Good morning, everybody. Welcome to Terveystalo's Capital Markets Day 2023. My name is Kati Kaksonen, I'm responsible for investor relations, sustainability and communications here at Terveystalo. I am super excited to see so many of you in person today here at the studio, and many of you online as well. We have a great agenda for you today. First, before I jump into the agenda, mandatory disclaimer, let's talk about a little bit about our agenda today. The purpose of this day is to give you an update of Terveystalo's strategy, operating environment and our journey to value maximization. We'll talk about our progress of our two-year profit improvement program and our near-term focus.
We'll start the day with a presentation by our CEO, Ville Iho, who will talk you through the overview of our strategy that is based on the fundamental core strength of our business. Our CEO's presentation will be followed by a deep dive into commercial by our Chief Commercial Officer, Marja-Leena Tuomola, who will talk you through on how exactly are we leveraging our leadership position in these growing resilient markets. We'll follow Marja-Leena's presentation with a Q&A, and after that we'll have a short coffee break. After the coffee break, we make a deep dive into our core competencies and what we believe are our sources of competitive advantage.
So our integrated care model, presented by our Chief Medical Officer, Petri Bono, and our digital competencies and solutions presented by our Chief Digital Nerd, Ilari Richardt, for you today. We'll follow those presentations once again with a Q&A before we go into a lunch break. After lunch, we come back to what is absolutely critical in this very supply-constrained market for our growth people. Our Chief Human Resources Officer, Minttu Sinisalo, will talk you through on our winning people strategy and what that means for our growth going forward.
Finally, our Chief Financial Officer, Juuso Pajunen, will tie everything together into numbers, what that means for our value creation going forward. A little bit of housekeeping. During the Q&A, we'll take first questions from the room, from the live audience and then also, via webcast. If you have any questions, do type them in any time of the day and we'll take them, when the Q&A session follows. Without further ado, I'll give the stage over to Ville.
On my behalf, Thank you. Thank you, Kati. From my behalf also, warmly welcome to Terveystalo Capital Markets Day. This is a hugely important day for Terveystalo and allows us to walk you through the Terveystalo journey, as Kati pointed out, the core strengths of our business markets, our model, our value capture. We'll talk about how far we actually have come already in 7 months in our profit improvement and then take a deeper look into the future as well. As a business, Terveystalo is in very strong position. Our business model is strong. Our unique world-leading integrated care health model, data-driven healthcare model is really, really strong.
We are operating, as we'll hear today, from Marja-Leena, in resilient growing markets, and we have best-in-class digital tools in our hands, and we can take all of these strong elements to the next stage. As a team, as a Terveystalo management, we have extremely clear focus on profit improvement during this year. Next year, we have the Alpha program delivering already. Beyond 25, we are in a super comfortable position to maximize the value and grow our business profitably. CMD obviously is about targets and visions and forecasts and you need to have those in your models obviously. Driving business is about execution.
Today it's a pleasure to present to you also the progress that we have made with our profit uplift. Since Q3 disappointment only in seven months we have made huge progress in our profit uplift, as you saw in our Q1 release, and we'll give more details on that progress. One of the headaches in last year and one of the discussion topics was the omnichannel optimization. What is the future of digital delivery in healthcare, and how is Terveystalo as a leading company able to optimize the omnichannel? I'm glad to say that there's plenty of potential to optimize the omnichannel. We are on track to get over pre-pandemic levels, and there's huge potential going forward.
The underlying markets are developing positively as we speak, and as you saw from the Q1 release. Fundamentals in place, very clear direction, and margin uplift is happening. Just as a reminder, who we are, what type of company Terveystalo is. We are twenty-four/seven, digitally sophisticated integrated health platform operating in two robust, developing, growing, private healthcare markets. Our core business in Finland, we have a high quality bridgehead in Sweden as well. A EUR 1.3 billion business, we are working with 17,000 healthcare colleagues in Terveystalo. I said twenty-four/seven, healthy, balanced, private pay revenue model, that's important in today's world. As we'll hear today, it's extremely inflation resilient as well.
Very strong platform in two different countries. Leader position in Finland with still room to grow, as we'll hear today. A lot of potential in our Swedish business going forward. As you saw from the initial entry video, it's about meaningful matters. What Terveystalo is in its core, in our DNA, we have extremely clear purpose. We as a company and as a team, we are fighting for healthier life. There could not be any more inspirational purpose for any company. We are target-oriented, but every action in Terveystalo is deeply rooted in our values. We always put human being at the center. We are embracing digital innovation. We are investing in that one.
In the core of the core, we are always steered by medical science. We always look for the best of the patients and best medical outcomes. With these values combined, we are driving for functional and humane integrated care. Healthcare that actually delivers, healthcare that actually works. That's something, even though it sounds trivial, it's something that the healthcare industry in Europe and globally needs. That's what we are doing. Our strategic focus areas are also built upon Terveystalo values. What we are concentrating during this strategy period are these three elements. You'll hear today about our people strategy. In supply constraint business and supply constraint markets, it's all about people.
We are building our leadership position as a, as a preferred employer even further during strategy period, concentrating on our people, our professional, professionals, working environment and delivery. We are concentrating on medical. We are concentrating on perfecting our data-driven integrated care model. Petri Bono, our Chief Medical, will shed more light on what we are doing in that domain. We do have great digital assets in-house already today. We continue investing on those, but even more so, we continue leveraging our current digital assets. As I tell you, in more detail, and our chief nerd, Ilari Richardt, will continue, there's a lot of potential in that domain. Values and strategic focus areas are fully 100% aligned with our target.
We are targeting at industry-leading profitability and net positive societal impact. In this audience, obviously the profitability is trivial, a target. Net positive societal impact is equally important. Because we are a leading player, we also need to build the market, not only leverage the market. That all leads to our final CL targets, 5% sales growth, 12% EBITA margin, which this team strives to achieve during 2025. Less than 3.5 net debt to EBITA, and 40% payout ratio to our shareholders. Discussing a little bit on a general level about the markets and where we operate. Megatrends are actually driving demand for healthcare services and services that Terveystalo is providing.
Aging population is not happening only in Finland, and Marja-Leena will have interesting details on that one. But aging population drives not only demand for healthcare services, but also willingness to pay for the healthcare services. Challenged public systems is a hot topic in Finland, but that's not only happening in Finland, it is happening in all of the aging countries. Challenged public system will still demand in many ways to private domain. Digitalization and shift to remote care is an opportunity and during COVID, obviously we have learned many lessons how to optimize that new delivery model and a new patient flow. It's an opportunity for us.
Constrained labor market, at first glance, might seem a negative trend for our healthcare service provider. We claim that for Terveystalo it is positive because as you'll hear from our people section, we are the leader, we are number one player, number one employer in this market. Being able to leverage that leadership position in constrained, labor-constrained market, we can guarantee our business growth, and we can guarantee our market share. All in all of these megatrends which are evident, they lead to private provision healthcare market to grow. More details to come in Marja-Leena's pre-presentation. When we look at the markets where we are operating, one can say that Both Finland and Sweden are roughly EUR 5 billion addressable market opportunities for Terveystalo.
Obviously in Finland, the market share is already super high. In Sweden, we are starting from a very low base, that of course is an opportunity for us. We have throughout the years, we have delivered on our growth promise. Growth has been 12%. As you'll hear today, market will allow us to grow and our strategy will allow us to grow also in the future. The margin development during, let's say post-COVID has not been where we want it to be, where we are targeting at. Today, you'll hear a lot about what's happening, what has already happened, to our margin uplift and what's to be expected.
Slicing our markets and operating model into the segments gives a more granular view on what we are doing and how we are operating this ship in Terveystalo. We have three different segments: healthcare services, portfolio business, businesses in Sweden. This group, all of the targets that we are discussing are on group level. As I said before, group needs to reach 5% growth and 12% EBITA margin, and EBITA margin in 2025. Segments are very different when you look at their size, their margin profile, also their growth potential.
Healthcare services is a very strong and healthy business already today, but just doing the math, of course, we need to get way higher than 12% that we are able to, on a group level, to reach our target. We are on track to deliver that one. In portfolio businesses, we are targeting at individual independent value creation. The businesses that are inside the portfolio businesses do not share too much synergies with the mothership, but they are healthy, nice niche businesses, healthcare-related niche businesses in themselves. We'll discuss a little bit more detail on those later. I said Sweden is a growth opportunity.
We have been able to grow the business, as I'll show later, and recover the margins and profitable growth needs to continue in Sweden. Healthcare services, our core business, a EUR 900 million business, latest 12 months and 11% EBITA margin. As I said, it's already today in its domain, it's a leading business in Finland and healthy margins, but we need to do better, and we can do better. In our Alpha program, which we initiated after Q3 last year, we are targeting and concentrating on commercial. We are targeting in improving integrated care, i.e., care continuity and a value capture from our care chains.
We are targeting a digital to really leverage the digital assets that we have and have integrated view on care chains and digital. We are concentrating on our people productivity, but also supply and capacity growth going forward. The progress which we have reported with our quarterly releases can be seen here. It's very straightforward. We have delivered on the target. We are on track to deliver EUR 50 plus million total run rate impact by the end of 2024. What we are saying today is that we'll have EUR 30 million P&L impact from this program during this year. Strong start for the program. We are still in interior program, but very strong start on track to deliver and overperform.
One topic which has been discussed a lot around Terveystalo model is our omnichannel and our capability to really optimize not only the volumes but the margins through our omnichannel approach. I said earlier that there's a lot of potential in omnichannel and hybrid digiphysical or physi digital model. Before going there, one needs to understand what actually happened post-pandemic for our omnichannel model. Early on in the pandemic, of course, brick-and-mortar access was limited, and that led also supply to decrease drastically. We were able to replace a lot of the brick-and-mortar supply and deficit on that side with a digital supply. What we saw was that the demand in those channels came with a totally different service mix.
Service mix in digital was short care chains and brick-and-mortar, obviously also went down during pandemic due to the fact that medical had a habit during pandemic not to do long care chains, not to do so much diagnostics. They basically said for the folks that stay home, just wait. This all of the elements, service mix, channel shift, different approach to medical led to eroding margins. The impact on Terveystalo, which we discussed after Q3, was fairly significant. On our way to recover, we are reversing the trends.
