are in the room. We will also look at any questions coming from remote attendance. Okay.
Any questions?
All right. Mario Pedrotti here. I would like to congratulate all of you because EUR 150 million of turnover, and then after 12 years, EUR 700 million or so. Congratulations to all of you and your staff. You will do even better than EUR 700 million, as Mr. Santoro said. You were very cautious, but I would like to renew my congratulations to you. Now, a little bit, some comments, please, on the Italian situation, please.
I would like to answer to this question. I think that we all deserve the country we live in, so I don't really like people constantly complaining about our country because the country we live in is what we deserve, because we're idiots. We have the wrong approach to politics, to our politicians, to the people who manage our lives, and Mr. Padrotti, we do not sign contracts. We sign agreements where some people are able to do whatever they want, so we have a country where 40% of the resources are in advance. The state of payments cannot be negotiated. We have market goals, and these market goals are not always achieved as the GPI Group. We do not always do everything perfectly. As Santoro said before, in very cautious terms, the market recognizes our value. We know who we are. We know what we can do.
The procurement management is something quite complex, however, and we do everything in a very accurate way. We always behave in a legal way, and for example, we were asked to add some articles to some national recovery plan contracts, but the addendum provided for a change in terms that would cancel everything we had done, all of our investments, if we did not change any details. We always try and take everything calmly, but nobody has tried to impose our terms as far as payment is concerned. We live in a country where payment schedules sometimes are doubled, and in our company, we are never late with payments. This is something that nobody else does. We're never late with payments, but the payments to our company are always late. We're very frustrated by the fact that our cash is never enough.
If we were able to generate cash to the levels that we're able to, we would not even need the markets. We have designed our goals accordingly because what we want to do in the next years is setting up a small multinational. We're ambitious enough to believe that we're able to do important things in the world. We come from a long journey, and we made some acquisitions. We will be the objects of some M&A operations one day, of course, but from the ethical point of view, we must never forget that our healthcare system is among the most effective in the world. What are we doing? We are allowing some people to destroy this effective system, and we should be more consistent with our approach, with our attitude. I'm talking about a political approach to this.
Therefore, as my colleague was saying before in a much more diplomatic way, it is us, it is people like us that keep the whole system alive because what we do is having projects. We have 80% of our projects from the national recovery plan, and we have issued invoices for 30% of them approximately. Do you think this is normal? What we do is some meditation, some mindfulness, some yoga practice. We talk with banks. We talk with institutions that are supporting the country, and these are the people that keep our healthcare system and our country alive. We're trying to perform a trade-off between the payments problem, but we do not have any leverage on this. If somebody tells you that the problem of payments can be solved, well, they're liars.
If somebody tells you that they can do better than GPI in terms of receiving payments, well, they are really good at what they do because there are other stakeholders, but not all of them behave in an ethical way. We do not want to behave in an unethical way, and we're not liars. Some stakeholders, there is an example, a very concrete example, a regional authority which was helped by GPI to manage 300 million EUR of cash flow into the national treasury, and then these people complained about us because there was a problem with a 17 million EUR contract. You will read about this in the specialized press, and what should we do? Call the police? Let them come? I don't know if we'll guarantee the issuing of services to these stakeholders.
I have no solutions, but I can tell you that we will continue providing services to our country. FM paid together with GPI, a lot of private equity, and now the recurring at minus 30%, but we did nothing about the situation.
Good evening. My name is Andrea Russo from Alantra, and I hope my question will not make you as angry as the previous one. I would like to go back to one piece of figure: EUR 700 million until 2029, and you are not ruling out mergers and acquisitions. You are focusing more on cross-selling, group synergies, and so on and so forth. Are these synergies already in place, or are there any gaps in the vertical dimension? Right?
Well, I'm not the diplomatic one. You are the diplomatic one, and our friend is asking for diplomacy. So it's up to you to answer.
