Good morning, and welcome to Fresenius Medical Care AG's Annual Press Conference. My name is Carla Burigatto, Executive Vice President, Communications and Corporate Affairs. I'm delighted to welcome you today and appreciate all the journalists joining via live stream. Today's press conference is virtual and being streamed publicly as a webcast in both English and German. You can select your preferred language at the top of your screen. Let me begin by referring you to our safe harbor statement, which you can see in our presentation. In just a moment, our Chief Executive Officer, Helen Giza, will present the results for the company's 2025 financial year and outline our plans for 2026. After the presentation, we will move into Q&A. Helen and our Chief Financial Officer, Martin Fischer, will be available to answer your questions. You may ask questions in English or German.
For technical reasons, please ask questions in the same language you selected for the webcast. Responses from the studio will be provided in English. Before we begin, a few quick procedural notes. You are welcome to submit written questions at any time. We also encourage you to ask your question live by video. Simply click the button labeled, "I would like to ask a question via video chat." You may do this now so that a brief technical check can be completed before you are connected. With that, Helen, over to you.
Good morning, everyone, and thank you for joining us today to discuss Fresenius Medical Care's full year results for 2025, and to look ahead to 2026. I'm very pleased to be here with you, and I would like to begin, as I always do, by acknowledging those who make everything we share today possible: our dedicated employees and all of our teams around the world. Every patient who entrusts us with their care depends on the dedication, professionalism, and compassion of our workforce. Their commitment is truly one of our greatest strengths. We are the world's leading provider of kidney products and services. We treat nearly 300,000 patients, operate around 3,600 dialysis clinics, and about 35 manufacturing sites. We provide care systems and consumables for kidney care. We deliver dialysis treatments in our clinics, in hospitals for critical care, and at home.
We also have an expanding footprint in value-based care, where we partner with payers and physicians to improve outcomes and reduce medical costs for people with kidney disease. This past year marks the culmination of our FME25 turnaround and transformation, which has made us a healthier, more resilient company. Today, I am proud to share that in 2025, we saw progress toward establishing a new standard of care in the United States, strong execution of our expanded FME25+ initiatives, and a significant step-up in profitability. Importantly, in June, we introduced FME Reignite, our new 2030 strategy to lead kidney care through exceptional patient care and innovation. FME Reignite is built on three pillars: reignite the core, strengthening operational excellence through scale, standardization, and technology.
Reignite growth and innovation, advancing clinical outcomes and setting new standards of care through R&D, value-based care, and digital and AI-enabled solutions. Last, reignite our culture, putting our people first and living our values. We care, we connect, and we commit to drive sustainable long-term value. I will now highlight some of our accomplishments in 2025. Stepping back, three years ago, when we launched FME25, our goal was clear: to enhance performance, strengthen our foundation, and position Fresenius Medical Care for long-term profitable growth, and we met our commitments. We delivered sustainable savings beyond the original 2025 target, deepening our focus on operational excellence and the program expansion, FME25+, is also exceeding expectations. Against an initial target of EUR 500 million in sustainable savings, we achieved EUR 804 million by year-end 2025.
I am proud to share that FME25 is on track to deliver EUR 1.2 billion in sustainable savings by 2027, yet another extension of our original target. Additionally, we continue to execute our portfolio optimization program with disciplined rigor. We introduced a new capital allocation framework, and we announced an initial EUR 1 billion share buyback program over two years. By the end of 2025, we completed the first tranche, and in early 2026, we began the second tranche, which is expected to conclude by May 2026. We also introduced last year in the United States, the 5008X CAREsystem, an innovation I will highlight in a moment. We continue to add exceptional talent. Two new members of the Fresenius Medical Care Management Board joined early in 2026.
Joe Turk, our CEO of Care Enablement, and Charles Hugh-Jones, our Global Chief Medical Officer. We also welcomed Tommy O'Connor as CEO of Interwell Health and head of our value-based care segment. Each bring deep expertise and leadership that will help guide our company into the next chapter. We closed 2025 with strong results. Let me highlight a few metrics. Organic revenue increased by 8%, driven by all operating segments. Reported operating income grew by 31% and reported net income by 82%. Operating income, excluding special items, grew by 27%, reaching the top end of our financial outlook. Operating income margin rose to 11.3%, landing well within the midterm target band of 10%-14% that we set three years ago.