First, first step, obviously, is to get brick-and-mortar supply to the same level as we had pre-pandemic and growth further. On that one, we are on our way to deliver. As we said in Q4 and after Q2, Q1, supply increase has been really strong. When we have the brick-and-mortar supply, we are able to steer the right service and case mix to brick-and-mortar so that we don't unnecessarily erode long care chains and feed to our diagnostic services. What we have also been able to improve is a referral rate in all of the channels. Basically, re-referral rate in physical has improved drastically since the lows of the pandemic. I'll show some data on that one later.
Even more importantly, we have learned how to use digital channel better in much, much more efficient and better way. Referral rate in digital channels has increased. Finally, productivity in our digital, which is the key driver for better profitability going forward in our omnichannel approach has improved. There's room to improve that one even further. All in all, what we are seeing today is, yes, it took our margins down in our core operations post-pandemic, but we are with our actions and recovery of medical processes, we have been able to recover that almost to the pre-pandemic level. We are on a way to go beyond pre-pandemic level.
In our Alpha program, where this is a key part, we have clear and concrete actions to improve care continuity, our omnichannel profitability, core operations beyond pre-pandemic. Beyond that one, there's even more potential, which we don't have concrete plans yet, but we do have the assets, and we do have the capability to capture that value in long term. We are reversing the trend as we speak. The negative story will become positive story going forward. What we are doing in this trend reversing and recovery, care continuity is the key. In our model, we need to capture the value from not only appointments, but diagnostics path. That is the margin driver for Terveystalo model, and that's very important for care continuity and also medical outcomes.
We have been able to improve care continuity in physical and digital with our actions. Customer steering and patient steering is other key point and topic. We need to be able to be precise on what patient to steer to digital and what patient to steer physical to physical, and also to what type of doctor will take the first appointment. We are piloting digital triage, and that will be a major boost for better customer steering in future. It will be live somewhere during summer. With a better customer steering and couple with that one, we need to be able to steer our capacity also in more flexible manner.
To steer our doctors to right channels at the right time, and we have made progress in that domain as well. Remote channel efficiency can be boosted as Ilari will describe later. There are elements in place. We have already done steps in that direction, but there's more potential there. Finally, to capture the maximum value for Terveystalo, we need to optimize the pricing in channels and on each step of that care chain. We have already altered the pricing model for omnichannel services, and we continue to optimize that. On the right-hand side, in the graph, what you see is development in referral rates.
That's the best proxy on the recovery of the care continuity and i.e., our core processes margin potential. As you see early on in the pandemic, this tanked. It stayed low, but it's been recovering since H2 last year. That trend continues. Couple of words around portfolio businesses. As I said, independent value creation. We have three larger businesses inside this segment: public partnership, partnerships, staffing, and dental. Then we have a tail of smaller nice and niche businesses. Each and every element and business have their own independent value creation and profit uplift plan, and they are executing on that one.
Commenting on the progress, very happy to see that two of the main businesses, staffing and dental, are recovering not only from a revenue point of view, but also the margins are improving. Public partnerships is a legacy business. It's a legacy model, old outsourcings. We are not aiming at growing that part of the business anymore. That's going to be replaced by a different model as Marja-Leena will discuss later. This is low-margin business for Terveystalo, legacy model, but these contracts will come to an end. It's a self-solving issue for us. Where we want to be, we are making good progress, and our public partnerships, it's a diminishing business.
Finally, Sweden, as I said, we have been able to enter the market with high-quality bridgehead, Feelgood. We have been, since the acquisition, we have been able to grow the business by 30%, roughly. We have been able to recover the business from lows of a pandemic. As you saw from Q1 releases, actually, the margin uplift has been accelerating. From Q1, we reported 7% EBITA margin. We are firmly in occupational health, organizational leadership, and harmful use. During next two years or this year and following year, we need to continue profitable growth of the core operations in Feelgood and in our Swedish business. We also want to make our first entry into healthcare. That will require an acquisition.
We are not looking at a transformational acquisition, but a acquisition either way. We also aim at truly leveraging our digital synergies in our Swedish platform during this year and next year. Tying this all up, as I said, Terveystalo fundamentals are really strong. We start from solid base. We are a leader in really strong and growing private healthcare markets. Our healthcare delivery model, data-driven integrated care is best in class. We do have digital capabilities, and leveraging, really leveraging those in in coming years. Short-term, long-term is a key to success, and we'll deliver on that one. In a supply-constrained market, supply of professionals is a key. Whoever has the professionals will have the business.
We are number 1 employer in our core market, and we'll continue developing Terveystalo as a best choice for healthcare professionals. Finally, as a starting point, we do have a strong balance sheet allowing us to invest and target our focus wherever needed. As a team, as I said, we have extremely clear focus. Short-term, we'll concentrate on delivering 12% EBITA margin. With the support of a strong cash flow, we are then beyond 25 in a position to accelerate, and it's inspirational for all of us to think about Terveystalo as a EUR 1.8 billion business in medium term. With that one, I will hand over to our Chief Commercial, Marja-Leena Tuomola.
Great to see you all here and online. Happy to be here. My name is Marja-Leena Tuomola. I'm the chief commercial officer of Terveystalo since 2021. I started to take care of the occupational healthcare business in Terveystalo. Since the operational model changed in November, I started to act as chief commercial officer. This means that I'm responsible for marketing, customer steering, pricing, revenue management, sales, and customer relationship management to all our customer groups, consumers, public sector, and of course, corporate customers. I have more than 30 years' experience in media, marketing, sales, digital development in both B2C and B2B businesses, and also P&L responsibility. In fact, my last job before Terveystalo was in this building. I was responsible for the marketplaces, digital marketplaces and SaaS services of Sanoma.
A very, very deep knowledge also in digital businesses and earning models in there. I have also a wide board of directors experience. For example, I've been in the board of directors of a Finnish bank, regulated industry, also at private higher education, and now at the moment in a private equity-owned IoT broadcasting and telecom company. Also learnings from there to bring to Terveystalo. During the past year, me and my team and the whole management team of Terveystalo, we have been concentrating very much on pricing strategy, which is a key driver in a supply-constrained market. We have invested a lot in customer steering, as Ville explained.
We have very nice, very interesting pilot project ongoing, will be in production now in June, and that will really change how we steer customers in healthcare industry. The other part that has been on my table and on my team's table has been changing the sales policies and tendering policies in the occupational healthcare business and in the public sector healthcare business. There is quite a lot of work to do still, and I think that there is also a lot of opportunities to change the whole earning logic of this private healthcare business. Ville presented our journey to value maximization, I will continue to talk about how we strengthen our position as a market leader in the private healthcare market in Finland. We have three main growth drivers in this market.
We operate in a growing and resilient market. The private pay, private provision healthcare market is growing around estimated to grow by 3% in the coming years. The public pay, private provision healthcare market, I will explain more about that in later, what does it mean, it's expected to grow by 6% in the coming years. The second big growth driver is the global mega trend, a demographic fact, the aging population, and the Finland-specific problem, especially in Finland healthcare system challenges at the moment. The aging population has much higher healthcare needs than the younger population, and they are also able to pay. The wellbeing services counties, they are really struggling with labor shortage and tightening regulation. The third lever is Terveystalo's very strong brand. We have a very solid customer base and our market position.
With our market position, we are able to maximize value capture. All in all, that enables us to optimize pricing, outperform the market, and improve margins. Some facts about the Finnish market. We operate in a EUR 4.5 billion private healthcare market, which is around, like, 1/3 of the total Finnish healthcare market. The projected growth in the coming years, in the coming three years, is around 3%-4%. After the operating model change in November last year, healthcare services Finland, which I'm presenting here, is operating in three different markets. In occupational healthcare, EUR 1 billion market, 3% growth. In the private clinics market, consisting of insurance customers and out-of-pocket customers, that's also around EUR 1.8 billion, with CAGR growth, 3%.
We operate in the very interesting public pay, private provision market. Market size at the moment, around EUR 8 billion, and the growth rate is very interesting, 6%. Our colleagues in portfolio business, they are also operating in this business partly. We have a nice division of labor here and also joint operations. At the portfolio business operates also in dental, private provision and holistic outsourcing, and both of these markets have either low growth or then no growth. We'll explain Ville already explained about the public partnership market, which is the holistic outsourcing market. All the segments that Healthcare Finland operates in, all the segments are growing. We have this very interesting, very promising public pay private provision market with 6% future growth.
It's a market to make in the future for us. The underlying market growth is very good, what are the root causes for this demand growth that we see on the market? That's the aging population. I think that you know that, Finland has the world's oldest population after Japan and Italy, the numbers are quite sort of like astounding. We don't only have the oldest population, but also our population is growing old the fastest in the European Union. We have now around 1.2 million of Finns out of the 5.5 million Finns. 1.2 million is already over 65 years old. In the coming years, that share of the population will increase to 1.4 million.
Around 25%-26% of the Finns will be, in the near future, more than 65 years old. What does this mean to us, the whole healthcare industry? Very obvious. The social and healthcare expenditures, the spend is increasing due to the growing aging population. We estimate that to grow around 6% CAGR in the coming five years. That's total social and healthcare expenditure. We read this morning in the Finnish newspapers that the wellbeing services counties, they are really exceeding their budgets already within the first quarter of the year. Huge expenditure increases on that side can be seen every day. What are the other implications of the aging population, the plus 65 population? What are the other implications? I name here now four.
The healthcare spend for a plus 65 aged is three times higher compared to younger population. Healthcare spend of plus 65 is estimated to be three times higher compared to younger population. The demand for aging-related specialties like chronic care and surgical specialties, that's growing. Of course, high demand for healthcare services will also increase and worsen the constraints and the bottlenecks in the public healthcare system. I give you some numbers that I got from my medical colleagues. At the year-end, at the last year-end, there were, in the public healthcare, almost 11,000 patients waiting for knee or hip re-replacement surgery. 11,000 in the queue waiting for knee or hip replacement surgery.
There are very many working age, aged people in the queue having long sick leaves, being away from the workforce. They are queuing there for a very simple operation. If replacement is a simple, but basically a very simple operation that could be done in the private sector. Terveystalo could take care of, according to our experts, 3,000 of those surgeries annually. A second example, 12,000 patients are waiting for cataract surgery, which is kaihileikkaus in Finnish. Terveystalo could take care of 5,000 patients annually out from that queue. Why don't we do that? Why I say that we could take? The thing is that it's not possible at the moment due to the legislation. We are trapped in the legislation that is not necessarily best for the Finns.