The plan does not include any M&A. Our offer as a group is a complete offer. There are markets such as the U.S. ones, which are quite complex, and it's quite difficult to enter them, but they're high value. The American market, in terms of IT, is quite high value. It has significant stakeholders, very recognized players. Our investments are much higher than the ones that we have performed before. If there are opportunities, we will consider the opportunity for that because that's a high-value market. These operations are not included in the plan.
Luca Manzoni, Banco BPM, and I would like to ask something about the situation in Italian public administration. Oh, no, I was only joking. I would like to ask you a question about telemedicine.
At the beginning of your contribution, you told us that you believe in telemedicine, but telemedicine does not really impact figures because we have to work on telecare. Can you please expand a little bit on that?
Yes, certainly, well, telemedicine is not just about supplying technologies. We do have platforms. We have a very effective platform. It works perfectly, but who is going to perfect this platform? Well, our point of reference is our country. Our poor country, very simply, has not made a decision yet. Maybe you remember community hospitals, community housing, a lot of beautiful projects which were not financed anyway, and no decisions were made. We think that the situation is a similar one as for telemedicine is concerned, and we mentioned something very interesting before.
The Regione Lombardia, which bought our telemonitoring system to monitor 60,000 patients in the COVID period, that was meant to support primary care physicians, but things did not go well because these primary care physicians did not activate these monitoring systems. However, this solution proved very successful when it came to managing the waiting lists of patients waiting to be hospitalized, and the hospital departments were able to manage the pipeline of admissions to hospitals and streamline the various patients' needs. What we need is a leadership which is able to manage this context. However, the primary care physicians are not the people responsible for these decisions. Hospitals are not always the best stakeholder when it comes to managing the local dimension of patient management, healthcare management, and this is a little bit like table tennis with a match which has been going on for years now.
Telemedicine is an excellent example of that. GPI has never had telemedicine as a single objective because what we have in store today is nothing if it is compared to the potential of telemedicine. If telemedicine really becomes a thing in Italy, we think about the potential. There is much more that can be done. Let's think about the so-called COT project. We were able to remark something about the community operational centers which would serve broader territory, but nobody listened to us. So if we have concrete projects, we have the potential to reach concrete goals. Otherwise, this is not the case.
Well, may I add something?
I think this is a domain which has a lot of potential. There is a mismatch between supply and demand.
Just think about what happened during COVID.
Telemedicine was mainly seen as telemedicine consults because digital consults during COVID used to last longer than traditional evaluation. But telemedicine is not for consults. Telemedicine is for streamlining, is for managing to keep the whole system together. The hospital will not be able to manage the entire journey of a patient in a few years. COVID was a little bit of a deviation throughout a digitalization journey that we are making. We need infrastructures. We need more eCare, and telemedicine will become vital in a few years. And when this happens, you will see if we're stubborn or really smart. Let me tell you what is happening in Malta with diabetes patients from 13 to 18 years old. Healthcare is about logistics, not only about clinics. We are being paid for this project, a daily fee with margins which are up to 70%.
We monitor the patients, and when we fear that there will be a critical event, the patient is streamlined towards the closest facility, and we are convinced that this project, which is really successful, will take place in Italy too.
Good evening. I would like to ask a question about investments. Do you think that the strengthening of your managerial team can be useful when it comes to reaching certain areas from the geographical point of view?
Yes. We're taking into account the costs, not only the investments and the care that we put into designing these systems; these models will enable us to increase our effectiveness in individual areas, including remote ones, throughout an organization which is more on scale than what it is today.
So my answer is yes, of course.
Thank you, Mr. Bertuzzo from Intermonte. Now, three questions. The first one is about software.
In the last years, the National Recovery Plan and Consip has supported growth, and these financing programs, financing plans are limited in time. What will happen to software when this line of financing is finished? My second question is about the Care SBA. The margin for this SBA is higher than the results that you have notified before. So what is the target? What worked? What did not work? Why did you not reach the target that you had previously identified? And the third question is about automation. There was a positive impact from the divestment of Business Pay. And are you open to a similar operation as far as automation is concerned?