Earnings per share grew by 44%, reflecting both earnings strength and the impact of our accelerated share buyback program. Net leverage improved to 2.5x, the bottom end of our lowered target corridor. All three segments contributed to this success. Care delivery achieved strong results, supported by savings from the FME25+ program and positive rate and payer mix effects. TDAPA, which is a temporary Medicare Add-on Payment for innovative dialysis drugs, provided additional tailwind in the U.S. As expected, we saw flat same-market treatment growth in the U.S. We still see midterm, the 2%+ recovery due to our quality initiatives and 5008X helping to reduce mortality.
On top, we introduced our 5008X machine in the United States in preparation for expanding the rollout of HDF in the U.S. in 2026. Value-based care achieved positive operating income for the full year. Revenue grew 34%, driven by contract expansion and strong member months growth, a key value-based care financial performance metric. This business continues to play a critical strategic role in advancing best practice clinical outcomes and integrated patient management. In care enablement, we saw higher volumes and positive pricing developments, despite negative effects from volume-based procurement and other regulatory policies in China. We continue to capture sustainable savings as part of FME25+, driven by disciplined execution of the next level of footprint optimization across both manufacturing and supply chain.
In care enablement, preparation for the large-scale launch of the 5008X and shipment of new consumables continued to advance as planned. Fresenius Medical Care is performing at a higher level, more consistently, and with greater discipline than ever before. Moving to what we delivered in 2025. At the beginning of 2023, we set demanding midterm profitability targets for 2025 as we began the three-year journey to build a stronger and more resilient company. I am proud to say that we have delivered on that commitment. We increased our care delivery margin to 13.1%, achieving the middle of our target band for the segment. We more than quadrupled our care enable margin from below 2% to just over 8%.
When these targets were set, we operated with just two segments, with value-based care still part of care delivery. This is why there was not a specific target for value-based care. However, improved performance in that segment is reflected in the group development. Even as we return capital to shareholders in the form of dividends and share buybacks, we are in a significantly stronger financial position. We have reduced net debt and improved our net leverage ratio from 3.4 x at the end of 2022 to 2.5 x at the end of 2025. We also delivered on the committed key strategic initiatives. This execution supported our improved operational performance to date, and importantly, has positioned us well as we transition towards the next phase of growth and innovation. I previously mentioned that we exceeded our already upgraded sustainable savings target.
With our FME25+ transformation program, we committed and over-delivered, exceeding our already upgraded sustainable savings target with EUR 804 million in realized sustainable savings to date. We executed our portfolio optimization program at pace, focusing our international clinic footprint in 25 core markets across 34 countries, down from 49. A key pillar of our strategic plan, announced in 2023, was to unlock value as the leading kidney care company. The introductions of 5008X in the U.S. and leadership in renal value-based care are powerful examples of how we have delivered on that ambition, while raising the standard of care for patients. Cash generation is an inherent strength of our business model. In 2025, we generated EUR 2.7 billion in operating cash flow, clearly demonstrating this capability.
Our strong cash performance, supported by disciplined capital allocation, allows us to invest in our core business for profitable growth while returning excess capital to shareholders. Through our accelerated share buyback program, we repurchased shares with a value of EUR 586 million in 2025, completing the first tranche of our initial EUR 1 billion program, which supported our EPS growth. In January of this year, we initiated the next tranche with around EUR 414 million, further accelerating the share buyback program. For the 2025 financial year, we plan to propose a dividend of EUR 1.49, representing a 3% increase to 2024 and corresponding to a payout of 33% of adjusted net income, well aligned with our target payout ratio of 30%-40%.
One of the most exciting developments in 2025, and a key priority for 2026, is the introduction of HDF therapy in the United States through our new 5008X machine. This is the largest product launch in our company's history. HDF has been the standard of care in Europe, Latin America, and Asia Pacific for more than a decade. The CONVINCE study, an international randomized trial comparing HDF with standard high-flux hemodialysis, reaffirmed key clinical outcomes. A 23% lower risk of mortality compared to standard HD for patients treated with high volume HDF. Meaningful improvements in patient outcomes, well-being and recovery, and reduced mistreatments and improved treatment adherence. In 2025, we conducted a carefully planned introduction of the 5008X machine in select U.S. clinics. Feedback has been overwhelmingly positive. Patients report increased energy, improved sleep quality, and shorter recovery times.
