Good morning, everybody. It is my absolute pleasure to welcome you to our Capital Markets Day today here in Helsinki. My name is Kati Kaksonen, and I'm going to talk you through our agenda today. We have an exciting agenda today for you. We will talk about the important progress we have already made since the last Capital Markets Day 18 months ago, and more importantly, how we are moving forward as a company. But first, a mandatory disclaimer regarding forward-looking statements. I'm sure you have memorized it by now. But so, as said, we have a great agenda for you today. Our CEO, Ville Iho, will start with an overview of our strategy, our progress that we have made since the last Capital Markets Day, and our revised targets for our business areas and the group as a whole.
After Ville, our Executive Vice President of Healthcare Services, Sari Heinonen, will show you how the business is stronger today, where she and the team are tapping into opportunities for profitable growth, and how they are further strengthening our position as a leader in our core markets. After the first break, we'll dive into our digital agenda, and our Chief Digital Officer, Ilari Richardt, will show you some really exciting opportunities we see in further improving our productivity, professional engagement, and medical quality through our digital solutions. I'm also delighted to introduce you to our newly appointed Chief Medical Officer, Petteri Lankinen here today, and with Petri, we'll have a discussion on the integrated care model and the value we see there from a medical perspective. After the lunch break, we'll continue with our Portfolio Businesses led by Henri Mäenalanen.
He will share with you his turnaround and growth agenda regarding each of the business areas there. After Henri, we'll continue with Stefan Kullgren, CEO of Feelgood Sweden, and he will talk you through the ongoing profit improvement program and how that will make the business stronger and structurally more profitable going forward. And finally, our CFO, Juuso Pajunen, will tie everything together in terms of financials. You have all seen our recent guidance upgrade for this year, as well as the revised financial targets. So Juuso will elaborate our progress on the financial perspective and our thinking around the capital allocation going forward. Before each break, you will have a chance to ask questions. I will first take questions from the live audience and then through the webcast. And as a reminder, you have a chance to send in your questions any time of the day.
In this physical location, we have coffee available during the breaks, and the lunch will be served just by the corner in the cafeteria area there. And the restrooms are behind there for important information as well. So with that, I'm really excited to welcome you all here today and continue with our agenda. So let's welcome Ville on the stage.
Good morning on my behalf. Delighted to be here today. As many of you remember, the last time around we had CMD; it was May 23 after Q1 2023 release. Now looking back, actually, it's quite funny to think about the fact that Q1 2023 and after that one, the CMD, that was the period of all-time low performance for Terveystalo's profitability during a stock-listed period. Back then, of course, with that, the agenda was all around turnaround, credibility of our plan, and how we bridge our journey and our agenda from that low point to our then set ambitious target of reaching 12% EBITDA in 2025. As you also well know, the progress that we have made since has been impressive. We have not only reached the target that we set, but we have overperformed ahead of schedule.
We recently upgraded our full-year guidance and set the minimum level for this year to 12.5. Against the CMD storyline in 2023, one can truly say the team present here has delivered, and Terveystalo today is stronger than ever. With that, from my behalf, welcome to Terveystalo Capital Markets Day. As Kati already said, we have a really exciting agenda for this day. If 2023 CMD was about credibility and storytelling around turnaround, this year CMD is much more about confidence. Why we are confident in the next chapter of Terveystalo and how we position ourselves financially, medically, operationally, commercially into that journey. We have several reasons for that confidence. The track record that the team has is, of course, one key pillar for that one. The other one is the market, how we see the market.
The market continues to support Terveystalo business model and Terveystalo profitable growth going forward. Third element is our model, data-driven integrated care, and as Ilari, Sari, and Petri will elaborate in their presentations, there's ample opportunities to further perfect the model and increase efficiency, productivity, medical quality, and customer experience, especially through digital. Finally, as Kati already mentioned, we tie this all together into finances. Juuso will deep dive into that one, present in detail our updated financial targets, and in numbers present our commitment to value creation. First, as a reminder, Terveystalo, we are, of course, a healthcare company, and we have an extremely simple, powerful, and clear purpose. We fight for a healthier life.
Terveystalo as a company, our operations, our team, and everything we do is deeply rooted into our three core values: human being always in the center, reforming healthcare through technology, and in the core of the core, always being honest with medical science. Through those values and to achieve our purpose, we drive data-driven integrated care. We know our customers. We care about our customers throughout the care journey. We steer them. We care about them, and we relentlessly always measure the outcomes that we get from our services. Our competitive advantage and edge will rely on this integrated care model and perfecting that one going forward. If the last stint since CMD has been all about fixing the basics and profitability, the upcoming stint and chapter will be more balanced. We'll invest in enhancing the value of our services to customers and the professional brand of Terveystalo.
Our integrated model and our values, our targets are fully aligned with both achieving high profitability and positive societal impact, which as a healthcare company is utmost important for us. So integrated care, data-driven integrated care, maximizing the value for all of the stakeholders will be mentioned many, many times during this day. And I will shortly explain why it's so important for us and for our business model and for our plan. Four key points to take home from this one. First is outcomes. Second is integration. Number three is shared targets and incentives with our customers and payers. And the fourth one is data. I will start from outcomes. It sounds trivial, but really in this industry, it is not trivial. We are for outcomes, and also our customers are for outcomes.
So what that means is that we, with our integrated model, by operating in prevention, primary care, and specialist care, are targeting throughout the full care journey for the end outcome for every patient and for every customer. So we are not an outsourcing partner typically for a healthcare organizer, just taking care of one small tiny piece of the service. We are a holistic provider of the whole healthcare solution. So outcome is what we are keen at looking at, and that's what our, especially in the private domain, our customers and payers are keen at looking at. Balanced shared incentives is the second thing. Typically, even if a healthcare company in a market is outcome-driven, outcome is typically only defined as cost and medical outcome. For us, it is much more balanced.
So on top of that one, of course, medical outcome is the core, and our customers and payers are always interested in the cost of our services, but they are very interested in fast access to care, throughput time throughout the care journey, and customer experience. So it is a balanced view. With that balanced view and our integrated model, where we are actually, we are in charge of the whole journey, we are able to optimize, we are able to define the processes, we are in charge of care guidance, patient steering, we have ample opportunities to optimize the full care chain and our integrated processes, and to use not only medical best practices, but also operational best practices and commercial best practices from other industries as well. So it's a different type of much more holistic model than you typically see in the healthcare space.
That then again enables us to invest into technology to truly integrate our processes, commercial, operational, medical processes for the benefit of the end customer and the patient. With customer data, we can further enhance the service, create true intimacy with the customer. So what we like to say is that when in Finland people are talking about a family doctor model, we are here to create a family doctor model into your pocket through the technology in scale throughout our whole network in physical and digital. So we truly believe in our model, and that's the core for our plan. Not only do we trust in our core model, data-driven integrated care, but we have high trust in the markets that we are serving. Megatrends supporting the market growth, they have not changed. They have not changed since the last CMD or five years prior to that one.
Some of the megatrends have even accelerated. Aging population will guarantee that volume-wise demand for Healthcare Services will grow. It is just a fact. Constrained labor market, on the other hand, will mean for a private provider like Terveystalo, first of all, a healthy pricing environment. There will not be an oversupply and benefit for a company like Terveystalo who has the employer brand and attractiveness for the professionals to exceed the market growth in supply. So in simple terms, recruit professionals. Challenged public system is a thing to stay. Deficits in funding cannot be solved by just hosing money into the problem. That will guarantee that the private part of the funding, which is our main business, will grow, and it will grow faster than the public side of the funding.
Finally, if you look at this challenging equation from the society point of view, the only sustainable solution to really make progress is through technology. Truly increase efficiency and productivity into the system, and that can only be done by applying modern technology integration, and for a company like Terveystalo, once again, that is a great opportunity because we have the robust technology platform already in place, and we have the cash flow to invest further into that one, and Ilari will share in his presentation exciting examples of what we have already done and, most importantly, what we will do in the future. These megatrends, they translate into actual numbers. Healthcare spend based on demography and cost increases in specialty care will mean that the spend will increase roughly 4% annually during the course of 10 years, so it's big numbers accumulated. We are talking about big numbers.
And again, a funding gap that cannot be solved just by hosing money into the problem. That's why, for the reasons I explained, private money into the system will grow slightly faster, 5% a year. And as a big picture, this will mean that there are this equation, this market view will support Terveystalo's organic growth plans. And this view and 5% growth does not even include the potentially emerging private-public partnerships between healthcare providers and new healthcare districts. And Henri, in his presentation, will touch upon this opportunity. So we have the model. We believe in our model. We have huge potential in further perfecting that one. We have a market supporting our profitable growth agenda and value creation. Third pillar for our confidence, as already mentioned, is our recent track record.
This is a great day for the audience, for you to hear from the team who actually delivered the turnaround details into that journey. Please take most of that opportunity. Looking at what we have achieved, we can say, as I already mentioned, that Terveystalo is stronger than ever. In a tough macro environment, we have been able to grow the business. We have taken the profitability to all-time high in normal operational times. Our leverage is decreasing, and our cash flow is strong. Terveystalo today financially is stronger than ever. As I said, this has been delivered in a tough macro environment. We have not gotten support from the public market, nor from the consumer market. At the same time, while delivering this turnaround, impressive turnaround, we have been able to raise the customer experience measured in NPS to all-time high level, 87 in NPS.
At the same time, also improving the medical outcomes, as Kati and Petri will discuss in their presentation. So model, market, track record, three very clear and strong reasons to be confident in our future. When we started our turnaround journey in the fall of 2022, we organized our business into three different P&Ls. Main business, Healthcare Services led by Sari, who will give a deep dive into this business later after myself. Portfolio businesses led by Henri, and finally Sweden led by Stefan. All of these three businesses have a crystal clear agenda for coming years and a mandate to deliver value creation. Our main business, Healthcare Services, has been the focus for our turnaround actions, and the development has been impressive. We have reached 15% EBITDA level LTM, and as a next step, we go beyond 16 and continue incremental development in that area.
We have a lot of opportunities in Healthcare Services, especially through digital, increasing the value of the services for our customers, really investing into that one, focusing on the right growth areas, as Sari will explain, and further investing into the employer brand. Portfolio businesses have been living through a difficult time when you think about the macro public side has been silent, and consumer businesses, dental massage, they have been suffering from all-time low consumer confidence. Despite that one, we have already seen positive development quarter to quarter in our portfolio businesses' profitability. So Henri and the team have started delivering that bottom line increase. The team and Henri, as he'll explain later, they are committed for doubling the profitability by 2029, and we have planned for that one, while also tapping, as I said already, into the emerging potential of private-public partnerships with healthcare districts.
Sweden has also suffered from tough macro, as Stefan will explain in his presentation. Stefan has started the turnaround journey with a steady hand, and we see today already run rate improvement in that business, and bottom line improvements will be shown during the course of next year. We will take the business to previous profitability and beyond, and the target is to reach over 10% by 2029, and we have a plan for that one. So all in all, this is a more balanced portfolio, clear agenda for each and everyone, incremental improvement potential in Healthcare Services, step change potential in portfolio businesses and Sweden. One thing to add on to that one is that this is also a less risky portfolio than, for example, two years back.