If the government would make the decision now that, okay, the private healthcare sector could help the public system to shorten the queues, we would be able, in Terveystalo, by the year-end, start to ramp up our operations to meet these numbers. It's a political will, and of course needs a little bit legislation changes also, it's about political will. The fourth implication of this increasing aging population is that the plus 65 customers, they have better insurance coverage. I just recently read from OP's release that there is a huge increase in health insurance. Health insurances, at least in OP group, in the beginning of the year. It's for retired people. Retired people take more in the.
Take more insurance coverage than ever before because they know that they would have to wait for one year in order to get the knee replacement or hip replacement in the public sector. All the factors, they will drive up our demand in private healthcare. Let's look at the public sector problems or challenges, a bit more deeper. As I told in you in the beginning of the market slide, We expect the EUR 8 billion public pay private provision market to grow by 6%, and we want to be the one who is leading the market development. A little bit about like more detail about the challenges that the recently established wellbeing services counties are facing at the moment.
There is the shortage of labor, long care queues, as I explained, tight budget, and they have urgent need to offer digital services, both not only to the patients, but also their professionals are demanding that they want to use better digital tools. there's the tightening legislation and care requirements. I take one example from here. The shortening treatment time guarantee, hoitotakuu in Finnish. you have heard and read in the, in the media that the queues are months. We talk about months even in non-urgent care. the treatment time guarantee is shortening now, first of September, to 14 days. if there is a queue for two months, it is now in non-urgent cases, care, it should be 14 days. next year in November, that will be shortening even to seven days.
Quite a lot of, like, work has to be done before the public sector are in these numbers and are these deadlines met. What is our response to these challenges? We continue to offer traditional staffing services, diagnostics like screenings, and secondary healthcare services. We also have invented and developed together with municipalities, and now with wellbeing services counties. We have developed new cooperation models, such as coordinated care and care path outsourcing. Instead of large scale total outsourcing of healthcare stations, we have developed partial outsourcings or outsourcing of a certain, of the medical care of a certain customer group, like for example, elderly people in nursing homes.
Our doctor employed by Terveystalo would be responsible for the medical care, all the medical needs of a group in a nursing home, or a process of. Like occupational healthcare is a good example of a process or like, also, population group outsourcing. Not the whole outsourcing of wellbeing areas population, but part of that, like in the business terms, business process outsourcing would be, I think, the similar to this healthcare world. We have a very good example, what we are already doing with the wellbeing areas, personal doctors. That model is a very good model to continue with other customer groups. We now do it with elderly care.
The third way that we want to help and are able to help the wellbeing services counties is that we are offering population-level digital tools that we are using in occupational healthcare. In occupational healthcare context, population means a workforce of a company. In the context of wellbeing counties, it would mean the population or part of the population in a wellbeing county. What we do in the occupational healthcare, those tools and processes can be easily implemented and used in a public sector. We can use, for example, in the preventive healthcare, we could use health surveys combined with AI-assisted screenings. That what we do now in occupational healthcare business, it's not any vision, it's easy. It is already the thing that we are selling in the other sector.
We, of course, are offering solutions combining digital platforms and healthcare services. We call these new cooperation models, these partial outsourcings or combination of digital platforms and healthcare services, we call them integrated care partnerships. Let's look at where we are in this market at the moment. We expect this public pay, private provision market to develop towards integrated care partnerships. These are here in this graph. It requires a little bit explanation first. Here we have described and shown what are the existing cooperation models. Let's start from the low left end, staffing. Staffing business is ongoing doctor, nurse staffing, EUR 300 billion market with 5% annual growth.
Healthcare and our portfolio businesses are in this business, healthcare services Finland, we are not in that business, to make a small note here. Healthcare services, sales, that's diagnostic sales, secondary healthcare. We are in this business. It's a EUR 300 billion market growing nicely at 5% per annum. We have the holistic outsourcing market. It's a EUR 500 billion market. EUR 500 million market, it will be decreasing. Unfortunately, because due to the legislation, the big deals that all the private healthcare providers have made, those will end in the coming five years, and the legislation prevents us to do the new kind of deals or new deals for that. That market will be shrinking.
Our portfolio business is operating in that business, as Ville said earlier. This integrated care partnership, this coordinated care path outsourcing, population outsourcing, business process outsourcing or healthcare process outsourcing, this is the way that the market will go. It's now a EUR 100 million market, but it will grow to, in our estimates, to EUR 300 million. Some of you might wonder where are the service vouchers. The dot would be so small that it wouldn't fit in the scale. Unfortunately, I have to say that the existing model of organizing service vouchers will not be the savior of Finnish public healthcare system. It's because the production model is not efficient, and the administrative cost of even from the public side is too high.
Lasse Lehtonen from HUS said that the minimum value of the service vouchers should be EUR 800 in order to be of any help to public healthcare system because the administrative cost of the existing voucher system is so. There are three systems, three parallel systems. I'm not going into details, but I wanted to only share them because I know that some of you might be expecting that the service vouchers are here, the big thing, but it has to be changed if we want that to be a big thing in the future. Integrated care partnerships, that we believe is the way to go forward in the cooperation with the public healthcare system.
The aging population, combined with the serious problems in the public healthcare system, will increase the demand for private healthcare services, and this will open up new opportunities for us in the public pay private provision market. To the third growth driver of us, of Terveystalo. That's our market-leading position. The market-leading position has three elements in my presentation. It has our position in the integrated private healthcare market, and the secondly, it's the strong brand, and thirdly, it's the very diverse and solid customer base. Let's start from the integrated private healthcare market. We are the market leader in the integrated care healthcare market. Except for Mehiläinen, none of the other players are big enough to challenge our position. Furthermore, as Ville said, this is a supply-constrained market.
The company who is able to recruit and retain the healthcare professionals will win in this market. Minttu will talk about that later in her presentation. There is no free capacity on the market at the moment. Due to the earlier merger control decisions, it is widely thought that further bigger consolidation in this market or M&A would not be possible. I referred to Mehiläinen-Vielä decision, this market is more or less like here with the players. This is very attractive for us. We focus on organic growth, which is supported by the underlying growth in demand, as explained earlier, we focus on economies of scale. We are the biggest on the market. We can focus on economy scale, both in the integrated healthcare delivery and in the digital operations. About our brand.
We have very strong brand in this market. Every Finn knows what is Terveystalo. In recent years, we have systematically invested and developed our Terveystalo brand. The work has led to excellent results in all customer segments. Recent market studies show that we are the most preferred consumer brand in the Finnish market in private healthcare, and we are the most frequently considered brand among consumers, and we are seen as the number one provider of modern digital B2B solutions and provider of data-driven occupational healthcare solutions. What does this mean to us? A strong brand brings with it increased customer loyalty, which means longer customer relationships, more increased purchase frequency, and lower customer acquisition cost, of course. A strong brand increases also pricing power and also the pricing premium.
For example, from the past eight months, we have not seen increased customer churn in our business, despite the fact that Kela reimbursements were stopped, terminated in January. The consumer confidence has been all-time low during the past eight months. We have increased our prices in the consumer market three times during the past eight months, and one record high increase in prices in occupational healthcare market. My key message in this is that according to Kantar Studies, brand equity studies, strong brands can achieve on average 6%-10% higher prices for their products without significant customer impact. To mention also employer loyalty. The stronger the brand, the stronger the employee loyalty. Minttu will talk about our employer branding in her slides later in her presentation. To our customer base.
We have a very diverse inflation-resilient customer base. 90% of our revenues come from private pay customer base. Corporate customers, 58% of the revenues, consumers 31%, public sectors customers 11%. We serve more than 27,000 customers in the occupational health care and more than 740,000 employees, both in the corporate and public sector. Let's then go to the start of my presentation. I hope that I can exceed my time a little bit. Very good. Thank you. I have to ask because I've, because this is one of the most important slides in my presentation, I think we should spend some time on this slide. How we grow in the EUR 4.5 billion private healthcare market? We are driving the growth and margin uplift in two different ways.
First, in our biggest business segment, occupational health, was 50% of our sales. Here you can see the market size and the growth numbers, how we are going to win in this market. We will increase our productivity and what has been doing very with very nice numbers and I think Juuso has in his presentation some of the results. We are optimizing pricing and production model because there has to be connection with the price and the production model and the service level. we follow very strict sales and tendering policies because we make long-term agreements, so you have to be very careful in the inflation environment, what kind of deals you do for the long-term future.
In the private and public pay, private provision market, we will selectively gain market share. Let's start from the top priority specialties, which in our case is mental health, orthopedics, pediatrics, to name certain few examples. That's 25% of our revenue. Market growing very nicely. There, we will leverage our 740,000 employee customer base. We are using the processes and digital tools, as I explained, and offering them also to the public sector. Public sector is partly here included. Insurance company cooperation in this section is very important. Also top of mind brand, because the consumers are able to choose which brand which service provider they are using when they go to see a doctor. In general practice, 15% of our revenues, this is a volume section.
Here it's very important to increase the productivity, to optimize the pricing and production model, as Ville said, because this is an entry-level product. If we are able to improve the care continuity and adherence to our care protocols, this is also very good business. Other specialties, the smaller ones, there we will really prioritize the specialties that we choose to operate in by growth and margin. All this, we will succeed only in this growth and margin uplift if we really keep three fundamentals which are common for these two different ways of of growth and margin uplift. We have to develop further the advanced customer steering what we have, right professional in right channel in right time with optimal price.
We also have to take care of that our integrated, data-driven care delivers the best medical outcomes, because that's what the customers are paying for. They are paying for us for the best medical outcomes, that's the core of our business. Of course, this game is won by the company that is able to recruit and retain the best talents on this market. Petri and Ilari and Minttu will continue with these very important topics in their presentations. To sum up, we operate in a growing and resilient market. The demand is growing to demographic fact and due to the healthcare system challenges that we have in Finland. We are able to leverage our strong brand and market position also in pricing and maximize value capture. That enables us to optimize pricing, outperform the market, and to improve margins simultaneously. Thank you.
Thank you, Marja-Leena and Ville. Now we are ready to take questions. We'll take first questions from the audience and then come back to the webcast. Do we have any audience questions?