Nurses and technicians highlight more automated workflows and reduced stress. Clinics are seeing early indications of improved treatment quality and operational efficiency. That's the kind of impact we are scaling nationwide for providers in the dialysis industry. This year, we will begin replacing approximately 20% of devices in our own U.S. clinics across 28 states, transitioning about 36,000 patients to HDF and training more than 7,200 staff in a single year. This is a massive undertaking. It positions us for improving patient outcomes, experience, and mortality, greater patient retention, and stronger competitive differentiation in the United States market. It gives us the opportunity to gain additional market share by growing patient admissions, along with capturing growth for consumables that are essential for performing a dialysis treatment. 2026 is a strategically important year.
This expanded rollout reflects our commitment to setting a new standard of care in the United States and improving patients' lives. Moving to our full year financials in more detail. In 2025, we realized 5% revenue growth at constant currency, driven by accelerated revenue growth with contributions from all three segments. Our organic growth reached nearly 8%, and we successfully executed our portfolio optimization plan, while divestitures resulted in some revenue growth headwinds. Operating income growth of 27% reached the top end of our financial outlook, supported by all operating segments, resulting in a significant margin step up to 11.3%. Special items mainly include costs related to legacy portfolio optimization and the FME25+ program.
Within our care delivery segment, we grew revenue by nearly 2% at constant currency, driven by positive impact from the aforementioned TDAPA regulations and favorable rate and mix effects. Organic revenue growth reached almost 5%. Divestitures negatively impacted growth by 210 basis points. As mentioned a few minutes ago, operating income grew by 18.5% at constant currency. In our value-based care segment, organic revenue growth of 34% was driven by an increase in member months, mainly due to contract expansion. Operating income turned positive. Business growth was mainly driven by a favorable savings rate and partially offset by an unfavorable effect from CMS' CKCC program. Savings within the FME25+ program offset inflation impacts. Focusing on care enablement, we saw revenue growth of 2% at constant currency, driven by volume growth and continued overall positive pricing.
On the other side, we saw negative impacts from volume-based procurement and other regulatory policies in China. Operating income grew 33% at constant currency. Savings from the FME25+ program and a favorable impact from business growth, driven by higher volumes and positive pricing developments, overcompensated the inflationary cost increases. Moving to our outlook for 2026. Following a significant step-up in profitability in 2025, we are comparing against a very high base in 2026, while significant temporary benefits from TDAPA regulations start to phase out this year. Our 2026 outlook underscores our disciplined focus on sustaining this higher base. While we expect care delivery and care enablement to grow, we are assuming broadly flat revenue growth, largely reflecting changes in value-based care's risk contracting and related revenue reductions.
For earnings, we assume operating income will remain on a consistent level, with an upside/downside range of a mid-single-digit percentage change. Our goal is to maintain our enhanced profitability while investing for future value creation and navigating regulatory headwinds. This implies a margin range of 10.5%-12% at group level. 2026 is a transition year by design. This year will serve as a pivotal milestone as we continue to strategically position ourselves for sustained value creation. During our Capital Markets Day in June, we communicated that margin development in care delivery is expected to be more weighted towards the later part of the strategy program, whereas care enablement demonstrates a steadier pattern of improvement. To enhance transparency regarding the group's future trajectory, we have added an aspiration for 2028.
We see a clear path toward operating income growth, targeting a compound annual growth rate of 3%-7% through 2028. This growth will be driven by the focused execution of our 2030 FME Reignite strategy, which includes the expanded rollout of the 5008X machine in the U.S., our quality strategy to reduce mistreatment and mortality, as well as continued progress in revenue cycle management. Increased sustainable savings from our FME25+ program will contribute to this earnings growth. Our 2030 aspirations are fully underpinned by the strategic priorities and momentum of FME Reignite. At the time of our Capital Markets Day, we had not given explicit revenue growth aspirations to 2030, as the value-based care segment has an inherent volatility from changes in risk contracting, which makes top-line forecasting less predictable.
In order to give more visibility to the revenue development of our other segments, we are sharing a 2030 CAGR for care delivery and care enablement. For care delivery, we anticipate a low to mid-single-digit revenue growth CAGR, and for care enablement, we expect a mid-single-digit revenue growth CAGR. Our 2030 aspirations are to achieve industry-leading margins in all our operating segments. At group level, we maintain our aspiration to deliver an operating income margin in the mid-teens. We maintain the same 2030 margin aspiration for both care delivery and care enablement. Recognizing that value-based care is a structurally lower margin business in a relatively nascent industry, we have a low single-digit operating income margin aspiration to 2030. We are well positioned for continued value creation in the years ahead. Before closing, I want to return to our purpose.