If you deep dive into that statement, looking into the Healthcare Services, Healthcare Services has been the profit driver for Terveystalo, but it has been relying a lot on single high-margin diagnostic services. That is not so anymore. We have been able to, and Sari's team has been able to balance that view so that the margin contribution comes now from more balanced, more sources. So we are less risky in that core business. Portfolio Businesses, on the other hand, they have been able to gradually exit from risk-exposed contracts, legacy contracts with the communities and healthcare districts. We suffered from those low-margin risky agreements earlier, but now even the portfolio business portfolio is more balanced and less risky.
Looking forward, of course, when we are able to reach the targets of portfolio businesses and Sweden, the full portfolio is more balanced, and all of the three cylinders will produce profits. So less risky and a lot of potential in the group. So as you'll hear, this business agenda for three P&Ls, they are crystal clear. From a group level, we have priorities as well, and they are equally clear. If last two years or so have been a lot about fixing the core, fixing the profitability, closing the profitability leakages, it's going to be much more balanced view. We will invest into the team, into the employer brand of Terveystalo, further enhancing that one. We have taken the team through a fairly tough period.
We will invest and accelerate the development of our services to enhance the value of our services to the customers, and that's going to be the key. It's going to be based on an integrated model, and it's going to be accelerated through digital. Both of these employer brand values of our services to our customers are the basis for our organic growth agenda, and especially Sari will walk you through what it means in practice. We have been concentrating on profit improvement, and I said it's going to be more balanced, but of course, profit improvement will continue. As I said, from the group view, we have incremental improvement potential in Healthcare Services and step change potential in portfolio businesses and Sweden. And we have focused projects which are going through the full group, which will either decrease the cost or increase the revenue.
Finally, optimized business portfolio, we are always on the lookout, backed by our healthy, strong cash flow, for disciplined value-creating acquisitions when there is a synergistic service that either we are not, as a market share, high enough or if it's missing from our portfolio. So with agendas from the P&Ls, from the group point of view agenda, we are prone to grow and create value. If one then ties this one into our final share targets, it's a slightly different kind of view than it has been. It's a more balanced view, and it's very, very credible. We will drive for profitable growth, 10% EPS growth on average with the moderate leverage ratio which we have reached during the turnaround program, and reward our shareholders with attractive dividends.
With the profitable growth agenda that we have created, this is doable while at the same time leaving dry powder for value-creating acquisitions, as Juuso will explain in his presentation later. So 24 months back, roughly, I set for this company then a very ambitious plan of reaching 12% in 2025. As you have read, as you have heard, and as you will hear today, of course, the target for this team was not quite ambitious enough. So we have overperformed. We have overdelivered ahead of time. Terveystalo today is stronger than ever. We have the plan. We have confidence in our model. We have confidence in our market. We have a fresh team with energy, but a team which has already been tested in this tough turnaround journey. With these elements, it's my absolute pleasure to close my presentation and invite Kati to the stage.
S ari maybe, but. No, Kati, please go ahead.
So good morning, everybody. My name is Sari Heinonen, and I have been heading the Healthcare Services business segment from February early this year. And before joining Terveystalo, I worked for over 10 years for the largest financial group in Finland in different leadership positions, the latest being the CEO of a life insurance company. I have a PhD in marketing and a strong background in digitalization, different kinds of commercial activities, and customer experience in both B2B and B2C segments. And since joining Terveystalo, my focus has been, of course, on finishing the implementation of our profit improvement program, but also on building our development agenda for our next phase of the strategy. So I'm really excited to be here today to talk about the progress that we have already made and our forward-looking development plan. So we have clear targets.
We are aiming for above-market growth, continuous incremental improvement in our profitability, and best-in-class customer experience and people experience. From a revenue perspective, we aim to both grow our market share and grow our share of wallet in order to reach the 5% annual growth in revenue. Then, from an operational excellence perspective, we will continue to incrementally increase our profitability by investing in digitalization and automation. And finally, we are committed to delivering industry-leading people experience together with high medical quality and high customer experience. So during my presentation, I will talk about our development agenda. In other words, how are we going to reach these targets? But before going into that, let's take a look at our strategy, how we see our relevant markets developing, and what we have achieved with our strategy so far.
As Ville said, the core of our strategy is to offer exceptional value for our customers by providing comprehensive and integrated care. This includes prevention, where we empower our customers to be more in control of their health. It includes primary care, where we offer fast access to care and, of course, fluent care paths. Finally, specialist care, where we demonstrate superior medical outcomes. We will continue, of course, to develop each of these different parts to be more effective and more high quality. The thing that distinguishes us in this model and the competition is the seamless commercial, operational, and medical integration of these different steps. We believe that that will give us an edge when we look forward to changing market trends and customer needs. Next, let's take a look at how we believe that our relevant market is going to develop.
We see strong fundamentals driving the growth of the private healthcare market in the next years. First, as Ville told, demography is driving the need for care, aging population. Then we also see that insurance is gaining share. The volume of voluntary health insurance is growing, and people are using their insurance coverage more frequently. And finally, we also see a gradual increase in the number of employees in Finland, which, of course, supports our growth agenda in occupational health. The demand environment is positive, and it is expected to support our growth agenda. Next, let's take a look at how we see our position in this market. We operate in three key private pay segments: occupational healthcare, out-of-pocket consumer market, and then insurance market. We are the market leader in each of these segments.
When you look at these three, insurance is actually the fastest growing one, as more and more Finns, especially adults, are getting voluntary health insurances. When we look back 10 years, the volume of voluntary health insurances has actually grown in Finland by 30%, and also, during the same time, the collaboration between insurance companies and healthcare providers has had many different phases. One could say that it started with insurance companies focusing on cost efficiency in care paths, so quick access to care, no overtreatment, cost-efficient prices. After that, insurance companies started to take more steering power to themselves, and they started building different types of manual care assessment tools. After that phase came a phase of strong partnerships. One maybe remembers that at that time, for example, OP Group built its own hospital chain, and also LähiTapiola acquired part of Mehiläinen, one of our peers.
But now we believe that we are moving towards a multi-production model where digitalization is the key. So insurance companies are looking for private healthcare providers who can offer a digitalized customer journey, who can steer their customers, who have high-quality care paths, and who have transparent reporting capabilities. And we believe that we are in a good place here as we have high-quality, efficient care paths, and we have industry-leading digital capabilities. But next, let's take a look at what we have achieved with our strategy so far and from where we are starting the next phase of our strategy. So, as a starting point, we are structurally stronger as a business after the successful profit improvement program.
Here you see that during the last two years, our revenue has grown by 13%, and we have also reached our profitability target, actually one year ahead, our EBITDA margin now being 15%, and at the same time, we have record high customer satisfaction, our NPS in appointments being 87, and in our hospitals, 95. We also start our next phase of the strategy from a place where we have actually outpaced market supply growth, and we have balanced our profit margin, as Ville mentioned, so during the last year, we have been able to grow our physician supply by 4%, which is actually twice faster than the market, and this is due to our good and valued employer brand. We are especially pleased with the growth that we have had in occupational health doctors and GPs.
And then, at the same time, we have been able to increase the profitability of our appointments significantly. Here on the graph, you can see that during the last two years, the appointment share of our total revenue has grown by 5 percentage points, and the appointment share of total salary margin contribution has grown by 9 percentage points. So, to put this together, we have been able to grow in physicians, occupational health doctors, and GPs who are the professions who actually perform most of the appointments. And at the same time, we have been able to significantly grow the profitability of our appointments, this leading us to a place where our EBITDA is growing, and we are not so dependent on the margin of diagnostics anymore.
We are in a good position when we look at our financial figures, but next, let's take a look at what our customers think about us. As we all know, brand is a key factor in the private healthcare market where we operate. Our brand is highly evaluated by our customers. According to the recent research from Taloustutkimus, we are the most respected consumer brand in the category of private clinics in Finland. Also, according to our continuous brand tracking, we are the most considered consumer brand in the category of private clinics. We are the most preferred consumer brand, and we are the most preferred brand among occupational health B2B decision makers. To sum up, we have made a strong profitability improvement.
We have been able to balance our margin structure in a way that we are not so dependent on the margin of diagnostics anymore. We have grown our supply. We have high customer satisfaction and a leading brand. And now, when we look forward from here, our focus will be on profitable growth and creating more customer value. So next, let's move on to our development agenda. So what will be our key focus areas in the future? So we have prioritized four areas where we see further growth and customer value potential. First, we will scale prevention and care paths. This is something where we are just in the beginning. I will come back to this in a minute. Second thing is that we will strengthen our insurance partnerships and customer experience.
Our goal is to be the best partner for insurance companies and the best service provider for insurance-covered end customers. What this means in practice is that we will build digital integration with insurance companies and also smoother digital customer journeys. Third thing is that we still see growth pockets in selected geographies, hospitals, and specialties. What this means, for example, is that we will invest in growth centers with bigger entities and with a wider variety of specialties. And finally, we will grow in digital channels. During the last year, we have been able to improve significantly the profitability of our digital channels, and now we are ready to scale our digital channels in order to offer our customers even more convenient access to care in a cost-efficient manner. But next, let's take a look at a few of these focus areas in some more detail.
Let's start with prevention, so we believe that effective prevention has a huge potential impact on workability and public health. We have recently deepened our cooperation with blood test company Nightingale and integrated their risk identification in our health checkup process, and by this, we can actually identify the risk of developing eight most common lifestyle diseases before they show any symptoms, and so far, we have delivered over 100,000 risk reports to individual customers, and we also have population-level data for over 10,000 corporate customers. We have also identified effective interventions and care paths for different types of risks, and our nationwide population data shows that there is a high need for these kinds of interventions, as for example, a huge proportion of working-age men in Finland have an increased or high risk of type 2 diabetes or cardiovascular disease.
We believe that when we succeed in effective prevention, we can decrease morbidity, increase healthy working lives, and extend working lives with a huge societal impact. We are just in the beginning here. Next, let's jump into specialties. We have earlier chosen three specialty areas: orthopedics, sleep, and mental health. Now we can say that we have successfully delivered growth and customer benefits in all of these areas. If we start from orthopedics, during the last year, we have grown 25% and at the same time delivered a reduction in disability and sick leaves. Then with sleep, the growth has been 32%. For example, at the same time, the prescription of sleeping pills per visit has decreased by 27%.
With mental health, the growth has been even faster, 49%, and with great results, mental health-related absences decreased by 45% despite the annual increase in the number of diagnoses. We still see future growth potential in these three, but in addition, we have selected new specialties where we want to grow in the future. Let's take a look at what they are. Starting from right, ophthalmology, that is an area where demand increases as the population ages, and we are still a fairly small player. The same goes with a few conservative areas like dermatology, neurology, and obesity care. In all of them, the demand is increasing, and we have still room to grow. With pediatrics, the market is not growing so fast, but we have room to grow our market share. Then there's gynecology, where we see potential, especially in the treatment of menopause.
I will come back to that in a minute, but overall, there are important specialties where we can still grow and create customer value, but let's come back to my example of gynecology, so menopause impacts directly half of the working-age population at some point, and it is still an area that is very commonly underdiagnosed and undertreated. Menopausal symptoms are not often recognized in Healthcare Services, even though the treatment of more severe symptoms can have a crucial impact on the well-being and workability of women, and as Terveystalo, we have, of course, taken action to offer better treatment to our customers and this population of 1.5 million women in Finland. We have started to train our professionals. We have started to inform our customers, and we have also taken the role of a spokesperson over this subject area in Finland this autumn.