Okay. Hi. Sami Sarkamies, Danske Bank. I have a question regarding data you presented on slide 14, where we saw that referral rates collapsed due to the pandemic, also in the physical channel. Can you explain why the pandemic impacted referrals in the physical channel?
Yes. Thank you, Sami. Very important topical question. I think Petri Bono is in a way, he has the education to answer this one. Really what we saw, making this in a way simple, was that for majority of the cases, for example, respiratory infections, et cetera, et cetera, so the standard treatment during pandemic was stay home, don't come here, don't show up. That was the major driver for that one. The other one was that,
Well, that was really the key driver for that one. That one we saw, and now it's reversing, as I showed and told.
Maybe a follow-up. I mean, the situation has continued for quite some time, so why didn't you react earlier? I mean, based on the data, there was no improvement during a 2-year period, so why didn't you react earlier?
Well, again, very good question. The first priority early in into pandemic was to get the supply up because there was really not access to physical care many times for many patients and many customers. That was a number one priority. One has to say that even for Terveystalo, it was a major change in the customer behavior. It took some time for us to learn how the channels work, how we steer customers, how we optimize the care chain in each and every channel. Learning time.
Of course, the COVID testing at the time was a heavily ramp-up exercise for Terveystalo. Most of the focus went to the COVID testing in the diagnostic side.
Yeah.
Olli Vilppo from Inderes. I have a question for Marja-Leena. A very good presentation. About the market, the public market, you told us that you would have like, capacity to clear the queues in the public, like in this large scale. Why does the legislation prevent you to do this? Is it because it's so large scale or can you do like, only with the voucher? How does it work?
There is Petri, what's in English, kaihileikkaus?
I think something Centralization Act.
Yeah. Petri, could you answer this? Because this is a very specific medical thing. There is a legislation preventing us doing this.
Thank you. In 2017, the Centralization Act was established in Finland. That means that major surgery cannot be operated in places where you don't have emergency care appointment 24/7 available, called hoitotakuu in Finnish. That's been a fact that restricts how much private can be used to help in larger surgeries. Actually that's something that is quite much discussed at the moment that should that be replaced. For example, in the hip replacements, that is where the longest queues are in Finland at the moment. That should be centralized in certain hospitals that at least perform 600 operations a year. As a comparison, for example, in Germany, the number is 100.
Actually, whether there's a fast access to the emergency care in case of some complication, it's not an issue at all because let's think about one single patient who gets somewhere operated. That patient, if it's a day surgery, actually may go back to a summer house to recover from the operation that may be 250 km away from the place where the operation actually was done. It's a theoretical idea to centralize everything, but patients just don't behave that way in real life. Therefore, I think there's really room for improvement in the legislation, and that's quite key if we want to tackle the long queues in Finland. I believe that will be modified now within the next one or two years.
As I said, there is the political will. This is one of the topics that the private healthcare industry has now taken up to the government discussions. This is one of our proposals that this is if you really have the political will to reduce and shorten the queues. Let's change this legislation which is preventing us doing the wise thing and the right thing from the population point of view.
Yeah. Maybe to add on, to that one, thinking about how this type of services typically are organized, it is a standard practice internationally that, basically you specialize in certain type of services. You outsource, for example, this type of knee and hip replacement, surgeries, in a large scale to private sector because we are able to specialize, make it really efficient and operate it in scale. There's nothing in a, in a way special about Finnish situation. It's a standard practice in international markets.
Maybe I can add to that I think the basic idea was actually quite good on the Centralization Act. For example, if you think, organ transplants are very rare procedures, but it was, I think, written in a too large way, so that now when there's anyway a major problem in the country, to have access to operations. There are some reasons that actually are reason for the queues in the legislation. That could be loosened a little bit, let's put it this way. The idea is not certainly to touch on the more tertiary specialty care parts of the act, but there are also other parts that could be a little bit modified.
Thanks. Any other questions from the audience?
Hi, this is Iiris Theman from Carnegie. With regards to potential orders from wellbeing services counties, what kind of margins do you target to reach? Perhaps, what is expected timeline for these orders?
Well, if I start. When we are talking about our network capacity, uh, provided from Healthcare Finland, integrated network, of course, we need to look at the replacement factor and how we all-allocate the capacity to different customers and different services. Our target, as I said, is well above 12% in healthcare services Finland in our core business. Public sector service also needs to reach on average that same target limit. Depending on the case, of course. If we have loose capacity, if we have idle capacity, then that can be in certain cases solved with discount. We, and Marja-Leena's team, we have been now and will be in the future, fairly strict on what type of services with what type of margins we'll allow to be operated in our integrated network.
In a supply-constrained market, you don't have two different kind of doors to the same service and two different prices. You have to be very careful with that. We most probably would be able to sell the supply-constrained capacity on the private market in occupational healthcare to insurance companies with a higher margin to public sector. We have to really be careful, as Ville said, we talk about capacity, really like capacity management.
Yeah. When it comes to building new type of sort of disintegrated services to public sector, then we in in cases will allow low margin. Of course, taking care of that group margin targets will be reached, which is 12%. In those cases, when we are not talking about same capacity pool, we can allow slightly lower margins and typically, those type of services are low CapEx services as well, so fairly easy to ramp up and require limited investments into them.
What is the expected timeline for these public orders?
Yes. What we have said quite a long time is that we'll see first implementations and applications from our integrated care partnerships in, during H2. That's still the scenario which by we are planning our services.
Okay. Thank you.
Victor
Yeah. Thanks. Joni Sonn from Nordea. Maybe one question regarding the insurance companies. You said on the page 31 that you are maybe improving the cooperation even further with the insurance companies. Could you give us some comments on, from your behalf, what are the, you know, main drivers when thinking cooperation with the insurance companies?
I would say we deepen. We have good cooperation. We want to deepen it. The main driver, if I think about it from our customer insurance company point of view, the main driver from their point of view, the main driver is not necessarily the cost of the treatment or surgery, but it's the whole, the length of the care chain and the treatment, meaning that the biggest part of cost to insurance company doesn't come from the surgery, but it comes from the sickness. Sick leaves, days, and possibly even work ability problems.
We, what we want to do is to take care that the treatment chains, the care chains are fast access to service, fast access to care, very short, very well-standardized processes that the insurance companies see that what's the, how long does it take really that the person is back to the workforce or back to sports or whatever is the person suffering from or what is the context. It's the fast access, very good treatment chain, and reducing the cost of the insurance company also. This is a mutual. This is our joint effort to to also reduce the cost from the, from the insurance company side. I think this is the core.
So we
We have a very wide network. One of the fast access to service is based on our very large network. There is a service very close by for the insurance company customer and then very fast care.
You don't have to reserve too much capacity, you know? I'm just thinking that is there risk that you have slack in the, you know?
We don't reserve any capacity to any customer. They, and I think that this is quite good flow of insurance customer insurance customers in our network because there are not that many changes in the, how the population is during the wintertime. We know that they hurt their knees and ankles and whatever due to slippery time. We are reserved. Our production has made the capacity for that kind of treatments, for example. Then we know that in the summer there are different kind of injuries and accident in the insurance customer population. No. No. We would love to improve, increase the capacity and would love to have more insurance customers. No, no problem with that.
If I complement little bit, in our model, as Marja-Leena has said, fast access to care is the key. Care chain efficiency is the key and also ability to showcase the effectiveness of the care chain. There needs to be numbers to back our unique value prop up with the insurance company. As to access to care, our capacity utilization in our hospitals when it comes to facilities basically theaters, it is lower than on public side.
It's our model because there needs to be this fast access to care. There's still we can improv e the utilization. There's room to grow in those, and if there's no room to grow, we are in a position to invest and increase number of theaters. The dynamic part of our system is the professionals. In our model of course, since they are private practitioners, it's in a way automatically ramping up and ramping down. That's not idle capacity.
Okay. Thanks. Thanks. I think we're running a bit over time, if there are any other questions from the audience, let's take one more.
I have a question on Sweden. I think you alluded that the next step is to become a player also in healthcare services. Just curious about the ambition level here. How sizable player do you think you need to be in Sweden in order to be relevant, and are you thinking about nationwide presence, or is this going to be more, you know, centralized to larger cities?
We'll take I wouldn't say careful steps, but well-considered steps in Sweden. The thing is in business model, not so much in scale in first stage. We are now well established in occupational healthcare. We have nationwide network in that domain. It's a high quality business in occupational healthcare. We'll complement that one with high quality healthcare service, whatever that first step then is going to be. It can be local as well, but with that one, we need to be able to demonstrate that we can spice Swedish model up with our integrated model from Finland. Size is not decisive at the first stage. We are already roughly a EUR 100 million business there. It's a healthy platform and we can go step by step.
Okay, thanks.
Thanks. let's finish this Q&A session for now. Then we'll continue at half past with, more deep dives to integrated care model and digital solutions. See you soon.
Thank you.
Welcome back from the break. We'll continue now with deep dives into integrated care model and digital. First I'll let our Chief Medical Officer, Petri Bono to run through the integrated care model that we deliver in Terveystalo.
Please, Petri. Welcome back, everyone, after the break. My name is Petri Bono. I'm the Chief Medical Officer at Terveystalo. Been in this position for almost 4.5 years now. I'm a medical oncologist by my basic background or training, and before joining Terveystalo, I was a Chief Medical Officer at the Helsinki University Hospital District, and also Medical Director before that, at the Cancer Center at the same university hospital. My responsibility at Terveystalo is to lead our professionals, almost 17,000 professionals, and to guarantee that we provide best possible care for our patients and customers. Today, I'm more than delighted to tell you actually what we've done, how we've done that, what have we achieved, and furthermore, how we will move forward with our integrated care model and what's unique to Terveystalo.
Of course, I will also try to highlight what's the added value for the patients, for our professionals and of course, for the shareholders. I'm really proud to be Chief Medical at Terveystalo. We at Terveystalo are a true master of providing world-class integrated care, and we can measure our results, and based on our results, we know that we are on a top-notch level. We have also all the required know-how to integrate both physical and digital services to optimize the outcome of our patients. We also know how to master integrated care. I will have some deep dives today or two examples, but we actually have developed 25 different care protocols to optimize care continuity and the outcome.