Last year, we supplied life-sustaining medical technology for patients in 140 countries and delivered more than 44 million dialysis treatments worldwide. Behind every treatment is a person, a family, who depends on us for nothing less than excellence. Our mission is simple, yet powerful: to create a future worth living for patients worldwide, every day. 2025 was a milestone year. We are healthier and more resilient as a result of our achievements. In 2026, we remain focused, disciplined, and determined as we continue executing our strategy, expanding innovation, and delivering value for the patients we serve, our employees, and our shareholders. Thank you.
Thank you very much, Helen. We will now move on to the Q&A session. Once again, a brief overview of the process for our media participants. On your screen, you will see a blue button located directly below the video window. When you click this button, a member of our technical team will connect with you to check audio and video quality. You will then be added to the meeting when it is your turn. Please be prepared to grant your browser access to your camera and microphone when prompted. When asking your question, please state your name and media outlet. Please also inform our technical colleague which language you have selected, as simultaneous interpretation is provided. In the event of any technical difficulties, don't worry. You may alternatively dial in by phone to ask your question on short notice.
Should you encounter any issues, please contact us via the support chat. With that, we are ready to begin. We will take the first question now. The first question that we will start with, came in in our chat. It is from Patricia Weiss at Reuters.
Despite the growth you reported for 2025, your outlook remains fairly cautious. You have cited several headwinds to explain this. Which factor is currently the biggest drag on the business: ongoing inflationary pressures or the costs and operational burden related to the launch of the new dialysis device in the U.S.? Could you quantify, as specifically as possible, the costs associated with the U.S. launch of the new device in 2025? Helen, over to you.
Thank you. Hi, Patricia. I think I'll tag-team this with Martin. As you heard from my comments, our, you know, obviously, our 2025 results show an exceptionally high level of profitability, and it was important for us as we went into 2026 to maintain that level of profitability. For maybe the back half of the year, have referred to 2026 as a transition year deliberately, recognizing that we do need to invest for the launch of HDF, as well as in, you know, kind of core systems. We also recognize that the transitionary payments that we get on binders in the bundle, they start to ebb in 2026 as well. I think, you know, that's kind of the plan and the goal going in.
Martin, would you mind just unpacking some of the other headwinds and tailwinds?
Yeah.
Particularly on inflation?
More than happy to. Hello, Patricia. Supporting that consistent level of operating income that Helen outlined, we have assumed business growth to contribute EUR 250 million-EUR 350 million. We are expecting about EUR 250 million savings that come from our FME25 transformation program. These two elements help us to offset inflationary assumptions that we have between EUR 200 million and EUR 300 million, and that includes our typical 3% labor inflation net of efficiencies. To your point and question, we are navigating additional headwinds that come from regulatory effects, between EUR 150 million and EUR 200 million, and we are investing EUR 100 million-EUR 150 million in the rollout of high-volume HDF and the harmonization of our IT platforms.
That will help us with the introduction of SAP S/4HANA to harmonize and standardize our processes, driving further efficiency. I hope these give a better feeling for the main building blocks.
Right. Thank you. The next question is about 5008X and our investment in it, and I'm going to go to Britta Becks from Dow Jones. The question is:
Can you estimate the approximate cost to FME for the large-scale 5008X launch in the U.S. this year, meaning 2026?
Yeah. Thank you. I'll take that question, and maybe double-clicking on what Martin just shared. We're very excited about the launch, and it is accelerating at speed. As I said, it's probably the biggest thing we've ever done in the company, and we're very excited about it. The obviously, the benefits of HDF, we've spoken at length about, but what we will have in 2026 is upfront cost for training, the nursing staff and tech staff in the clinic. There is a investment needed. As Martin mentioned, we sized our strategic investments of between EUR 100 million and EUR 150 million, and I would roughly say about half of that is HDF. We'll start to see the benefits the longer that we have, HDF.
As we implement HDF, we'll start to see the benefits coming in at the back half of the year. That training cost gets overcome by benefits. It is an upfront investment due to the size and scale of what we're accomplishing here.