And so far, the feedback from both professionals and customers has been overwhelmingly positive. So we think that here we have a fantastic opportunity to improve the health and working capacity of people in their prime working years, and also thereby support businesses and the economy as a whole. Okay, but then finally, I will move on in our development agenda into our focus areas in productivity and people engagement. So, as you will soon hear from Ilari's presentation, digitalization plays a major role in further enhancing our productivity and people experience. Here we have chosen three different focus areas: optimizing and digitalizing routine work, and in that way, enabling our people to focus on more value-adding tasks. Then, modernizing our resource planning solutions. Here, we, of course, drive process efficiency, but also we want to have the right people at the right place at the right time.
Finally, we are committed to developing the best-in-class digital tools for our professionals in order to create a more fluent workday experience and, of course, increase our productivity and care compliance. We still see major potential in these areas to improve our profitability and people experience. As I said, you will hear more about this after the break. Finally, I will sum up my presentation. We have a clear plan to strengthen our position. We are targeting an annual revenue growth of 5% and incremental improvement in our profit margin, and we aim to increase our market share in all of our customer segments. Today, our business is structurally stronger. We have a balanced margin structure, robust supply, high customer satisfaction, and a leading brand.
And we aim to grow by scaling care paths and prevention, forming deeper partnerships with insurance companies, targeting selected geographies, hospital specialties, and expanding our digital channels. And we will improve our profitability through automation and digitalization. And finally, we are dedicated to providing an industry-leading employee experience and maintaining high medical quality. And here again, digitalization plays a major role. Thank you.
Thank you so much, Sari and Ville. Now we are ready for your questions. So first, if there are questions from the audience, we'll give the speech over there. I think Anssi was first, and then Sami.
Yes, Anssi Raussi from SEB. Thank you for the presentations. So far, just one question regarding the big picture here. You increased the dividend payout ratio target, and you mentioned selective M&A possibilities.
So just to confirm, you're not looking for any transformational M&A transactions or new countries, for example, at this point?
Yeah, actually, you answered the question yourself, so it's going to be very disciplined. It's going to be value-adding, and we are not looking for any transformational. I laid out the agenda for each and every business, and of course, you might be alluding to especially Sweden. Sweden is bang-on focused in their turnaround journey. End of story.
Sami Sarkamies, Danske Bank. I could continue actually on the same topic. If we look at the new targets, you have scrapped a top-line target. I think previously you had also a EUR 1.8 billion sales target for 2028, which included more material M&A. Should we read this so that you're not necessarily planning to do that larger M&A? The dividend policy would also suggest that.
Sorry, can you repeat the first part of the question?
So yeah, so previously you had this EUR 1.8 billion sales target for 2028, which included more material M&A. I guess you're not now planning to do it because the high dividend payout ratio will not leave money for M&A. Yeah, actually, you also will go in detail through the modeling and what it allows and what it does not allow. So maybe you will hold that question until then, but you are roughly right.
Having said that, of course, we are still very much focused on growth, but not material M&A is not only.
It's profitable growth, especially through organic agenda as laid out by Sari.
All right, Roni Peuranheimo from Inderes. You expect the private provision market to grow around 5%, and this has increased so much from the last CMD.
So could you briefly explain what has changed since then?
Well, actually, I think I laid out the macro view, why this is growing. The mega trends push the full healthcare spend to grow. That's evident. Funding gap guarantees that the private part of that spend will not decrease. It's going to increase slightly. And more detailed growth levers were laid out by Sari. I don't know if you want to elaborate.
Yeah, demographic. And then, of course, we see growth in the insurance segment. And then, of course, when we look at the occupational healthcare segment, there we see an increasing number of employees in Finland, which, of course, grows the market.
And then in terms of the Healthcare Services and appointments, have you seen any issues with the satisfaction of practitioners since now that you have increased the profitability of appointments and the share of wallet for Terveystalo?
Yeah, well, I could start with saying that in the Alpha program, we had more than 200 different projects, which, of course, many of them affected the profitability of appointments, and we have done a lot of commercial and operational changes and activities there that have been levers for the improved profitability, but it is true that we have also developed the compensation models for private practitioners, and our target, and we are committed to that, our compensation models will be competitive in the future as well, so we know that if our compensation models for practitioners are not competitive, we will not have supply.
Yeah, and in a way, dialing back to our bottom line, we have made urgently and, well, needed changes to our model, and Sari explained how it has been one of the contributors to balance out the margin profile of Terveystalo.
It has been very important for our progress. Despite those changes, as Sari explained and showed, the supply has been growing, and that's the bottom line.
Y eah, I think Minttu wanted to add that.
And we have, as Sari said, we have been overperforming against the market supply growth as a whole. So we are in a good place. We have been able to rectify the model. Supply is there and will continue from this strong base.
Maybe one more question about the competitive landscape. Now that the profitabilities of key players in the market have improved significantly, have you seen any increased pressure from competition or new concepts perhaps entering the market?
Well, maybe I will start. The market has been fairly disciplined with the players focusing on profitability, as you pointed out.
We have not seen any drastic changes in the stance to the market, nor any new openings, totally new services or models as such. But this is a market, and market goes somewhat in waves. And we are, of course, also prepared for different types of market conditions. But it's been disciplined and continues to be disciplined.
Sami Sarkamies, Danske Bank. I have two questions regarding the public pay private provisioning market. You estimated 5-6% growth, but when do you actually estimate this growth to start? Because I think two years into Sote reform, the market is shrinking at the moment. And then secondly, why didn't you include that into your core market? Is the reason that you're not believing in this growth or you're not sure if you want to play that market?
Yeah, that's a great question.
Henri will actually talk in detail about that one and our view on how that market is going to evolve. Why we did not include that into the modeling is that it's a fairly, in a way, black or white. When it happens, it happens, and it's very sort of anybody's guess when it will happen. But Henri has a full story around that one.
Yeah, maybe just quickly referring that it's an optionality for us. So we're not basing our model on that, but it's an upside potential that we are very much interested in tapping into. And Henri will explain in detail.
Yes. Joni Sandvall from Nordea. Maybe one question on the labor market. We know there are constraints in both nurses and doctors. So how do you see this going forward?
Is this a risk or can you maybe mitigate this with the data and, let's say, AI going forward?
Yeah, very good question. Again, first starting how the market dynamics have been evolving during the last couple of years. So especially in the late stages of COVID, we saw a huge bottlenecks in the nurse labor market, some bottlenecks in physician supply. But both of those for us have actually improved quite a bit. So we went through the physician supply development. It's been positive for us. We have been overperforming against the market. And actually, the nurses' labor market is way better than it used to be two years back when there was a lot of discussion around that one. All of the healthcare districts complaining about the bottlenecks and salaries going up. So that's totally shifted. We don't see bottlenecks in that area anymore.
Going forward, as you pointed out, productivity efficiency in the core medical process will be one of the key areas for our development. Of course, we want to further enhance the supply and also lower the unit cost by increasing productivity. And there will be stories around that one by Ilari later.
And maybe I can add that what are the factors that affect the supply? What we have learned is, of course, that we have to offer the professionals a fluent workday experience. We have to have high demand, and then we have to have competitive compensation models.
Sami Sarkamies, Danske Bank. This may be a bit of an unorthodox question, but are you sure integrated care that you talk about a lot is good for Terveystalo shareholders? What I mean is that preventive care sounds like high investments, perhaps a little appetite to pay.
And then, I guess sicker patients mean more business for you.
Yeah, starting from the sicker patients, maybe looking at the demography, looking at the whole healthcare spend, if you consider a risk that we make the whole of Finland healthy and there will not be demand, I wouldn't be worried. Of course, that would be a dream scenario. And if we are then able to achieve that one as one player, then all good. Maybe we'll, and Terveystalo will then find a great new opportunity somewhere else. If that is the case, as Sari explained in her presentation, preventive has and scaling that one has started. Of course, we are doing that one in our corporate market already today. But for consumers, as you pointed out, finding the business model, willingness to pay has been a challenge for any player.
But for us, it's not so much about scale and the revenue. It's about customer intimacy and customer loyalty. We want to strengthen our customer relationships with that one, taking care of a patient and customer throughout a full continuum. We are not afraid of demand dying out.
Good. I think there are no further questions from the room. There were a couple online. I think we have already covered the first one regarding the reasons behind the margin structure improvement and why we are less dependent on diagnostics. So one part is the compensation or revenue sharing models and then 200 other projects that have contributed to that change.
Yeah, one thing to mention on that front is that actually when you look at the cost that's been allocated to appointments, which is the bulk of what we are doing, that one is going down as well.
So that's been a major contributor for the appointment profitability, not only the practitioner model.
Yeah, a lot of process improvements.
Yeah. But then maybe a question around market shares in occupational healthcare, out-of-pocket and insurance. And how do you see the competition in these private pay segments?
Well, of course, the competition is there and challenging us all the time and keeping us awake. And as I told, our plan is to grow in each of these different segments. So we see growth potential and we see growth potential especially in the industry segment.
Yeah. Insurance segment.
Yeah, and it's a great thing that we have a healthy competition in this market in Finland.
Yeah. And then the other question was around the segments where we want to increase the share of wallet where our market share is lower.
I think that you already presented some of the examples in mental, sleep and orthopedics where we have seen robust growth so far and believe that there are further areas of improvement. With that, I think that we'll close the first Q&A session. We'll have a small coffee break here. After the break, we'll continue with our digital agenda with Ilari.
Thank you.
Thank you.
All right, welcome back from the break. We are ready to continue with our digital agenda presented by our Chief Digital Officer, Ilari Richardt. Please, Ilari.
Hello, and nice to see you again. My name is Ilari Richardt, and I'm a Chief Digital Officer and Senior Vice President for the Digital Services here in Terveystalo Group.
I have almost 15 years of background in healthcare digitalization and in various roles, and today I'm updating you on progress in our digital journey and journey going forward. Eighteen months ago, at the last Capital Markets Day, I told you how our digital platform creates value and competitive advantage. Since then, we have taken significant steps forward, and today I'm here to update on the progress, how the digitalization supports our productivity development, medical quality, and professional engagement. As Ville already mentioned, we have a clear agenda and a strategy where the digital plays a significant role. Our digital platform is already creating true competitive advantage, true superior user experience and data, and we have a great additional potential to improve the productivity through the digital solutions even further. Let me talk you through how. When talking about the process integration, we can think of two worlds.
One, what happens outside of the appointments, and two, what happens within the appointments. These combined were addressing over 70% of our total cost base. Firstly, we have an industry-leading digital platform that already creates significant value in process outside of the appointments, but the AI technology advancement creates additional potential in this area. I'll briefly tell you more about the achievements which we have made in this area. Secondly, in Western countries, the digitalization level of the process within the appointments remains low. We also see that the appointments themselves have not been digitalized to full extent, where we see a high potential. Thirdly, the customer data creates significant opportunities in preventive care and care compliance. By utilizing data wisely, we can detect the person's hidden needs for healthcare and utilize preventive measures. Data access enables integrating our processes, prevention, primary care, and outpatient specialist care.