To optimize that patients feel that they are taken care very well because they have the symptom, and that's the reason why they approach Terveystalo. Our flagship units, we have established focus areas within mental, within orthopedics, and within sleep medicine, and we have excellent results from there. For example, from the mental unit, we've been able to show 45% less, 45% better medical index outcome after the treatment at Terveystalo, and within orthopedics, with our care paths, we've been able to cut down sick leave days by 35%. Of course, when we treat our patients and customers well, at the same time, that yields great business results. It's, it's, it means added customer value with less sick leave days.
It means higher margin at every touch point, especially in the use of different diagnostics, for example, in the use of imaging, in the use of lab testing, and of course, also, these are strongest within the focus areas that we've chosen. What our professionals actually want to do, they want to be stuck to the medical excellence, and with our care path model, they can concentrate on treating the patients as well as possible, and this will guarantee our market share in the number of healthcare professionals. We are strong what we actually do, and when we deliver integrated care, it's our core strength. Actually, next I want to explain shortly what is integrated care and why does it matter. What is it actually?
It's care that encompasses a seamless transition between different care modalities, primary care, secondary care, diagnostics, and also post-surgery rehabilitation. Everything is happening around the patient and around the patient's need. Why does it matter? We are here to help patients. Of course, this will maximize the medical outcome, and very important nowadays, within the value-based healthcare context, we are more and more concentrating on measuring patient experience. It's not just enough that we measure the medical indexes and outcomes, but also how did the patients feel? Did they get help? For payers, integrated care and well steered care paths, they mean better cost controls. As I already mentioned, for professionals, they mean medical excellence, top-notch results from their own treatment.
For Terveystalo, lower costs for operations, maximum value capture, and better outcomes. Of course, for the society, reduced healthcare spending, overall spending, and better overall health. Let me explain that what is unique in the care paths to Terveystalo and what is actually our operating model here, and what it means to care continuity. We've been all used during the COVID pandemic to use telemedicine to reach out to professional very fast. With our care paths, we can guarantee the care continuity even after the appointment, to the diagnostics, to the possible surgery operation or into any other intervention, and importantly, also post-intervention therapy that may be done, for example, by the physiotherapist or some other professional.
We have these 25 care paths within the most common diagnosis, and we can actively lead them so that the patient, doesn't feel that he or she is dropped somewhere between different professionals or different procedures. By our care need assessment, we can steer customers optimally either, to digital channel or to physical appointment, and thereafter also to the right, further path. Of course, business-wise, this means, correct use of different diagnostics, correct use of lab testing, and it's not just to ensure maximal use of them, but also to help the professionals that they know what kind of tests they should, do when they start planning the treatment, for a patient.
Nowadays, with more and more data gathering all the time from different sources, it may be sometimes if you have graduated from med school 30 years ago to remember that what are the modern lab tests always required for certain symptoms, We have the tools to help our professionals. Of course, with our tools, we can maximize the conversion of the lab referral, or also that they are taken and the results can be used in the different diagnostics of the patients to optimize the right treatment. Finally, the heart of the value-based healthcare and integrated care models, it's the outcome. It's the medical outcomes, these patient-reported outcome measures that we measure from our platform, and also how did they feel, or so-called patient-reported experience measures.
Actually, we are very good in measuring our patient benefits. We know that after the appointment at Terveystalo, most patients feel that they are coping with their symptom or condition better than before. Actually, here's an example of an instrument. It's an international instrument that we use to measure that. We ask a simple question after the appointment within 24 hours that do they patient feel better or much better or the same after the appointment? Over 60% of our patients, this is based on last three months, 50,000 answers, answer that they feel better after their appointment, so that we really know that how our patients are feeling after appointment and did they get benefit.
Unfortunately, not everyone gets immediate benefit, and there are other measures than what you measure after the first 24 hours. Let me go more into these examples about integrated care and what it means within mental health and within orthopedics. First, let's start with the mental health. Mental health, as we all know, it's a major issue that is extremely expensive for the society. For example, in Finland, of the early expensive retirements, 77% actually occur within population that are under 35%. For Terveystalo's occupational health customers, the price tag for that is over EUR 700 million annually. What actions have we actually taken to tackle these issues? First, super fast access to mental care health path.
Then we have investment invested on different digital therapies also. We have been able to change the treatment pattern of our professionals towards a more modern approach, which includes also therapies called brief psychotherapy that is that is causing added value in addition, for example, to antidepressive drugs if they are correctly used. We can show that the brief psychotherapy, so the growth rate from 2019 to 2022 has been 98%. So we are using that a lot more. In the next slide, I think I can show more that why that's beneficial.
However, there's still a major opportunity to grow beyond the current numbers since we know that not all patients at all are getting currently the referral to another professional to get help to their symptom. In mental health, fast access to care means best results. However, it's not enough. We need to continue after the first contact also with the patients very well, and we have, it's called Mental chat, Mental sparri with, where the patients have instant access or the occupational health customers instant access to professional. From there, they are steered either to remote channel or to physical appointment, and thereafter, for example, to psychotherapy that typically lasts from eight to 20 times. We know that already from the beginning, they start to get benefit from the treatment.
Of course, it's important not just at the end of a psychotherapy treatment episode to measure how did the patient cope, but rather the unique thing is that now with our tools we can steer that how the patient is doing when they answer these questions and the professional can then make a change to the treatment if they are not seeing a decline in the medical indexes how the patient is doing. This is very important. If we measure NPS from the mental health focus, it's 93. It's super high. It's pure NPS from these customers. What about the outcome? What's the added value for the payer?
The one-year return of invest, it's 4.8 lower than five, and it's I think it's a very nice number for anyone who thinks about return of invest. Customer experience, that was good. The growth in the sales of this psychotherapy last year, 45%. The outcome, if we measure these medical indexes, so in the beginning, they are depressed, they get the psychotherapy, and at the end of the therapy, they decline to normal level, which means that they have received benefit. Most of all, very important for the employer, for the society, we've been able to show that we can cut by one-third the sick leave days with our care model. This is the result what we have received.
Our care paths say they decrease those symptoms and result in this annual return of investment of 480% for the employees shown here. Before going to the right part of the slide, I want to emphasize that our results, so they are also pretty unique internationally. Actually, I'm glad to go and tell this June to London to a meeting to give an oral presentation of our mental health care path results because they are pretty impressive. You can cut down all sick absences by 40% when the correct care path is implemented. Finally, from the right side of the slide, what the correct clinical practice means to the risk of permanent disability.
You can see three different curves, and the risk, the orange curve, the uppermost curve, shows that there's a 15% risk of over 300 day permanent sick leave if with chronic depression, the patient only sees the one and only general physician or GP. It's not enough in mental disorders. If they get a referral to psychiatrist, it cuts down by half the risk for permanent work disability. The lowest curve that is completely flat represents those patients who have received referral not just to psychiatrist, but also to the brief psychotherapy. Superb result, this is what I'll be presenting in London next month. Could I get the previous slide, please? Yeah. It's not for some reason changing. No. The previous one. No, next one.
It's the orthopedic case. It shows here the orthopedic slide, but it's not there. Great. Thank you. What about the deep dive into the surgical care? It again, here, we can show world-class results. If we start with the customer experience, the NPS within orthopedic surgery, 96.2. If we go to these hip replacement surgeries, the NPS is 97. We really know how to do that. Then, about value capture, how we're doing our growth last year in the orthopedic surgery, it was 14%, and in the hip and knee replacement surgeries it was 91%. Of course, when there's a problem, how to get access to care on the public side, we know how to do it, also patients seek our help.
What about the medical outcomes? There are international standards called Oxford Hip or Knee indexes. We can see that the outcome after the operation, it increases a lot to so-called normal level, which means that less pain and better workability or sportability, whatever you want to call it. For the society, the workability numbers, after shoulder surgery, we have shown that 34% decline in the number of sick leave days, and after these hip replacement surgeries, 31% decline in the number of sick leave days. Very constant results on the medical indexes and also on the impact of the sick leave days.
About our processes in the operating theater, currently out of the hip replacement operations, over 30% are done in a day surgery setting, meaning that the patient can be sent back home on the same day, and this is the highest number of any player in Finland within the public sector or within the private sector. Integrated care, it means major cost savings. Here we can see that after we implemented these care parts within orthopedics 2 years ago, we've been able to deliver maximized employee workability and cut down the total cost of the absence days significantly.
It means the patient over EUR 10,000 savings per episode when we do this as fluently as possible with our tools, with our effective rehabilitation after the procedure. As a summary, our investments in integrated care is clearly working, and it brings benefits for all stakeholders. We've been also able to show that we certainly can master these care parts, and that results in excellent medical outcome and also makes it possible for excellent business results too, because we know that the number of different diagnostic modalities that are used, for example, within chronic disorders, it's not sufficient according to the current national guidelines, which are actually the same that all international guidelines are. How we wanna move forward? Within the next year, of course, we want to be even better.
We want to improve still our care continuity and the medical outcome. We know at the moment that our care continuity indexes, they are very, very on a very high level at the moment, but there's certainly place for improvement. Like there's always place for improvement also in the NPS measurements, although our current number for all services at Terveystalo is at the moment 85, and I showed from the case orthopedics, for example, that it was 96 or 97. It's so high that actually it almost makes to think that that can it be so high because patients are so satisfied with this with the service that they can get from us.
We have also other means of measuring patient experience. We know from them that they are in line with the NPS scoring. What we want to do further is, of course, to optimize the multichannel care delivery. We do have their expertise so that we can steer our patients to the right channel. Doesn't always need to be a physical appointment. It can be telemedicine that helps the patient, and it varies a lot between different specialties. For example, in psychiatrics, digital therapies are mainstream that can be done for almost all of the patients.
We have already a capability to develop medical device, and we want to further develop the Software as a Medical Device and use them wisely to guide not only to our care decisions, but also to our customer and patient steering to the right channel, to the right professional. I think in the next presentation, Ilari will tell you more about them. Finally, I'd like to thank you for your attention, I'm more than happy after Ilari's talk to answer any possible questions. Thank you.
Good morning, everybody. It's my pleasure to be here to talk with you today. As Ville said previously, the digital is an integral part of our strategy and the uplift program. I'm here to talk more about this topic. First, let me introduce myself. Officially, I'm Senior Vice President of Digital Services, but as Ville and other mentions that may be Chief Nerd Officer as well. I've been part of the Terveystalo's digital journey for almost 10 years in various different roles, starting from the software development and data and analytics. Digital enables the best medical and business outcomes. Our digital strategy is tightly aligned with integrated care, which Ville and Petri have described before.