Thank you very much. I'll answer your first question.
When it comes to Italy with the plan of recovery and resilience, we had a specific study of the market to understand the potential and how they are affected by the effect of this national plan. Consip tenders started before this plan. Even if this plan shuts down, I mean, it has an expiration date in June 2025, so it could have a positive effect. We should be able to actually gain cash flow and have more revenue. In Italy, we expect 11% of growth even without considering the National Plan of Recovery and Resilience , and we are sure that some centralized tenders will still be present. It depends on how they are funded. The end of these tenders and these plans allow us to understand the OpEx expenditure for healthcare because everything that's been created has to be maintained, so we had less recurring revenues, more extraordinary revenues.
So I think we should work on that. Consip was a tool for all tenders, but it reduced rates by two-thirds, and it created a distortion of the market because the activities are acknowledged and recognized if they are proven, but they pay us only if we provide a record of what we've done. So we are paid after two years because according to them, it is difficult to understand who did that. We have over 1,000 developers, so it is difficult to say who did what operation. We have to take stock of all the operations done hour by hour by which operator. So this is impossible for us. The second question was about targeting and margin. Yes. Well, in the past, we talked about 9% margin. This hasn't been expressed so far. We are trying to make things more optimized.
We had solutions in the past thinking of 25%. Since some players didn't really get it because since care is the most important thing, for example, for ASR, so if you want to book a visit, you have to call a booking center. We are trying to choose the operational units where we can invest in terms of technology to reduce human presence, increase the presence of technology, and decentralize. We are trying to make things more rational. We are choosing the clients who want to be with us. The question is why we haven't reached these margins. We didn't because the evolution of the working contract cannot be paid by the customer. We have regular contracts, and public administrations say that this or that. We really struggled in changing the cost of labor, which had increased.
We had an increase of the cost of labor over 12%. But then tenders say, "You cannot change the labor cost." So basically, they are requesting a discount. So basically, with these tenders, the increase of labor costs will not be paid to the company. The other question was about automation. Will we sell automation? Well, the word is half for sale and half for both. I mean, you can either buy or sell. I mean, we believe that differently from pay, automation does not express its full value. Our technology is truly acknowledged as top-class. We have commercial difficulties that we need to overcome. So the buyer should be someone with a very thorough commercial network.
That's something that you can take to heart. [crosstalk] so the connection between therapy and logistics, for example. [Foreign Langauge] in Israel. So it means that there is a value in this automation.[crosstalk] .
A question from Mombelli TP ICAP in Paris.
Underline the importance of synergies after years of M&A and focus on internal growth. What are the main goals for the optimization of acquired companies and maximize margins in the next few years?
Could you please read it again? [crosstalk] M&A. What are your main goals?
companies and maximize margins in the next few years. [crosstalk] . We would like to define an organizational model.
[crosstalk]
And how you want to challenge the competition?
[crosstalk]
We walked a long way, but now we have to look at the world in a different way.
Another question. [crosstalk] Do you think you can make a significant difference [crosstalk] Beyond the covenant level, do you think you can use your leverage?
Well, we've seen an improvement in the ratio between debt and EBITDA. It was below 2.5x for 2027 and 2029. Of course, we will use this leverage and we'll see what we can do with these results that we are freeing, basically. Anything else? Yes. Can you hear me? Are you happy with the sale of the Pay division? [crosstalk]
We bought it and it was a small component. A few hundred K of revenues. We bought it because we were interested in the areas we worked in. We prepared it, we set it up properly, and it was an independent business. . We didn't really have any important issues. [Foreign Language] We think we should have the same risk because [Foreign language] so we're going to the exit strategy because the buyer is now in charge of the project they are keeping, the staff, they are keeping the office, and Zucchetti delivered. [Foreign language]
Are there any more questions? . We had an hour and a half, so we're perfectly on time. Thank you very much for your attention, and we wish you a fruitful 2025. Thank you. Bye-bye.