Now we will dive more deeply into the first part of the presentation, the process outside of the appointments. First, let me give you a concrete example. This gives you a proof point that we know how to create digital solutions that deliver value. This is not something that we're planning to do. We're already doing this, and it's already delivering significant business and customer value. Here we have a case example that illustrates one of the key processes outside of the appointment room, the appointment booking process. By systematic development of individual customers' channels, mobile app, and the website, we have achieved over 75% self-service rate in appointment bookings, and you can see the development in the graph. This means that three out of four of our visits start from the digital channels already, without the need for introduction between the customer and the customer service.
Our digital channels have over 2.5 million registered users, meaning that we have a direct connection to our customers through the digital channels. Now, if you think that the cost of appointment booking in the call center costs EUR 13, and in digital channel it costs EUR 1, you can easily see the efficiency gains by digitalizing the process outside of the appointment room. But it's also crucial to understand that while we have been able to create significant efficiency gains in this area, we have also been able to improve the customer experience and the satisfaction at the same time. This proves that we can and know how to build digital solutions that the users love and deliver value. But it doesn't end there.
As technology, especially the AI, takes significant leaps forward, we can unlock the new ways of thinking the process and even further improve the productivity and the customer experience. We have around 30 million payroll in supporting process outside of the appointments. In this transactional work and process, we have clear evidence that the AI-assisted process can increase the productivity by 15% within a year. And it continues. When introducing agentic AI to transactional process, there is up to 40% productivity potential. During 2024, we have, for example, introduced AI to our call center, and we can see already how the phone calls are getting shorter after introducing this technology. Now we will jump to the second part of the presentation. What potential does the digital platform have within the appointments? Let me introduce you to Terveystalo Ella.
The Future Electronic Medical Record, also called EMR, provides support for the professionals, allowing professionals to focus on the most important: meeting the patient. Ella is our new EMR, which we already have introduced to chat appointments. But what does the Ella do in practice? Let's start by jumping to the deep end of what the traditional EMRs do. They replace paper. They have only little automation in real time, and the UX for the professionals hasn't really developed further within the last 20 years. Ella, on the other hand, is not just a journaling tool. It's a process tool for healthcare professionals. It guides the professionals' appointments and the work-a-day process. It allows us to automate tasks in real time and rapidly exploit new technology.
We have already, for example, integrated AI into Ella, which generates medical journals on behalf of the healthcare professionals, and the results are really promising. We can see over 50% reduction in the time spent writing medical journals. Now we will watch a short demo video on Ella, how it works in practice. This is an actual view on Ella from a professional's point of view. Here on the center area, a professional can see the data from self-triage, for example, and the chat with the customer. On the right side of this view, the professional can see all the necessary data to complete the visit. It includes, for example, contract data, telling about the policies regarding sick leaves, as well as customers' known history. Professionals get AI-suggested journaling based on the entry data and the discussion.
It allows easy selection of the diagnosis, as well as the necessary referrals for the visit. Ending the visit is just a one-click, which you will see here. This makes a huge difference, removing the unnecessary step from the appointment process, making the professionals' work fluent and efficient. Now let's talk about the advantage that the Ella can bring within the chat appointments. As Sari already mentioned, we have successfully decreased the margin on the remote channels, and this allows us to develop the chat and the remote service further. Ella has been introduced to our professionals working in chat already, and we can see already over 20% productivity and throughput gains compared to the situation before Ella. This comes from the fact that the number of clicks gets lower.
Up to five minutes savings per appointment can be achieved just by optimizing the workflow and reducing the clicks from nearly 100 all the way to a couple of. We see a huge potential in productivity in the future as well. Up to five-fold productivity gain can be achieved through the wise use of technology by 2029. Reaching the full potential requires also further optimization of our channel mix. We have introduced digital capabilities, for example, self-triage, to the customer path, allowing us to steer the customer based on the data. By managing the channel mix right away, we can reach a full potential and the productivity gains and ensure the continuity of the care chains regardless of the channel. The next step is to expand Ella to the professionals working in physical appointments, and here the value drivers differ a little bit.
It's not only about the efficiency, even though we see a potential in increasing the throughput within the physical appointments as well. The main value drivers are the professionals' experience that creates stickiness to Terveystalo from a professionals' point of view, and the care compliance. This essentially means that by guiding the process and suggesting the next best actions to the professionals, we can make it easy for medical professionals to do the right thing according to national guidelines. These factors combined give us an opportunity to increase the EBITDA 30% within the primary care segment. Finally, let's talk about the customer data and how it connects to all of this. First, the data is enabled for superior patient and professional experience. Secondly, the data is the way how we integrate prevention, primary care, and outpatient specialist care into a complete care chain.
Thirdly, the data is the integrator with the process outside of the appointment room and within the appointment room. Let me give you a concrete example on each of these topics. As we wisely utilize and visualize the data, it allows every professional to feel like your personal doctor, and as Ville said, it creates the personal doctor to your pocket through the technology. Based on the data, we already identify over 500,000 individuals' health risks annually based on the data. This allows us to help our customers with different health needs, and this is the prevention at its core. As an integrated care provider, we can use the same data to start the care path and lead the patient to the primary care and all the way to the outpatient specialist care. Last year, we introduced the self-triage to the process.
This process part produces the data outside of the appointment room, which we can use to do channel steering, for example. But it doesn't end there. The same data can be utilized to familiarize the healthcare professional with the case before the appointment and in the future to suggest the next best actions to the professionals as well. This means process integration outside of the appointment room and within the appointment room. In summary, the data is enabled for the customer and the professional experience, care chains across the three domains, and the process integration. So, you can see how we are using the digital to power the profit potential of the Terveystalo. We have a world-class digital platform that's a key strength to our core business, and it boosts our competitive advantage.
We have a strong and solid track record of creating digital solutions that deliver value, and we have already delivered over 50 million efficiency chains in process outside of the appointment room, and here's more to come. Digital solutions can further boost the productivity significantly, both in appointments and in cost reduction in transactional processes outside of the appointments. The use of the customer data enables exciting opportunities in preventive care and care compliance throughout the care path. With our comprehensive database, we are well positioned to lead the development in the industry, and the future is that we are very, very excited about. Thank you, and next up, we have Petri.
Thank you, Ilari, and welcome, Petri. It's super nice to have you here after one week with Terveystalo. Tell us a little bit about your background and your experience.
Hello everyone. I'm so delighted to be here today as Terveystalo's new Chief Medical Officer. My clinical background is as an orthopedic surgeon, and my academic background, I'm an adjunct professor in orthopedic surgery and traumatology. I've done an executive MBA at Aalto University, and my professional background is from both public and private hospitals and healthcare. In public healthcare, I've mainly worked at university hospital level at Turku University Hospital and at central hospital level in Satakunta Hospital District.
At Satakunta, I worked as the hospital district CEO, and before that as Chief Medical Officer and Director for the healthcare operations there, and just before joining Terveystalo, I worked as Chief Medical Officer and Senior Partner in a social and healthcare consulting group company called Nordic Healthcare Group, so professionally, I'm really excited that now I'm able to use my past education and experience so widely here at Terveystalo.
Yeah, I believe that your extensive experience from both private and public sector are for sure an asset for us going forward. Tell us a little bit about why did you decide to join Terveystalo's team? What attracted you in the company?
As a medical professional, I've always respected what Terveystalo has done. You have managed to uphold the medical value as high as possible and also combine it with commercial goals. Well, Terveystalo has a clear and important purpose as a company, as you have already heard. So anyway, about the core, for me, it's quite important that the care is integrated and fluent, and people are provided with fast and excellent access to care.
All this is supported, as Ilari already told us, how the IT solutions can provide the support for the professionals and also for the patients, how they can cope better, and professionals how to do their job easier and better. The professionals that work here are the ones that I have always respected, so nice to join them now in the private side. It seems that the people here are so committed to go ahead and develop and do their best, so.
Absolutely. Pleasure to have you. You mentioned integrated care. Would you like to share some of your thoughts on the model and what makes it special from a medical perspective?
The most important for me is that we understand the needs of the customer, both the payer and the patient and our collaborators in this. This is the most important for me.
And as everything starts from the prevention, as you already made a question about that, something we can concentrate in and how we can aid patients to take control of their own health and also give service to them. And in the end, what we are producing for our customers and for the patients is the outcome or the value, and the value is something that now we are able to measure and find out and refine our treatment processes and productivity based on that. And in bigger picture, this means that, let's say, the occupational healthcare patient is something that we can follow from the prevention, and prevention has been there for occupational clients for, well, decades or at least many, many years.
So that's not something that's totally new, but for the general public, the aspect of doing something good for the public health is a bit more new to the private side. But in the occupational healthcare patient, we're able to do everything in-house from the prevention up to the, well, surgeries and highly specialized treatments. And now, as we have the data, this data is something that I've used actually in scientific work previously in my life, and I've studied what kind of factors are the things that hold back the patient from returning to work and how long it might take to segment patients and find out how to serve or treat the patient the best. And now this kind of data is readily in hand at Terveystalo, and based on this, serve each patient individually and on a larger scale better.
This always causes or ends up in benefits for the patient, the payer, and also for the society or public health. That's what is actually the meaning for me, this integrated care path. For the patient, it truly engages the patient and helps the patient to go through these different steps and know when to go where and follow how the treatment has actually progressed.
Yeah, that's super important to know what happens next in your care as well. When we met last week, we also talked about some of the case examples that you found really exciting, namely prevention, mental, and obesity care. Would you like to share some of the highlights with the audience here?
Okay, so a couple of examples here.
Already before I joined Terveystalo, I've been following what you have done and what's going on in the market and what new ideas have been coming up. And one of the examples was how you define risk. And on this map, you can see actually the results. Sari already initially said, and Ilari continued, but on the map here, you can see risk factors from people in Finland, between male Finnish inhabitants between the age of 45 and 54, how the risk factors for cardiovascular and metabolic diseases are divided. So you can see some differences. And what's the medical and also commercial aspect for this is that more than 10% of Finnish males after the age of 55 will end up with type 2 diabetes.
And going back to, again, the occupational healthcare aspect, people with diabetes are three times more likely to end up being unable to work due to their sickness, and even if they are able to work, they have much significantly more sickness absences than their healthy counterparts. And you have to bear in mind the risk of elevated sickness absences increases up to three years before the diagnosis is set. So this risk factor identification allows us to start treatment as early or allow the patient to get some kind of intervention before the diagnosis is set or the sickness is, well, arising. So there's much to do before that already. And beginning the treatment enhances the potential of getting good results, but also makes the workability for the patient much better.
The third is actually that through the risk identification, we can start the patient steering and based on this, go through the integrated care path so that the primary care does what they do, and then go through the specialist care and maybe in some other cases also to surgical operations and other more drastic treatment methods. So this is really like a really good example of what the integrated care path could mean.
Yeah, an important area for sure. Like Sari just mentioned, it's important from a societal point of view and an important topic for public health going forward. Another big topic is mental health that we discussed earlier. You were really excited about some of the recent findings and outcome data. Would you like to share those as well?
Yeah. Of course, as we all know, mental health issues and conditions are a widespread cause of human suffering and one of the top three reasons for early retirement so what to do with this is something that all Western countries should do. Sari already showed a bit about this matter, that what are the benefits or outcomes for patients that have participated in these brief psychotherapy sessions and commercial-wise, Sari already showed how good this has been for Terveystalo, but I'm so excited to show you how satisfied the patients have been and what the actual outcomes have been for the payer and also for the actual patient.