All right. Thank you, Helen. I have a second question from Britta, at Dow Jones, it is about U.S. treatment volumes this year. The question is:
FME is forecasting continued stagnant growth in U.S. treatment volumes for this year. When do you expect to see a turnaround?
Yeah, we recognize, that, you know, the flat volume growth has been with us through 2025, and we're projecting a very similar level for 2026. You know, we are very confident in the underlying fundamentals of our business, but what we are seeing is a higher level of mortality still and a higher number of mistreatments. Obviously, that's compounded right now with the flu season and, as you're all probably reading the headlines, severe weather in the United States. We are forecasting it flat for 2026. We have every confidence that we return to a 2%+ growth once we normalize that mortality level.
A lot of the work that we're doing on our quality initiatives and just you know, kind of the whole patient experience, along with HDF, will continue to add to that increase in same-market treatment growth.
Okay. Thank you. We have actually several questions on same-market treatment growth, I'll go through them. The next is from Maria Rugamer at Reuters, it is about, you know, seeing a path back to 2% +. The question is:
You've said repeatedly that once mortality normalizes, you see a path back to 2% + same-market treatment growth. When do you expect mortality to normalize concretely, and in which quarter or half should we see that 2% + trend show up in reported volumes?
Clearly, our 2026 outlook, in light of what we've seen with the flu season and weather, we're kind of calling that the same as 2025. I think, you know, as these initiatives on improving mortality, kick in, we'll start to see a gradual increase over time. We haven't given, you know, kind of a, a day, a week, a month, a quarter on that timing, but just expect it to gradually improve over our outlook period here to get back to that 2% + that we saw, you know, pre-COVID.
Okay. Now, we have two questions that came in from Bloomberg, and I'm going to, you know, sort of break them up. You know, one is about U.S. tariff changes and refunds, and then the other is about our investments in Germany. Oh, sorry, different question. All right. Sonja Wind, Bloomberg. Let's start with the tariff changes. The question is:
What is your perspective on the latest U.S. tariff changes? Are you considering to seek any refunds for the tariffs?
Yeah. Thank you. Clearly, it's a hot news topic at the moment. We were very fortunate that you know, tariffs were very immaterial to us in 2025. We do benefit from some of the protocols because of the, you know, the classification of our products. We obviously have a large U.S. footprint, and a lot of our products are produced locally. Where we do start to see an impact on tariffs is in purchased goods that we have to buy from overseas. Obviously, we do expect to see some impact from tariffs in 2026. Our outlook reflects what tariffs were in place as of last Friday.
You know, obviously, we are, like probably every company and every C-suite in the world, continuing to monitor the developments, and we will see if there's a path, first of all, a path of clarity, but then whether there is a path of refunds or what tariffs may end up being in place when, and by country or maybe a broad based one. Obviously, it's very, very fluid in the last couple of days. We feel good about our assumptions for 2026, and of course, if there's an opportunity to seek a refund, we will put our best foot forward there.
All right. Thank you. You know, we have two questions left, I'm just gonna ask our journalists who've joined us, if you have any remaining questions, please feel free to submit those now while I go through these. Going back to the investment in Germany, we have a question that came in from Marcel Dinkel at Main-Post, the question is:
In which locations in Germany is Fresenius Medical Care planning to invest?
You can hear the, and sense the excitement from me when I talk about the 5008X. Two of our, you know, biggest manufacturing plants are in Germany, both in Schweinfurt and Sindelfingen, and are core manufacturers and high-volume producers of, you know, kind of our Dialyzers and our new machine. We're, you know, we're excited about, you know, the work and the product that's coming out of there. Martin, anything else you would add in terms of...
Yes. I mean, as you saw, we have just also made acquisitions of those manufacturing plants. We are investing into them on the back of the rollout of our products. Having said that, we are, as Helen outlined, having a global manufacturing network, where we are producing a lot local for local. Those sites are part of that global manufacturing network, which consists of main manufacturers in the United States, in Asia, as well as for Europe, in the German and French environment.
All right. Actually, that was our last question. We're going to go ahead and close and thank everyone for joining us. You know, first of all, thank you to all of you for joining. This concludes today's press conference. We appreciate your interest, and should you have any follow-up questions, the members of our press office will be happy to assist you at any time. I would like to thank Helen, and thank you, Martin. We appreciate your time.
Thank you all.
Thank you.