Digital allows us to provision the integrated care efficiently, optimizing access to care and focusing on supply/demand balance. We're able to guide the patient through the right channel to the right professional at the right time. Increasing professional efficiency and productivity allows us to scale the business, especially in digital channels. Improving care continuity ensures the best medical outcomes for the patients and financial outcomes for Terveystalo as well. Digital solutions are already creating value, and we know how to do this. They enable easy access to care, higher margins per appointment, and significantly higher volumes when managed the right way. We have a good track record on developing digital solution for healthcare, and later on, I'm going to show you some statistics about this topic as well. We are also in a great position on creating unique competitive advantage by combining software, medical expertise, and data into award-winning solutions.
In our updated strategy, we have identified five key levers to improve integrated care. By capitalizing the population and organization-level data for preventive care, we have already reached really good results, especially in occupational health care. We will continue to work on this topic, and in practice, it means that by gathering and processing data, we're able to detect the persons at risk of getting ill and be able to guide them towards our integrated care paths to improve their health. By optimizing access to care and focusing on supply/demand balance, we ensure that the customer gets the right treatment when needed through the right channel and gets to meet the right professional for his or her treatment.
By striving professional excellence, we're able to enable our professionals to work more efficiently, and which Minttu is going to talk to you later on as well. By improving care continuity, we ensure that the care path produces the best medical outcomes for the patients and the best financial results for Terveystalo. By focusing on the commercial excellence, meaning pricing capabilities in digital channels and pricing capabilities in other in physical channels as well, we're able to capture the full business value of the care chains. We built the digital solutions to be modular, scalable, and adaptable to be able to scale them into the new business needs quickly. During COVID-19, we were able to demonstrate the speed of our development, for example, in COVID-19 referral automation. Data and AI are the key enablers to succeed in the topics mentioned before.
We also take truly care of the security and the compliance to make sure that the data in Terveystalo is taken good care of. Our customers can trust that our digital solutions handle their data carefully. In future, the data security and digital solution compliance will get even more important since we can see that the customers are being more aware how their data is being used and processed. Next, let me show what value the digital solutions are creating. Digital solutions create value for all stakeholders through integrated care. Patients get fast access to efficient care through the right channel and can trust that their care path continues to ensure the best medical outcomes. Our professionals can focus on the most important, to meet the patient in digital and in physical channels.
They can rely that the data and digital solutions help them to make the right choices. Terveystalo as a company has the most efficient and scalable integrated care paths, which produce the value for the shareholders. Finally, we're able to help the society to solve one of the biggest Western world problems called the care gap through the efficient integrated care. Our aim is to be Nordic-wide leader in professional excellence and in care continuity, supporting our top line and EBITDA growth. These are our two strategic objectives for the next two years. By increasing professional excellence and efficiency, we can enable our professionals to work more efficiently, both in digital and physical channels. This also improves our professionals' experience, making them want to work more for the Terveystalo, which Minttu is going to talk you after the break.
By improving care continuity and quality, we ensure that the patients get the best medical treatment, and the Terveystalo is able to capture the full value of the care chain. In practice, it means that the digital solutions guide the doctors and the patients to work according to medically right care paths, which Petri has described before. We will also continue to work on preventive care and optimizing access to care, but we see the biggest opportunities are coming from the two previous one. Let's take a look at these business opportunities in more detail. This slide is really important for you to understand what value the digital is creating. Digital enables easy access to care, higher margins per appointment, significantly higher volumes when managed the right way.
We can see on the left-hand side graph, the absolute EBITA per appointment is higher in the physical appointments. The cost of digital appointment is significantly lower and the margin is better. The key point here is the volume and the scalability. The digital channel throughput is already twice higher than the physical. It can be accelerated to 3-5 times higher than it's today, and this will lead to financially better outcomes. We are also confident that by focusing on care continuity as well, we're able to create great medical quality and financially sustainable treatment in digital channels as well, as Ville has also mentioned in his opening words. Let's take a look at some statistics about this topic. Our digital solutions are already doing the work of hundreds of persons here in Terveystalo.
One case example about this is the COVID-19 chat automation, where we created end-to-end automated COVID-19 testing process, which relied on digital channels. The only touch point with the human was the actual sample taken in our clinics. All the rest was automated in the digital channels. As mentioned before, we see huge potential to make the digital channel three to five times more efficient compared to physical channel. One indication is the middle graph, where we introduced self symptom assessment to the process. Just by introducing this asset to certain service area, we were able to lower the time spent in digital appointment by two minutes, and we see huge potential of bringing this to more bigger use and optimizing it more further. Our professianals are using our digital solutions a lot.
One case example that is a Terveystalo Pro mobile application where our professionals can manage their work, open new supply, and manage the supply. We have over 2,000 daily users already using the Terveystalo Pro mobile app. We are constantly connected to our professionals even though they are not working our clinics during that time. The customer is always at the core of our digital services. We create the digital service for our customers. Our customers are loving them. Customers benefit directly from our strategy. By focusing on professionals excellence, the doctors and nurses can create higher value for the customer. The customer can be sure that the diagnosis is informed and based just for him or her. By focusing on care continuity and quality, the customer always knows what's happening next on their way of getting healthy.
In practice, this means the digital channels guide the patient throughout their journey of getting healthy. By capitalizing the data, we create peace of mind for the customers since the customers can know that we utilize his or her data to detect the possible early signs of getting ill. By ensuring to optimize access to care, the patients can be sure that he or she gets to meet the right professional through the right channel in the right time. In future, this actually means that the customer only needs to know who he or she is and where does it hurt, and the digital solutions will make sure that we guide the patient to the right place. As said, our digital services are loved by our B2B and B2C customers.
The monthly sessions in digital services are already exceeding three million monthly sessions each month. Terveystalo application has over 1.2 million users already, in total, our digital services have 2.5 million registered individuals, which is a leading number in Finland. Our self-service level, which indicates how many actions the call center, customer service, and our professionals need to do manually compared to the volume of these actions in digital channels. During the last strategy period, you can see that we have been able to improve the self-service rate a lot, while keeping the customers happy. Our B2B session volumes in Suunta service are also rising rapidly, as well as the customer satisfaction, measured in NPS or customer effortless score.
What this is showing that we know how to build digital solutions that the customers and professionals love and use in increasing volumes. Next, little bit harder topic. Let's talk about medical devices and what value those are creating. First of all, medical device can be a software. Regulation makes sure that any software that is being used for diagnosis, prevention, monitoring, treatment, or alleviation of disease is counted as medical device. These medical devices or softwares which are counted as medical devices are required, for example, population management, symptom assessment, automated digital channels, and interactive digital therapies, which are required for efficient digital-based integrated care. Developing medical device requires certain capabilities that the Terveystalo has: a world-class medical know-how and the real-world patient data.
To get the fast return on investment in this area, it's necessary to leverage this software that has counted as medical device to core business immediately, which can be only done when these are manufactured in-house. By building medical devices, we are able to create unique competitive advantage that is hard to copy or replicate elsewhere, it allows us to move into the patient processes and automate them. As said, we got unique competitive advantage and capabilities to make difference. That's because we can and know how to combine software, medical expertise, and data together. Our priority is on the left-hand side of the graph, where we can combine these three elements.
We also see selected opportunities in other areas, where the applicable solution for healthcare business logic doesn't exist, but our core expertise is in the area where we can combine the software, medical expertise, and data. As a summary, our focus for the 2023, 2024 is in Finland. We ensure that the Alpha program proceeds as planned or faster than planned. It requires digital capabilities. During this period, we're importing our first digital assets to Sweden, in the areas where they're easily importable, for example, in remote services. During this period, we are also utilizing some of our digital capabilities to public wellbeing services counties, as Ville and Marjaana has mentioned before.
After 24 or, when the Alpha has reached its goals, we're shifting our focus on Nordic expansion and scaling the digital assets to benefit business, especially in Sweden. In summary, the big points I've talked here about are we're successfully using digital for integrated care, and we see great potential in future as well. We know how to build digital solutions that create value, and we know how to capture the full business impact through the digital channels. We are able to create unique competitive advantage by doing medical devices, which combines the medical expertise, data, and software together. Thank you. It was my pleasure to be here to speak with you. Now I think we have the Q&A session following this. Thank you.
Thanks, Ilari and Petri. Now we are ready to take questions first from the audience.
Olli Vilppo from Inderes. Question for Ilari. How big is the IT department? How many developers do you have in Terveystalo, and do you still buy something outside, or is it mainly in-house development?
We have insourced our digital development during the years due to more cost-efficient ways of doing software development. We have roughly 70 developers working in Terveystalo currently, and we are also buying excess capacity from the consultants firms here in Finland since we don't want to scale our own expertise to the level that cannot be scaled down in when case needed.
Can you, like, buy from the market, like, ready-made softwares also?
Yes. Yes, we can, and we have. In many cases, we see that there are, let's say, utilities and certain capabilities that are not our core business, where we cannot combine the medical expertise, software, and data together. In those areas, we always seek the possibilities to buy a ready-made software and integrate it to our processes.
Okay. Thank you.
Other questions from the audience?
Yeah. Thanks, Joni Sonn from Nordea. One question related to care need assessment. How the steering is done currently, I mean, before the practitioner, and how important factor is the new digital triage for the future? Yeah. I can start. Basically, as I said earlier, and Ilari and Marja have also referred to the fact that we are currently piloting care need assessment tool, which will have great benefits as described. Prior to that one, the main means of guiding patients have been sort of, for example, placing certain services in the right way for right type of customers, so classical digital sales type of tools.
They have not been in the domain of medical as such, more like in digital sales. This is a big step for the care chain optimization for Terveystalo. One thing maybe to add to that is that previously the data gathering of patient symptoms starts only in the appointment. Yeah. Now we can move that part of gathering the symptoms to previous step and in a way self-service that to make the doctors and nurses the process more efficient in the actual appointment, so saving time. Yeah. Exactly.
Sami Sarkamies, Danske Bank. Coming back to my earlier question regarding referrals. I have a question to Petri Bono. How do you explain collapse in referrals on comparable basis in the physical channel during the pandemic?