The NPS has been above 90, above 91, and the outcomes for the payer are that the return on investment is more than sixfold, and workability-wise, this means that these patients have had 45% less sick days than the patients that haven't received brief psychotherapy sessions. You have to bear in mind that this is a short period and the starting point of this mental illness. This is really exciting and taking this even further, so there's a great potential in this.
Absolutely. This is one of the areas that we've been really focused on, finding solutions with our corporate customers and developing best low-threshold services to tackle this issue together with the corporates, as Sari mentioned, and we've seen the growth rates in these services. A third topic that we also talked about was obesity treatment and the newest developments there.
Yeah, as I know orthopedic surgeons, I'm pretty familiar with that. Obesity is rising. People are not anymore overweight, but they are obese, so the drastic change in the nation and all around Western countries, and you have to bear in mind that people that are really obese, there are significant risks in surgical operations, and it really causes complications quite actually frequently, so for everyone, this is something that can be done and should be done, but talking about the integrated care path for obesity is that we are starting with digital coaching, all the low-threshold mentality, so the patient is empowered and doing something themselves, and we give tools for them. Going the next step is the aided support and actual treatment by psychological support or nutritionist consultation, and next step is treatment with pharmacological terms, so drugs.
The last step that can also be done in-house is obesity surgery. This is all in hand at Terveystalo. Combined with IT solutions is that the metrics and the outcome metrics have been chosen for this so that they are internationally accepted and standardized. This allows us both to boost our productivity and find out what is actually the most significant meaning in different parts of the world at the moment, which patients want. What's the most important thing for the patient? Is it the ability to move, ability to work, or just to get the weight down? We're able to do international benchmarking with the standardized set of metrics.
Yes, and definitely a big topic that's globally an issue and increasing, as you said, in the working-age population here in Finland as well.
Then maybe going into summary, how would you then summarize the key strengths of Terveystalo from a medical perspective and a couple of words then on your priorities going forward?
Yes, I tried to sum up in these five points what I aim and what I feel is important. So we develop broadcast health promotion and prevention strategies and prove how their effectiveness is and what's the population-level impact. Integrated care and medical excellence enhance well-being and health on individual and also population level and support by this sustainable growth and also social impact. We offer transparent and straightforward patient journeys that enhance patient engagement and improve also medical outcomes and medical excellences, I like to say. Digitalization plays a major role in developing medical excellence and also the professional engagement and professional experience.
Lastly, the integrated care, medical excellence, and customer value are key components in sustainability and societal impact creating general well-being and health for the population. Yes, so important in our fight for a healthier life.
Thank you so much, Petri, and warmly welcome once again. Last question, what are your priorities now as you have officially started as a Chief Medical Officer?
Okay, during the first week, I've started to meet people, and also later this year, my absolute priority is to meet as many as Terveystalo's healthcare professionals as I can, to visit our units all around Finland and familiarize myself with what Terveystalo is actually doing and in-depth understanding of it. Then, well, taken together, as you can see from the previous examples and what you have heard today and what I've told, there's a really important mission. Now just to work.
Yeah, just to work. Great. With that, I think that we are ready for our next Q&A session, and I welcome Ilari back here with us. I think we have the first question then from the audience. I think Anssi was first here again.
Yes, Anssi Raussi from SEB. About your digital services and applications and so forth, how's the monetization with the public side? I know that you offer digital solutions to the public side as well, but are you in discussions with another county, or do you see that you could expand this side?
Yes, during the year, we have been expanding quite rapidly.
Two weeks ago, we had, for example, the one in the Lapland area of Finland, and I think Henri will be touching on this topic on the commercial side a little bit further in his presentation, but we can clearly see that there is a huge demand for these digital platforms, and the private players are producing the world-class digital solutions.
Yeah, so currently, our software as a service production and commercial models are focused for serving wellbeing services counties here in Finland.
Any further questions?
Hi, Roni Peuranhako from Inderes. Just about the competitiveness of your digital tools, maybe since the competitors are obviously working on this as well, so could you just briefly tell the key factors that differentiate you from competitors?
We have a really functioning in-house development capabilities where we have been on many benchmarks to see that we are ahead in the many areas, for example, individual customer areas, which I showed you already. Then I think one of the key enablers is also that we have a capability on building software as a medical device, which means essentially that we can produce the software that can take actions based on the data in the medical field as well. And that's a crucially important topic, especially when moving to the process inside the appointments. And we have, for example, a certified ISO 13485 quality system, which other players at the moment don't have.
Joni, here in the front.
Yeah, Joni Sandvall from Nordea. Maybe one question. I think you didn't mention this, but the funneling of the remote appointments. I think we heard quite much of this in 2023.
So can you, although I know it's more balanced now with the profit contribution, but how this funneling has evolved since the last CMD, let's say?
Really well, and I think one of the key enablers compared to the previous CMD is that previously we got data only when a person came to the appointment. Now we have introduced a self-triage, meaning that we know before the appointment what is the actual cause for the need for an appointment. And based on that data, we can steer the patient to the right channel, and that way also affects significantly on the completeness of the care chain. And that's a key asset which we have introduced during the last year.
Yeah, and additionally, in chat, as Ilari demoed, the AI is supporting the professional to do the right thing and also steer the patient care journey during the chat appointment as well.
I think Sami.
Okay, Sami Sarkamies from Danske Bank. I have two questions starting with Ilari. You showed, Ilari, the EMR tool. Is that developed by Terveystalo, or is that like a third-party product you're buying?
It's purely produced by Terveystalo. Of course, there are certain components in architecture which we of course buy, but what you saw in there, it's totally Terveystalo's IPR.
Okay, and then for Petri, you spoke a lot about integrated care. Are there any benchmarks or peers internationally or in Finland that you can look into when you're developing your integrated care offering?
Well, that's a quite good question because that's like a trend in the healthcare business to be able to have in-house all the services that are needed for the patient. So even the Finnish public sector and all the competitors are probably doing it some way or another, but the way that Ilari has managed to provide the tools, it means that now we have the, well, elements that we have the capability of combining the data and the patient need to develop them by ourselves now. But bits and pieces you can gather from different, well, units around the world and probably also in Finland, but it's a trend in the market at the moment.
But can you maybe name some companies who would be leaders in this area in addition to Terveystalo?
I would have to go to the U.S. and go through the idea of generating value for the patient and how to prove it. I would have to go to the U.S. or Central Europe.
Okay, thanks.
Thanks. It looks like we don't have any further questions from the audience, although there's one question that it's an important one to Ilari from the webcast. Two years ago, we did a write-down related to digital development. How can we now ensure that the digital investments we are making are made correctly and there's no risk of future write-downs?
Really good question. One of the key elements is that we're doing iterative development based on the customer needs. We are not doing this big bang ERP project to some extent. And one proof point is that the Ella is already in production. What you saw here is already true today.
Our doctors in the chats are using that. We add increments all the time, and we push those to production continuously. So we are not doing this huge three-year project where at the end something big happens. We're doing incremental development based on the customer needs, constantly evaluating on the value generation that it creates, and that way make sure that we make right investments throughout every period of every year and from now to future.
Good. With that, I think we're ready to finish our second Q&A session. We'll have a lunch break here. Lunch will be served down the corridor and on your left. And to the webcast audience, we'll return with our portfolio of businesses after the lunch break and see you then. Thank you.
Thank you.
All right, welcome back from the break. We are ready to continue with our program and the two other business areas, namely portfolio businesses, followed by Sweden.
Without further ado, over to Henri Mäenalanen.
Hello. My name is Henri Mäenalanen, and I have a responsibility for leading our portfolio businesses. I have been in this role for a year now, and I have spent eight years in Terveystalo, working in different positions and businesses, including Chief Operational Officer and Executive Vice President in Healthcare Services. My background before Terveystalo is in the retail sector from Kesko, one of the leading trading companies in Finland. So today, I will explain to you how we will plan to maximize our value in our portfolio businesses. My presentation has three parts. First, I will give you an overview of our portfolio businesses, where we can see clear improvements. In the second part, I will dive into both consumer pay and public pay businesses and explain where we see growth areas and upsides.
Finally, I will summarize our value maximization strategies. We have clear priorities for maximizing the value of our portfolio. Our portfolio businesses were carved out from the core businesses in 2022. They initially included eight different businesses, but one was divested successfully in the spring. At the moment, the portfolio business is a platform consisting of seven different businesses which complement Healthcare Services offerings. In the public payer business, we have five different businesses to adjust our offering to the new market environment and changing customer needs. There we have three focus areas. In staffing, we focus on new market growth areas such as mental health. In our digital SaaS platform offering supports wellbeing counties with a high growth rate. The network capacity sales utilize the existing healthcare capacity and provide that capacity to the wellbeing counties.
As we know, at the present, wellbeing counties are primarily focused on cost savings and integrations, but we see that a new market will emerge by 2026 earliest. We have begun preparing this market ramp-up by strengthening our core capabilities to offer better solutions to wellbeing counties with deeper cooperation with the wellbeing counties. Then in the private pay businesses, we are focusing on expanding dental and massage services by increasing scale and profit improvements through both organic and inorganic growth. So overall, we aim to grow revenue 5% annually and double EBITDA margins by aggressively expanding high-margin consumer pay businesses, by investing in key areas in the public pay system, and by preparing for market growth in the public sector. Over the past two years, we have successfully implemented our turnaround actions within the portfolio businesses. Our profit margin has increased more than 4% during this period.
In staffing, we have been selective with the new contracts and partnerships, ending many public partnerships contracts that had mainly low margins. Outsourcing and staffing are the two largest businesses in the portfolio, so naturally, profit improvement actions have had a significant impact on the top line. Additionally, the low level of purchasing power in the recent years has negatively impacted the massage and dental demand. So what we can see today, currently, the portfolio business has a healthy and strong foundation. We have reduced the risk of our legacy outsourcing businesses, and this allows us to move on to the next chapter with sustainable growth and profit improvement. So next, take a look at how things are going forward. Now, I will go into the second part of my presentation and into the public pay healthcare market.
Yes, as you see here, we are a strong and solid player. We have outlined our focus areas for the next five years: staffing, digital solutions, and existing capacity of Healthcare Services. This positions us well with the growing and high-margin segments. In staffing, we are the market leader. Despite the focus on reducing costs on wellbeing counties, we offer high-value propositions in the long-term partnerships. In digital solutions, we cooperate with four wellbeing counties at the moment and are anticipating securing more contracts for next year through new tenders. In Healthcare Services, we have a potential to leverage our capacity through Finland's largest healthcare network. While the underlying market will grow gradually, shifts in the service mix will provide favorable conditions for our profit improvements. The public market expansion is significantly influenced by political decisions.
Although major changes could open new profitable opportunities, they are not accepted until the later half of the next government season due to the current situation. As you see, currently, the private healthcare public market stands at EUR 1.6 billion, with a predicted growth of EUR 500 million by the end of 2029. The legacy outsourcing market is expected to decline for the following years. However, new partnership models will arise in the markets, and the big point is that we are well positioned to capitalize on the potential upside of three elements. Now, let's take a look at the ongoing market trends, and we are well positioned to benefit from key market trends with a minimum risk in legacy businesses. We have identified four different market trends, and all of them we cover very well.
So, for example, in the digital services, we are one of the top players in the market, and through Finland's largest healthcare network, we can address public healthcare backlogs. This autumn, we launched a new service concept and brand for our public partnerships, Terveyskumppani. We offer high-quality, cost-effective products and services. Our goal is to become the most sought-after partner with the wellbeing counties. We already cooperate with all wellbeing counties, but with better segmentations and a customer-oriented business model, we can prove more value for the customers in the future. We are a healthcare sector player with clearly defined focus areas. We will not venture into elderly care or social services. So, by concentrating on high-margin segments with growing market opportunities, we aim to achieve revenue growth of EUR 100 million with an EBITDA level of 10% by the end of 2029.
To summarize, we aim to achieve this target for three key areas. To strengthen our customer relationships, we have renewed our relations model to understand our customer needs better. Seek growth through new partnership models, digital solutions, staffing, and healthcare service capacity sales. Develop new partnership focus on our strength. We are avoiding expansion in the elderly care or social services, and we are concentrating on our strength on Healthcare Services. We believe that there are opportunities for profitable growth in the public market, but change will be gradual. No major shift will happen before 2026. As I summarize, we see growth for our key areas: staffing services, digital services, and healthcare capacity sales.
In outsourcing legacy business, we continue our profit improvement actions. We see that new market will arise earlier than 2026, and we have started to prepare ourselves for that.
Now, we move on to the next section: private pay businesses, dental services specifically. So, dental care complements our healthcare service offering, and we have a synergy here. We consider dental care as an essential part of integrated care because infections in the mouth can have a significant impact on the overall health. For example, some oral infections can increase the risk of stroke or heart attack, and in some cases, they can be a barrier to larger surgeries. So, including dental as a key part of integrated care, we can add value for our customers. Dental health plays an important role in the overall health, and there are synergies with the healthcare system, especially with the occupational healthcare system. And that's why we have decided to set dental health as a growth area and aim to double our revenue and reach industry-leading profitability by the end of 2029.
We believe that we are well positioned to grow in this area thanks to our leading brand, digital capabilities, and capacity to invest in this area due to growth. At the moment, our dental business offers a comprehensive range of services in 31 units across Finland. We are the fourth largest player in the market, but we aim to become number one within the next five years. Over 90% of customers are private individuals, but we have started to develop our business models and care paths to provide more value to our occupational healthcare customers. Now, let's examine how the market dynamics are in the dental market. So, the dental market is projected to grow at a low single-digit rate in the coming years. Both public and private individuals are growing as they have over the past five years. The growth is driven by several mega trends.
Many wellbeing counties faced long waiting lines because of the lack of resources. The aging population has also increased the healthcare service demand, including dental services, and additionally, occupational healthcare and insurance package services are increasing in the future, and we, as a leader in occupational healthcare, can provide added value to our customers. Looking at the market structure, we see that there is room to grow our dental business. The six largest players account for 70% of the total market, and that is expected to consolidate even more in the future. There are many local players which generate about EUR 1 million in revenue, and as said, currently, we are the fourth largest player in the market, so in the short term, we will focus on implementing our operational excellence activities across all units and are prepared for more acquisitions in this area.
To summarize our dental, our goal is to become a leading dental care provider in Finland, recognizing that dental is a key part of integrated care. We offer comprehensive care paths from regular check-ups to hygiene care and specialist treatment. There is a huge potential to increase referrals from the occupational health to dental services, currently only 1%. Improving this process alone yields significant growth in the future. You can see we believe that there is untapped potential in the dental, and we aim to double our revenue and reach an industry-leading profitability by the end of 2029. To summarize for portfolio businesses, we have a strong foundation for revenue growth and doubling our margins from 2023 levels. In the public market, we are well positioned to capture market upside potential with limited downside risk. We expect to see a new market ramp up in 2026.
Our focus is in public payer, high-margin segments, and value-accreting Healthcare Services. We are not expanding in social care or elderly care services. In dental services, we are focusing on building scale, doubling our revenue level, and reaching industry-leading profitability by the end of 2029. With this, we believe that we can materially improve our profit contributions and create value for society, for our customers, and our shareholders. Thank you.
Good afternoon, everyone. My name is Stefan Kullgren, and I'm the CEO of Feelgood Sweden. I'm delighted to be here today to talk about our focus on improving profitability of our Swedish operations, the progress we made so far, and what to expect in the short and medium term. As a background, I joined as CEO for Feelgood one year ago.
I have an industry background of some 15 years from the care and healthcare industries, and I also have an M&A advisory background. I've been now with the company for 12 months, and my focus has been to initiate the profit improvement program and building a strong management team that will be able to deliver on that plan. Let me start with some key points. Feelgood has a very strong position on the Swedish occupational health market. There is a short-term negative impact on our margins due to contract losses in late 2023 and the weakness of the Swedish macro environment. However, we have a clear understanding of the situation, and we have a solid plan to turn the business around. The plan is already delivering, and with these measures, we will soon be at the break-even level.
We will be profitable next year, and we will not only reach historical profitability levels, but we will exceed those in the following years. We are now 100% focused on delivering on this turnaround, and after that, we see further opportunities for profitable growth. Now, let me go into more detail and present Feelgood and the markets we operate in. Feelgood is a leading occupational health provider for modern working life, and our vision is to have the healthiest customer in the Nordics. We have four specialist areas, of which occupational health is, of course, the largest one. In addition, we have organization and leadership and harmful use services that are well integrated into our occupational health offering. We have some 800 health specialists serving approximately 8,000 customers with over 1 million customer employees.
We operate in 140 units across Sweden, and our annual revenue is approximately 86 million EUR, and a little bit more than half of that comes from private organizations, and the rest comes from the public sector. So, through our services, we connect with a big portion of the working-age population in Sweden. Now then, a couple of words about the Swedish occupational health market. The occupational health market in Sweden is concentrated among three larger players, and we have a strong position as the second-largest player in this market. As you know, the occupational health system in Sweden is entirely funded by the customers, and there are minimal mandatory services. It is therefore more sensitive towards the economic cycles, and the average spend is much lower than in the Finnish system. We, together with the rest of the industry, have recently been impacted by the macro environment.
However, the economy is expected to bounce back and recover. The Swedish economy is robust, and the forecast for GDP growth in Sweden actually exceeds expected growth across the EU. So, we are coming from a challenging underlying market, but we now see early signs of turnaround. Now then, let's see where we started with our profit improvement program. So, to remind you of the recent background, in addition to short-term headwinds due to the macro environment and changing customer behavior thereof, contract losses in late 2023 had an impact on our margin development. The volume impact of these losses and changing customer behavior, focusing more on mandatory services, made a dent in our margin that had until then steadily been improving since 2020. We quickly assessed the situation, took action, and launched a profit improvement program to turn this around.
I think this is very important. We fully understand the dynamics behind this. We have the right people to make the necessary changes, and we have a solid plan to turn this around. As I said, we have a solid plan to turn this around, and it's already happening as we speak. We are targeting at least 120 million SEK in annual run rate EBITDA improvement during 2025. We are looking at each and every process in the whole company, and this is a perfect opportunity to reset the business. We are looking at every aspect of our operations, and we are already seeing results. As a first cost measure, we have cut operative and admin staff by some 15%. In addition, we're already seeing over a 10% productivity increase and a 5% run rate savings in facility costs.
Our contract rate has also improved during the last six months, which is also, of course, very important, so we are seeing progress and are very confident that the plan will deliver, so then looking forward, where will this put us, well we expect that these measures will allow for a rapid recovery followed by a gradual strengthening of profitability. As you can see, we started out 2024 from a negative territory, then in 2025, the business will recover to historical profitability, and from there on, further gradual improvement to approximately 70% in around 2027. The profit improvement program that started earlier this year will run through all 2025, and we are using the same methodology as in the Alfa program in Finland, and we can also draw from those conclusions, so we are very confident that we will deliver on this.
So, to summarize, we are 100% focused on turning the business around and improving the structural profitability of the business. Our plan is already yielding results, and the impact will be seen in the 2025 numbers. We are improving productivity, optimizing staff in SG&A and operations. We continue to improve win rate of new customers through tender excellence, and we also expand growth with current and new customers, predominantly within the mid-sized profitable segment. After a successful turnaround, we see further opportunities for profitable growth. Thank you.
Thank you, Stefan, and thank you, Henri. We are now ready for our third Q&A session, and we'll start from the audience. Sami Sarkamies.
Sami Sarkamies, Danske Bank. Starting from Henri, I have three questions. If we think about the margin progression, you've been able to improve margin by 4% over the last couple of years.
How much of that has come simply from ending outsourcing contracts with low profitability? And then looking ahead, how much tailwind do you have from the remaining low margin contracts if we think about the 10% margin target?
Yes. If first we think the approach in this space, we have done many different actions to get that profitability point, so we have limited risk for our current portfolio businesses, and also in staffing, we have been selective with the contracts, so there are so many different actions to this point that there are not only reasons, not only the reducing our outsourcing cost, and about the future, we are reaching 10% EBIT margin in this area, and at the moment, we have a limited downside risk with this portfolio business.
Yeah, so there's a limited tail of those outsourcing contracts in the portfolio now, and the bigger uplift will come from growing the higher margin businesses in the public payer.
Okay, then maybe second question on growth. You were targeting 5% growth, but if I look at consensus, it's like -5% growth that is expected from you in the coming two years. That's probably mainly coming from ending outsourcing contracts. So where will this growth come from? Will you be buying, for example, dental care?
Yeah. First, in the public sector, where the growth comes from, there are those three key focus areas: staffing, digital solutions, where we are waiting for new tenders for next year, and then digital capacity sales. And we can really utilize our existing Healthcare Services to provide more services for the wellbeing counties.
Those are the growth areas in the public sector that reach 5% uplift by the end of 2029. And then in the dental sector, there are the two main drivers. At the moment, we are focusing on operational excellence activities in this market and are prepared for more acquisitions in this area. So those two things are driven in our private pay businesses.
And then thirdly, you were kind of promising a public pay market growth in 2026. Where do you get the visibility?
At the moment, we have strong cooperation with all wellbeing counties, and we are renewing our customer relationship model with them. So that's the one indicator. And then the second very important indicator are the key market trends that I really showed. So those are really driving the new market growth in 2026, and we have a very good position over these key market trends.
Then finally, one question regarding Sweden, if I may. If we look at the operation at the time of acquisition, it was a profitable business with a revenue base that is much lower than today. So what has actually happened? Why is the operation loss-making with much higher revenue than at the time of acquisition?
What happened was that we had a lot of tenders that we had to re-tender in late 2023. And unfortunately, we had to submit all of those within a very short time frame. So we had to make one decision on the pricing point for all the tenders at once. And unfortunately, we misjudged that where the pricing was, where the market was, resulting in that we lost all of those tenders. And I would say it's so unusual that all of them had to be re-tendered at once. So that was basically it.
And if you also see that at the same time, the market, especially the public market, were really hit by inflation. So they were very much focusing on price. So those are the two major reasons.
Thanks.
Hi, Roni Peuranhako here from Inderes. Thinking about the growth ambition of 5%, would you say it's backloaded towards the end of the strategy period since you are expecting the wellbeing county activity to start in 2026?
I didn't hear. Could you repeat the question?
Is the growth ambition of 5% in the portfolio businesses, is it backloaded towards the end of the strategy period?
Yeah.
Or are you expecting stable growth?
Yeah. As I mentioned, we expect that the new market will open earliest at 2026 in the public procurement markets.