Probably professionals wanted to be fairly cautious at that time because you can actually act like a doctor without doing multiple differential lab diagnostics or testing, so that you believe that this is the most likely reason for the symptom and just start treating the patient according to that. In a perfect world, it may be that it's required. For example, let's take the depression as an example. You may require to take 10 different lab tests to rule out any somatic non-mental reasons for the depression.
In case of a pandemic, they wanted to be cautious and believe there's no somatic reason behind, which is usually just in one tenth of the cases, so that it's the most typical scenario, and let's just start treating. That's probably the most likely explanation of course there were some physical barriers as well to diagnostics because we were very much focused on the COVID testing. There was restrictions on other testing places as well, logistical reasons behind that.
I have a question to Ilari. I think there was quite a material change in course last year related to, let's say, IT systems. How do you see the spending level going forward relative to the previous years?
Maybe I will start that one. Actually, there will be a separate slide, I think, in Juuso's presentation regarding the CapEx levels, and he'll discuss that one. We asked him to test slide. All right. You will anyways comment that one. I know, I know. Last year's, you are referring to a write-off in Q3 and change in strategy. In a way, addressing that topic, one needs to take a couple of steps back to 2018, when the earlier strategy, how to build the architecture was decided. It was totally different world, totally different environment, totally different capabilities within Terveystalo. The process was initiated.
Last year we took a decision on upside downside assessment that this needs to be discontinued. As Ilari explained, we have since then been able to build more modular architecture. Benefit of that one is that it's easier to scale up, scale down also the investments, do those in smaller chunks. Digital is a key focus as you well heard during the presentations, we continue to investing in that one. Now we have more sort of ability to scale down, scale up depending on the business cases. For this year, we have said that the investment level will be lower than last year.
Anything you want to elaborate there as well?
I think that Ville's answer was quite comprehensive regarding that topic.
Thank you.
Thanks. Any other questions from the audience?
If not, there's one question from Jutta, through the webcast. Is the public sector actually willing and ready to apply digital tools? How does our digital offering tie into the public sector capability to take these into use?
If I may start. There's a big fuss in different wellbeing services counties around digital access to care and a lot of different approaches to how to invest or outsource that part to private providers. There's a lot of activities. The strategy is a little bit unclear still, and hence also our approach might change going forward. We have one case live where we are implementing digital tools for a single wellbeing services county. Lot out in the marketplace, similar type of cases. We need to be in a way strategic in selecting our approach.
As Ilari said, our goal is where we are able to combine capabilities of software development, data, and medical expertise. We don't want to be sort of a standard software supplier for sort of transaction service transaction service. Time will tell where the market will develop. If we have a place with our capabilities in providing those bundled services and software, we'll be there. We are very well positioned. As I said, it's the market is in the making.
Thanks. Any last questions from the audience?
If there are no questions, I just comment that you have heard quite many times integrated care today. The things that we are investing in are things where we are investing our medical efforts, our digital efforts involve around perfecting that integrated care model, where Terveystalo already today is world-class.
Thanks. With that, we'll go into a lunch break. We'll come back at 1:15 P.M. Finnish time, and continue with people strategy and financials with our CFO. Thanks.
Thank you.
Yeah. Welcome back from the break. We'll continue now with our people strategy, and then we'll dive into the numbers, with a presentation by our CFO, with closing words and a Q&A session after that. Without further ado, over to you, Minttu.
Good afternoon, everyone. Super excited to be here today. Ville and Marja-Leena told earlier how being able to win in a constrained market is a critical competence for us. Fully agree. People are super important in this industry. In my presentation, I will today tell you how we are able to support the growth strategy of Terveystalo from the human resource perspective. Before that, since I'm new to this audience, just a brief introduction of myself. I've been working in different HR leadership positions for over 10 years, of which three years at Terveystalo. Before that, I worked for Finnair, Finnish flagship carrier, for seven years, which operates also in a labor heavy industry.
My key achievements at Finnair include 10% productivity improvement in labor costs during the savings program, as well as after that, double-digit annual growth in key personnel groups during the heaviest growth period of the company. I've been working with the growth topics and with the productivity topics also earlier. Before Finnair, my background consists of management consulting as well as finance. Let's start the actual presentation then. In a nutshell, my story today has three main points. First of all, we are the best workplace for healthcare professionals. We have a strong position in the healthcare professional market. Secondly, we have been able to leverage that position and grow the healthcare professional FTE by faster than the market, and we have been able to do that without inflating our starting salaries.
Thirdly, we have updated our people strategy, which will enable us to further grow. Let me show you in more detail what I mean. Firstly, most importantly, we offer the best workplace for professionals. We do have the elements the professionals value. First of all, we offer a possibility to focus on meaningful matters and clinical excellence. Petri and Ilari told today how we have the processes, we have the tools, we have the facilities. As an example of this, our patient information system is rated really high by our professionals in terms of the user experience. Another critical success factor is our large size and our large patient base. When we ask about the doctors, the most important criteria to choose the workplace is the constant patient flow, and we can offer that.
Thirdly, we provide opportunities for pro-professional growth at all stages of career. We have variety of businesses from staffing to private clinics, so we can offer possibilities for students and for retired healthcare professionals and everything in between. Lastly, but maybe most importantly, we have a distinctive culture, we have strong work communities, and we have humanely efficient leadership. Some examples of this one is that our eNPS rating is really high. Our people leaders rate over four out of five in our employee surveys, and our wellbeing at work results are excellent. Let's look how the Best Workplace translates into numbers and success in growing the healthcare professional FTE.
As a result of our strong position in the market, we have a track record of growing our healthcare professional FTE by 2.5 to 9x faster than the market in the past two years. As you can see on the right-hand side, we have been able to do that without inflating our starting salaries. As the Best Workplace, we have not been forced to buy the professionals, but we have been able to remain our entry compensation levels at the stable. Strong track record from the past years. Let's look into the future. Despite the heavy growth, which I just explained, our market share of the healthcare professional market is still relatively moderate, so there is room and potential to grow further.
Secondly, if we look at the healthcare professional FTE growth requirement for the coming years, Juuso will talk about our numbers next and explain this. If we look at that and compare it to the track record from the previous years, we can see that the requirement for future is more moderate. I'm confident that with these numbers and with the updated people strategy that I'm going to tell you more about next, we are able to support the Terveystalo growth and strategic priorities. As I described, we have a strong track record. We have a solid position, and those are both visible in our numbers. People are super important in this industry. The operator who succeeds with the people will eventually win.
We have updated our people strategy, which will ensure attraction, engagement, and productivity with concrete and actionable initiatives. With the people strategy, we leverage our already existing competencies in employer branding, culture and leadership, proactive recruitment, professional growth, meaningful compensation, as well as increased focus on care. This is, of course, an area that requires work and one needs to be humble with the people topics. I'm fully confident that with these elements and with the strong position that we have, we will win in the future. Thank you. Next, Juuso and the numbers.
Good. Thank you, Minttu. Good afternoon, all. I'm Juuso Pajunen. I'm the CFO of Terveystalo, and I'll be talking a bit about how we will improve our value creation. We are well on track on that one. Of course, tie up with the numbers the earlier presentations. What it means from financial perspective. Most of you already know myself. I won't spend too much on introducing. Basically, I came to Terveystalo half a year ago from April. That is EUR 2.5 billion revenue company listed in Stockholm. Before that one, I was the CFO of Pöyry here in Helsinki Stock Exchange. Roughly 20 years in service industry from a bit different angle, same people business logic.
Couple of billion EUR of M&A, couple of billion EUR of funding, whether it's banks, bonds, hybrids, convertibles, you name it, I've done it. Of course, a bit of ERP, IT, and whatever you can do in finance. That's about me. Let's talk about numbers. That's the fun part of today. The key here is that we can deliver outstanding shareholder returns. We are at the moment on the profit uplift. It's on track. You have heard Ville telling that we will deliver EUR 25 million run rate, or we have delivered that one by end of Q1. Also we have told that EUR 30 million is in the actual P&L in 2023. We are clearly on a good path, getting forward to our target of being north of 12%.
We are saying that this will happen in 25, we will deliver 12% at 2025. The second part is that we have an attractive market growth, and we have a strong market position. You have heard how Marja-Leena described the markets and the environment. You have heard how Minttu described the supply part of that one and our position in it. When you top that one up with the mega trends, the aging population and the spend on health services, we clearly have an environment where we can grow. Finally, Ilari explained a lot about our digital strategy, and we can optimize, we can improve the productivity and boost the organic growth or capture the market potential, also supported by the omnichannel delivery models. The financial targets will remain intact.
We will grow 5% or north of that one, both organic and the bolt-on M&As included, during the strategy period. Ville also told that it will mean EUR 1.8 billion revenues in 2028. We will be north of 12%. We will keep the leverage under control at 3.5. At the same time, we will pay more than 40% of our net profit as dividends. Let's go a bit deeper into these topics and let's see what's happening. Before that one, just a reminder, we have a strong financial track record. If we think about our financial targets, 5%, above 5% growth, we have delivered 14% all included growth since 2018, 14% per annum.
Industry-leading margin, 8.4%-12.2% delivered during the same period. Remembering that industry leading, even that 8.4% is a strong performance compared to our peer group. It's not what we want to deliver. If you look our peer group, for example, in Finland, that is a solid number. In Sweden, not being in the 12%, being clearly below that one, we are still in our occupational healthcare, really strong. We will deliver industry-leading margins also in the future, but we have done it in the past, and we have been also earlier beyond that 12% that we are now targeting and where we are going to. Balance sheet, 3.5x in our industry. Not aggressive, but not super conservative either.
Let's keep the leverage intact, and let's keep that one in shape. At the same time, the strong cash flow supports this target. We have the cash to back up this one and the stability in the cash flow to back it up. Finally, we have been paying EUR 85 million in the past three years, 69% payout rate. We will continue the dividend payouts to our shareholders while we are growing the revenue, while we are going to the 12% in the EBITDA margin. What does it mean to go to 12%? We will do it. We will do it in 2025, but let's also look a bit backwards into the history. What has happened? 2019 is the previous non-COVID year. It's a previous comparable year by any meaningful sense.