And at the moment, if you think about the growth in the private pay segments, we are focusing on operational excellence activities. But of course, we are prepared for having more acquisitions in the recent years. So after 2026, we can expect more uplift in this area.
Then about dental, you mentioned that there are a lot of synergies between Healthcare Services and dental. Could you go through in history how have these synergies played out, and have you been happy with them, and if not, then why?
Yes. Of course, in the long term, we have been a leader in occupational healthcare. But in dental, right now, we have set our ambition target to be a top player in the market, and we can gain competitive advantage through the occupational healthcare system.
So we are focusing on that and giving more value for our occupational healthcare customers for the future. So those are the two points in this sector.
Yeah, maybe if I just elaborate a bit. So historically, we actually gained the dental business as a part of the Attendo acquisition back in the day, and it was integrated into the Healthcare Services. And we didn't have any history of actually driving dental business, and it was sort of sucked into the core and was not optimized as a dental business. Now, it has been developed as an independent business led by Henri within the portfolio businesses. We are much better in leading that business as a standalone business as well. And now we are actually in a position where we can start to gain those synergies between the businesses.
It didn't really happen in the first setup when we acquired the business.
Okay. Then about the profitability target of portfolio businesses, that would imply that the new partnership models with the public sector would be significantly more profitable for Terveystalo than the outsourcing legacy businesses. So could you just briefly go through why is this?
Yeah. Basically, the legacy outsourcing business was focused on long-term partnerships. And right now, the new partnership model is coming from different sections, not only kind of legacy outsourcing businesses. There are several models, for example, with the staffing sale, digital solutions, and using healthcare capacity sales. So there are much more leverage with the new kind of products and services than before.
No, so the legacy outsourcing contracts were, of course, quite inflation-difficult in an inflationary environment with the caps on price increases and so forth.
So we are now more aware of the risks and more flexible with the structures of those contracts.
Then about dental, still one more is the growth target of doubling revenues. Can you elaborate how much organic or inorganic growth?
Yes, there are both activities. At the moment, we are focusing more on operational excellence and profit improvements. But in the long term, it's coming more from the acquisitions that we are prepared in.
Okay. Then one question about Sweden. So just overall, is there kind of any way to make the Swedish business more defensive and stable, and are the profitability ambitions that you have kind of dependent on the macro environment?
I think that what we're doing is focusing, as I said also in the presentation, on the mid-size segment, and typically that are private, non-public sector, and they are not re-tendered as often as in the public side. So that is one thing that we're actually doing to mitigate that. And I think also what we see is that the market is picking up, and we see GDP growth now coming strong in Sweden. So we're quite positive also that the market now is turning.
Joni Sandvall, Nordea. Maybe one question still on Sweden. You mentioned that tenders were focusing on price last year. So has the environment changed, and how competition is behaving on this environment?
What happened was, and I can explain that a little bit more, was that we had the economy went down.
On top of that, we also had high inflation, and that actually stressed the public side very much because they can't really adjust their prices. They just have to deliver services. Now the inflation is going down quite rapidly, and we also see that the market is picking up in general. So I think that, and we don't see the same price pressure as we saw previously. So I think it was quite unfortunate for us that we had such a large portion of our tenders being re-tendered at just that point of time. So it was very unfortunate, but we now see the market picking up.
Good. I think that there are no further questions from the audience. We have a couple from the webcast, and I think I could have a Ville at least for the first one.
What's the long-term strategy for Sweden, and how do we plan to achieve that? If you can take the mic.
Okay, so I think Stefan said it all in a way. We are, and I said it earlier, we are bang on fully focused, 100% focused on turnaround. We are not buying scale at this stage. Once the turnaround is being delivered, and it will be delivered, we have several different opportunities for value creation in the Swedish market.
Good. Then another question. Given that we are not likely to do larger M&A in the short term, which would indicate that we are not planning to expand aggressively in Sweden to a higher margin private customer segment, how would we now assess the performance of our acquisition in Sweden, and was it the right decision to do that?
Well, this is a group of different Healthcare Services, and as a group, as you can see, since the last CMD, we have brought the full group to all-time high performance with any metric. And as a group, this will be led also going forward. There will be a portfolio of different businesses, and there will be different cycles for different businesses. But the important thing is the group.
Good. With that, we are ready to finish this Q&A session. Once again, we'll have a short break, and we'll continue with the financials and the closing words and one more Q&A. Thanks. Speak to you soon. Kun terveytensä luottaa toisen käsiin, niistä käsistä on oltava varma. Terveystalo Sairaala. Kun terveytensä luottaa toisen käsiin, niistä käsistä on oltava varma. Terveystalo Sairaala. All right, welcome back from the break.
We are now ready to tie everything together in terms of financials and talk about our capital allocation priorities going forward. Without further ado, over to our CFO, Juuso Pajunen.
So, good afternoon all. My name is Juuso Pajunen. I'm the CFO of Terveystalo. I've had the pleasure to be on a very exciting journey for two years within the company. We've been turning the business around. We have gone through a massive profit improvement, and we have already started our journey in organic growth when it comes to Healthcare Services. You have now heard from Ville on the solid underlying market, what is the dynamics in the world and where the market is going. Sari explained especially our market position when it comes to the private sector. So we have a strong, solid position in a growing market. We have also from Petri, medical quality.
That's in the core of our DNA. And happy clients, NPS, our patients. Then if we go forward, Ilari explained on our digital journey, how we can reap efficiency, how we can improve care guidelines, care compliance, and excellent medical outcomes. Then Henri told you about the public sector opportunities. We do know that there is optionality for a growth when it comes to that segment. And then finally, Sweden explained by Stefan, not where we want to be, but we have a very clear pathway back to solid numbers. So I will bring this all together from the financial point of view. We are focused on profitable growth. We are dedicated to results, and we will deliver value for our stakeholders. So let's go a bit deeper into the fun stuff. Before that one, just a quick look backwards.
From my perspective, Terveystalo has gone through three phases to develop what we are today. We have the first period, which is the market consolidation. Focus has been on growth and market share, creating the foundation of Terveystalo. Then came COVID. COVID, a global pandemic, was a big crisis throughout the societies. At the same time, it brought to Terveystalo a very rapid digitalization period. We were concentrating on from physical to digital, making sure that our operations can protect the society, bring the COVID tests, ensure that we deliver health to our patients. But digital was the thing. Massive, quick investments to digitalize the offering, to start working in a different manner.
Then COVID started little by little to fade out in 2022, late 2022, and we were in a position that we needed to fix the base, concentrate on the efficiency, go back to basics that were a bit overshadowed by the COVID period and the pandemic. And now, after those three phases, we are in a new crossroads. We are starting a next phase in the history of Terveystalo. And before going to that phase, let's still take one step to evaluate where we are, what is the foundation on which we are building our next steps. We have decreased our risk profile. We are a structurally stronger foundation with a lower risk profile. We have converted our appointments to be profitable. It means that we are less dependent on the diagnostics parts, on the full integrated care part.
This is not anymore coming, and then we will make our money later. We are more balanced in this perspective. And on top of that, our digital channels are also making money. So if you recall the previous CMD, there were still some difficulties on that. And now the digital channels are on par or even exceeding the physical channels. So we have definitely de-risked this one. At the same time, you heard from Henri, the public sector outsourcings. We have less and less exposure to legacy outsourcing businesses. We publish every quarter our kind of the tail, how it looks like: EUR 70 million this year, EUR 50 million next year, and so on. So we are step by step getting rid of those contracts. And as Henri explained, there are opportunities to have better, more balanced contracts with the public sector, however they will form.
And then finally, during the two years, both through profit improvement and cash generation, we have deleveraged. We have less leverage in the system than during the history of this group. So we are operationally de-risked. We are profitability-wise de-risked. We have a solid foundation and a strong balance sheet. That's the starting point. Then if you take the view on the financial development, we bottomed out at the 8.1%, and that one still included some positives from the COVID test period. So the real baseline is actually even lower than that one. Now, 12.5%-13.1%, you heard last week our upgrade on the guidance. So we have effectively improved almost five percentage points of our underlying profitability. So when we are looking at our next phase about our growth journey, about our efficiency levers, we have delivered, and we are starting that journey from a position of power.
We have a strong momentum entering that phase. So then let's go further forward. We have the market fundamentals. They support our growth. You have heard all of this one from Sari, Henri, Stefan, and Ville. But everything in here is based on the bottom of this slide. We have mega trends. You know them. You have heard them. They have not changed at all. It's the aging population. It's the advancements in the medical treatment. It is the interest in the personal well-being. Those are trends that carry forward. Those are not going anywhere. And we have seen that those have already impacted us. If we then look at the occupational health market, we see that on top of the aging population, we have a potential to grow our value to our clients. Sari explained how the number of employees are growing due to immigration.
We have a positive market momentum supported by the mega trends, and we are the player in this market to capture that momentum. Then if we go to look at the consumer market, no matter whether it's paid by insurance or you are paying it out of your pocket, I bet quite many of you are doing either of those ones, we have the both. The aging population, more need. We have the high insurance penetration. That means that there's a shift of the payer. You have a lower threshold to enter the services. And then finally, we have the distressed public sector that potentially creates further volume growth by a spill to private sector. So solid, sound market dynamics supporting volume growth. Public pay market is a bit more difficult to evaluate. Market will grow. There's no question on that one because of the mega trends.
Then you have the other components that play into that market: the budget constraints will mean that the public sector needs to choose. How they choose may impact positively on the consumer market. It may impact different directions, most likely in the positive way from our perspective. We are part of that solution in any case. For us, the other part is that when we are talking about the market growth, the other part will be that: what is the use of private provision services within that market. So there may be a shift within that market that is an optionality for us. We want to be part of the solution, but we don't want to be at any price part of the solution. But once private pay comes or private provision comes more and more, obviously we are there. Then we have Sweden.
I've been working a couple of years in Sweden, like some of you may know. I have been always super impressed on the dynamics of the Swedish market. They are always up on their feet already before you have even noticed that someone has fallen. And that one, I believe, will contribute positively in Stefan's business and the macro environment. Stefan has been suffering from weak macro. So in the foreseeable forthcoming years, I believe that we will get support from the macroeconomic on top of the mega trends that continue to support Stefan's business in any case. So then if we go from market and look at ourselves a bit, we have focused on efficiency. We have focused on productivity. We will continue to do so. Basically, if we start from operating leverage, we have talked about that one. We have a de-risked foundation.
Now, if you think about all of the communication we have given from the guidance narrowing to profit warning or guidance upgrade, the main reason has been strong operating leverage. That operating leverage combined with now, for example, the flu season this fall, when you add volume to this type of a machine, it drops through the income statement to bottom line. That one is a big component on our machine today. Ilari explained on the digitalization, automate to decrease costs, increase productivity. That one is not only an efficiency game. Medical outcomes are in the core of our DNA. This one also improves our care compliance. It improves the access to care, which is an enabler for volume growth. Then on top of that one, the channel mix optimization will allow us to further reap the productivity benefits. We have the medical quality.
You heard from Petri on that one. We will focus on the meaningful matters. We will increase the patient-facing time. We will improve the productivity. That one will continue throughout, and that one means increased value-add. When we increase the value-add, when we have the efficacy and the care compliance, our customers get what they need. We need to remember that we have the value prop that drives our pricing points. The better we deliver value, the more powerful we will be, and then we have the people part. We have continued the FTE and supply growth during the past two years. We have competitive. I would say the best remuneration model for private practitioners of the market that supports, and we have a strong employer brand.
So a system where we have a solid foundation fed with demand and volume, a positive supply environment, that means that we can improve the productivity throughout. So we have delivered efficiency. We have delivered productivity, and we will continue doing so. Just to highlight that one, a couple of concrete examples. Cost efficiency, productivity during the past two years. We have saved roughly EUR 10 million on the admin work. Less admin in absolute terms, less admin compared to revenue. It comes through FTE savings, but it also comes through other types of savings. This is a journey that we can continue still further. We have the appointment profitability. You have heard now so many times today on this topic, plus five percentage points. Improving cost efficiency. We have the new revenue share models, and we have the continued transition in the digital.
We have the capability to support private practitioners, digital services, and so on. Customer services. We have basically roughly 15% reduction already now when it comes to customer service staffing. This has come through optimized digital channels, through process optimization, and so on. We have not touched the AI base that Ilari was explaining. We have not gone there yet. We have further potential in there, like everyone in industries facing large customer service operations. We have taken solid steps. We will continue to do solid steps, and the outcome will be a more productive, more cost-efficient system with superior medical quality and value to our patients and clients. If we look about investments, you have heard the market opportunities. You have heard the efficiency levers. I have to say that grasping the organic growth, making the efficiencies happen, will not happen without investments.
We will invest in the organic growth, and we will do disciplined M&A. We have been the past two years, we have been a bit on the low side. You see that it's now in the 3% levels. It has been closer to 4% points from revenues levels earlier. I would foresee that the next two years will probably require a bit higher investment levels, and then it will stabilize somewhere around the 4% ballpark when we go forward. What do we invest in? We have the digital investments. You heard the journey from Ilari. User experience, productivity. Those are the things that we want to have the full control. We want to be the best. Then we have the physical assets. You know we have told we invest in a new hospital in Turku. We have just last week announced that we invest in Lahti.
These types of investments, including then the medical equipment, MRIs, and so on, that we will put on top of that one. So we will continue investing in physical assets. Then I have to say that part of these investments are defense moves. For example, in Turku, we are already present in Turku. So this is not a greenfield investment as such. This is an investment where we get modern, more efficient, better premises that allow us to drive for the productivity and then capture organic growth in a new manner. So it comes with a defense angle, and it comes with an offense angle. We will continue this type of thinking further on. Our footprint is fairly strong, especially what comes to Finland. Then we have the disciplined M&A agenda. That one will complement the organic investments, but focused on organic growth.
So let's take a view on our business profiles and inorganic investments. First of all, it is crystal clear that when we go to M&A, it will be disciplined. It will be EPS enhancing, and it needs to fit very well to our value propositions. It needs to bring us something positive new. So when looking on the Healthcare Services, we are now at the 15% LTM levels. We think that our potential is above 16, clearly above 16, I would state. And this is a stable cash-generating fee-for-service business. It's good to note that the capital intensity is at the high end in our portfolio, medium, I would say, if you compare to many other businesses. So in here, our M&A logic will be enhancing the value proposition. There's not that much volume to be bought in any case, especially in the Finnish market.
There could be some small white spots, but in the big picture, it will not be volume. But what we could do is that we have a value prop that is technology-driven capabilities. This is a place where we could accelerate our growth journey by improving our services, our value proposition to clients. Then if we go to portfolios, 5%. Henri promised to double it by end of 2029 to 10%. Here, the capital intensity in the private part is on the medium level. Dental is not that different from the Healthcare Services. On the public sector, it's actually low. It's a negative working capital business. We get money first, and then we pay it forward, and so on. So that also justifies lower margin ambition because of the return on capital employed will be better.
Here, depending on the niche, we can do dental, which would be basically consolidation move, adding volumes, and then reaping benefits. Or then we have the value proposition moves. Depending how, for example, the public sector segment opens up, we may see that we lack some type of a service, and we go in there or we enhance our digital capabilities and so on. Then we have Sweden. Profits, not good. Stefan explained how we bring it to solid levels. 10% definitely there, but we fix the base first. We will not go into acquisitions at the moment. Then going to balance sheet, going to cash flow. You have heard the positive market efficiencies. You know our cash profile. It ticks like a Swiss clock. We are less leveraged than ever.
But it's good to note that our leverage ratio and this type of a cash delivery will definitely enable still continued M&A. We can do disciplined M&A. So if we look at that one, we have market momentum. We have efficiency levels. We have balance sheet. So what does that count for? Focused on growth, dedicated on results. We have updated our financial targets. Basically, EPS to grow in average by 10% per annum. Noting that 2025 will be clearly better due to having less items affecting comparability. And what I would like to note is you don't see where adjusted in here. We think that the shareholder returns come from real profits. We drive for real profits without adjustments. Then if we look on the leverage, we come from 3.5-2.5. We have de-risked. We have solid cash flow. We concentrate on organic growth.
The higher leverage is not justified on that one. But if we would have a positive target, fulfilling all of our criteria, we are happy to momentarily surpass this level. And then finally, we have the attractive dividends, at least 80% of the net results to be distributed, taking into account long-term potential and financial status. So basically, we can grow profitably. We can keep moderate leverage. We can distribute solid dividends, and we can invest into our future at the same time. That's what our financial targets are about. So then let's summarize. We will drive profit. We will drive profitable growth. We will enhance the shareholder value. You have heard it. We have a structurally growing market with a solid market position, outstanding medical outcomes. So basically, we will grow faster than GDP. There's no way for any other.
We have transformed our base to a structurally more profitable and less volatile company. We have the efficiency levers to drive incremental profitability growth. Hence, EPS 10%. I don't think GDP will grow 10%. So just a guess, and we have the strong business, so we can invest both in organic growth and disciplined growth and still distribute the dividends. So that's our formula for the next coming five years. Ville, you want to say something?
I think you actually well summarized the contents of today, but maybe just to reiterate the core story, which is very, very simple. Looking back at the CMD 2023, we have truly delivered, and we had a discussion during the lunch break with a couple of participants that the CMDs are about promises and aspirations, but looking at the CMD 2023 of Terveystalo, every single promise that we made has been delivered.
There's a variety of those. Turnaround, of course, is the biggest thing. We have brought the company highest performance beat any metric. Margin profile is less risky, as we discussed back then. Technology platform has taken big leaps ahead. We discussed a care steering, for example, last time around. It is a mainstream today for us. We have Ella, a live, not aspirational target of launching something. That's been done. We discussed about strong supply fundamentals that we have our business against growing market. Market has grown, and we have been able to increase the supply all the time. A lot of ticks in the boxes. That's the strong foundation. Terveystalo today is stronger than ever. We have the model that we truly believe in. We have the market fundamentals in place, which will drive our profitable growth agenda forward.
We do have a track record. As you summarize, that translates then into very balanced financial targets of EPS growth, moderate leverage, and a dividend policy. With that, hand over to Q&A. Thanks. One more Q&A before we finish, and we'll start with Anssi.
Yes, Anssi, from SEB again. A couple of questions. And the first one is about your margins in Healthcare Services. We have heard that there's not that much of a difference between different services, appointments, or diagnostics. But what would be the biggest risk for your margins in this business area? Is there still something in your mix which has lower margins or something like that?
Well, one of the big discussion points back in the days, in 2022 and 2023, was digital channels and their profitability. That was sort of a realized risk back then.
We elaborated on a lower profitability and contribution to high margin diagnostics back then. What we said that we'll fix that one, we'll fix the conversion to diagnostics, but at the same time, the appointment profitability. That's what we have done. That really was the big risk that we, in a way, countered post-COVID. Now, looking at the margin contribution of Terveystalo service mix in Healthcare Services segment, it is balanced. Of course, you still have variation, but each and every cylinder is producing margins for our business. It's more down to volumes now and operating leverage, as you pointed out.
Yeah, and then it's important that we maintain our position from client value perspective. As long as we deliver client value, we are entitled for high margins. We need to be very clear with the medical outcomes and the client happiness.
So as long as you redeem that value proposition, we are in a good place.
Thanks. And then about your adjustment items next year, you, of course, mentioned that those will be lower than in 2024. But can you quantify in more detail?
Well, probably we come back to these topics in our quarterly releases. But as said, we expect them to be clearly fewer. And I think that our dedication is shown that we want to report the real, not adjusted EPS when we go there.
Maybe just to elaborate that the adjustment items recently have been rEllated to the profit improvement programs. So the profit improvement program is still running in portfolio businesses and Sweden. So those are anticipated to then wind down going forward.
Thanks.
Sami Sarkamies and Danske Bank. I have a question rEllated to mix going forward. You are suggesting roughly 5% growth in Healthcare Services.
How does that split between volume and price next year and in the long term?
Yeah, very topical question. So during the turnaround process, the revenue growth has been driven mainly by price, as we have discussed in the quarterly release events. Now, when we are talking about growth and what Sari is driving for is volume growth. And volume growth will take over from price-driven growth gradually.
But I'm sure there will be a pricing component still, but volume is the biggest.
Yeah, this is, as I explained in the market view, this is a business where we are, with the pricing, also in the future able to beat inflation. And that will not change. But still, volume growth is really the challenge that Sari is putting to her team, and that's the target.
So if you grow 5% next year in Healthcare Services, the contribution is sort of equal from volume and price?
Well, we don't go into it in that level, but you are not entirely wrong, if I put it like that.
In the ballpark.
Thanks.
Joni, Nordea, only one question. I think this maybe goes to Juuso. After the new EPS target, no capital return targets and weak property market currently. So have you considered maybe owning more key properties than leasing?
Well, we evaluate the market continuously. So just concrete examples, Turku Hospital has been announced. That one we didn't want to do on our balance sheet. It goes actually to a large institutional investor balance sheet. But we were contemplating the idea that should we do it with a balance sheet. Now, the Lahti will go through our own balance sheet.
So we are actually flexible from the return on investment perspective to evaluate different options. We will never be a real estate company as such. But when we see an opportunity and when we exceed certain type of a target in a certain type of a market, then we don't have difficulties to utilize our balance sheet also. So I would guess that materially we will work with the investors' balance sheet. But as said, we have our criteria. We will follow those ones. And depending on the situation, we will do the decision. We are also fairly wanted tenants, basically. We increase the value of certain type of assets clearly. So obviously, we want to take that one into account in our negotiations. And if someone doesn't appreciate it, then we have our own means to operate.
Good. I think there are no further questions from the audience.
We have at least one question from the webcast over to you, Juuso. Does the investment in organic growth mean higher OpEx in Healthcare Services? And if so, does the above 16% margin target take this into account?
First of all, we wouldn't say that we think that we drive above 16% and then would come back to you saying, "Just kidding, it didn't include ABC." So it's all included. That one I will guarantee. Then the second part is that, yes, investment in organic growth, remembering that we are in people business, it will always require an OpEx component and a CapEx component. So just an example, let's use the Turku. We are getting better, more efficient premises that allow volume growth. To capture that volume growth, we need solid supply. Getting that supply in will most likely require also some kind of OpEx investments.
Then you need to make sure that the demand comes in. So all of these ones are coordinated together. So there is no investment that is pure balance sheet. There is no investment that is pure OpEx. You always have a combination and depending on what you do. But as said, our margin ambitions are all included.
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