Even at that point of time, the company was different. It's not the same Terveystalo as four years ago. There was an 11.2% margin. If we now look today, we have higher volumes. We have been able to grow the supply like Minttu explained. We have been able to increase the machine. At the same time, the price and mix has been unfavorable to us. We have had on one part, basically, The learnings in the digital, the changes in the behavior due to COVID, and so on. The price and the volume mix has not been behaving in a favorable manner to us, and we have needed to take our lessons learned in that part. We have the cost and efficiency component.
This is coming partly from investing in the digital capabilities, partly coming from the world changing, and partly coming from the change in the sales mix. The new behavior, the new ways of operating have required different ways to deliver the services. You could also mix this impact a bit with the volume growth and with the sales mix component. We have lost efficiency, and now we are tackling that one with the profit improvement program, and we are taking ourselves forward. We have the positive impact of COVID testing. That one has been a booster. In 21, half a million tests or 370,000 tests, 22, with a clear revenue boost, but also with a clear margin boost. That's also quite evident, and you know it already. It's good to state out that that gave us upside momentum.
Finally, Sweden, that was a decision to acquire a platform in Sweden, but it has been coming with a lower margin and diluting the group margins from that perspective. At the same time, it's fair to say that Sweden is not providing the margins we want to achieve, where our ambition is. To take the next step requires integrated care. Like Petri explained, like Marjo-Leena has been explaining, that's where the value for the money is, and we need to be able to take ourselves there. Finally, portfolios, a bit of COVID momentum. You think about dental and the dentists, it has not been optimal time to go to the doctor.
At the same time, the outsourcing market went to a totally different place, and when you put that one side by side with the inflation impact of 2022, it has had a negative impact, but also not performing like it should be. All of this one leads to the 8.4 in 2022. If we look that we have actually been delivering. Our Q1 was quite solid, not yet where it can be, but quite solid. We have seen, of course, the drop in the testing volumes. Now we don't have COVID testing volumes anymore, it's fair to say. I think it was like EUR 100,000 in Q1 or similar numbers. Round it to 0 in any case. We have the care normalization, and we have been able to take steps forward.
That has led into a guidance of 9.1%-10.1% in the margin for 2023. We are clearly already on the road to improve, but we still have further steps to be taken. We have not yet tackled all of the items that have been impacting us, and we have still room to improve. Basically, we will grow in the volume. We will talk about that part a bit further in the future slides. We have the price and mix component. We are capable to be better in the pricing, and we have done it. Marja-Leena demonstrated that one. We have been giving high single digit price increases now during the past 12 months, and we have seen that the demand sticks.
We can do it, we will continue to evaluate the pricing and taking actions on that one. It's not only about the pricing, it's also about the mix, how we can get the referral rates up. Ilari showed referral rates, Ilari showed the digital part of that one, Ville described that. There's still clear room for improvement, partly it comes from the normalization of the behavior, and partly it comes from the actions we have already initiated, that one that are already on track. Of course, we will have further plans on that part. The cost and efficiency, we have the new operating model. You know our segments, but obviously it goes beyond the segments. We have taken the actions, and Minttu has been pushing those ones really well forward.
We have a better leadership structure, we have a better operating structure, and that one comes with an improved, kind of admin efficiency. We have, we have Henri here in audience who is running the operations, and we have room to leverage further and further the nurse usage, the doctor usage, and make sure that we have the right people at the right place at the right time, supported by the digital channels that Ilari has been presenting. We will get forward on that one too. We have the Sweden and portfolio. Neither of them fulfill our ambition, and we will take them forward. Portfolios, they will concentrate on the independent value creation. There's room to improve. Sweden, we need to take the next steps in the integrated care, one way or another.
Mental health is a good example on that one. There are also other ways to do it. We need to go more and more into the healthcare part on that one and to show integrated care parts. If we think about the profit improvement program, we've been talking quite a lot on this one. EUR 50 million run rate by 2025. EUR 25 million delivered after somewhat 4 to 5 months of running the program. We have a good speed, we have a good momentum, and it's coming with a positive impact to our professionals also. People continue to be happy, and you saw our NPS in Q1 at 85 record high. Concentrating on efficiency is seen favorably both by the clients and our people. What have we done in there? We have the commercial is the big one. Price increases.
Operations, we are taking continuous steps forward on optimizing how we use nurses, how we use this digital triage, how we take things forward in a most efficient manner. Procurement is easy to say we are big, we leverage our scale, we have the facilities, we have the IT, we have the medical equipment, and so on, where we are capable of taking steps forward. We have the operating model. We have the operating model in place, we can start leveraging our clarified ways of working better and better. We are on track. We have a great momentum. At the same time, the low-hanging fruits are closer and closer to be taken. Of course, the more you go to deep end of operations and efficiency improvements, the slower it gets.
I wouldn't expect us to double the double the run rate like we did from Q4 to Q1, if we take it in a simple manner. With all of this one along, we'll be at north of 12% in 2025. Then we still have the uplift potential of the portfolios and Sweden. We have also some execution capability or let's say execution headroom in the plan. Cost structure is another topic that we need to always address. Obviously, when we talk about increasing efficiency, it means either same revenue with less costs or more revenue with the same cost. If we think about what has happened and where we are standing today, it's good to note that our cost structure is, first of all, very understandable, but it's also resilient with the inflation.
We have the inflationary components are actually premises and IT. IT has a certain type of a mega trend where there's a scarcity of resources and certain vendors have purchase power or leverage to buyers and so on. Obviously, Ilari told that we are doing lots by ourselves in the core of the things, but it doesn't take away the Microsofts and Azures and those ones. There is a tendency. At the same time, we are in a new level on that one, from 2% to 3%. We are also now in a stable world from that perspective. We have personal expenses, which are 50/50 private practitioners and own employees. Own employees is a collective labor agreement world. We know that this year it's between 3% to 4%.
We know that it was 1.9% earlier, that tendency will continue. The agreements are in place, those ones will be crafted. The second part, the private practitioners, there's a 100% correlation to revenues we generate. On the other hand, if we increase the prices, this one will increase. If we don't get the price increases through, this doesn't increase either. Direct inflation protection, at the same time, no margin expansion potential from the private practitioners piece. It's fairly good, fairly well under control. We have the other expenses, 87, 6%, that includes now the success fees from the profit improvement program.
That one will normalize back to its place because it's clear that when the program is over, those fees don't exist anymore, which is also positive, of course, when you think about the items affecting comparability. We can and we will continue work with the inflation. Due to our market position, we are in a good place to make sure that we have a margin ex-expansion potential in here. Let's talk about growth. North of 5% growth, real growth. You saw from Ville's slide EUR 1.8 billion in 2028. What does it mean in practice? We will grow in line with the markets. Marjolaine demonstrated really well the market growth. We have the Finnish market growth. We have the occupational health market growth. We have positive niches growing 6%-9%.
Only with that one, we can get to a place that is between 3%-5% organic growth. Minttu backed it up with our very successful people strategy and the track record of that one. We can also make sure that we have the backup of the best professionals. Organic growth, 3%-5%, supported with the market dynamics, but we have a strong market position to back it up. Whether you look on the who owns the hearts of the clients, NPS 85, or who owns the heart of the professionals. With that one, we can go further. We have the M&A component, 0%-2%, give or take. In there, we will concentrate on the bolt-ons. We don't do anything that is transformational.
Now you can read between the lines and how we have phrased it. Sweden is integral part of that one. We need to go to the healthcare in there. We can accelerate the growth with very selective M&A. At the same time, it's good to note that in 2023, 2024, we want to do the 12%. Our top priority is profit, and then we will see if we can boost it with additional growth. We will grow at least within the market. Now some of you are already with your excess EUR 1.8 billion or 1.05 to 5. It's not EUR 1.8 billion, there's the inflation included in there. That, that's how you end up into that number. We will drive the growth also, but and it needs to be real growth.
If we have margins, we have revenue growth, what else do we need? It's cash, obviously. Even 2022, that was a big year. We delivered EUR 141 million of net cash from the operations. If we deliver in 25 the 12% margin, obviously this one is boosted because the cash conversion has been solid, it has been strong, and it will continue so. What can we do with that cash? We have basically, three different pockets. We have the first one is investments in organic growth. We have the digital investments. We will have a lower spend compared to 2022. At the same time, like Ville said, and Ilari confirmed, we need to continue to invest there. It's not like the world is ready and now we sit on our hands and we are happy chaps.
It's a vivid world. We will continue investing in that one. We have the other organic growth driving investments, new MRIs, also something in the premises. Brick-and-mortar will continue to be an important part of our strategy going forward. These ones will continue to be invested in. During the past years, we've been between 4%-4.5% of the revenues in the CapEx part and somewhere in that ballpark, however, at a lower level compared to 2022 levels we will continue being. The CapEx part is needed to maintain our position, but also to attack the growth pockets that are there. The second part that we can invest in is the M&A. Only EPS supporting M&A, no transformations. Our focus in 2023, 2024 especially, will be on the margin delivery. Some M&A.
If we see a nice pocket, nice return on investment, a way to take Sweden into the healthcare, yes. The other part is dividends. We will continue the dividend policy. We will continue to give back money to our shareholders. That's part of our journey. That's part of our financial strategy. Obviously, if we don't invest it, if the shareholders don't take it's the leverage. So we will stay within the current leverage, but we have a strong cash machine that also allows deleveraging. Finally, our financial position. We have a strong position, and that supports the strategy execution. We have a fairly okay maturity curve in our debts. We are at the 3.3 in the net debt to EBITDA. We have the revolving credit facilities supporting our liquidity.
We have dry powder upon need, we have cash in our coffers, and we have RCFs, and then we have debt capacity. At the same time, you can counter this one, the interest bearing debt was 2.8% cost in Q1. We hedge roughly half of the interest bearing debt, so obviously the interest rates will catch up as a function of time to current interest rate levels. At the same time, EUR 144 million of net operating cash, 1 percentage point on a EUR 400 million interest bearing debt is EUR 4 million. We have capacity, we have a financial position to continue on our strategic journey in basically all scenarios. Reiterating the financial targets, we will concentrate on the profitable growth.
We start from the EBITDA margin 12% in 2025. We will keep the 5% real growth and the leverage handbrake intact. Clear journey forward. Basically, wrapping it up, we can deliver outstanding shareholder returns. We will concentrate on the profit and revenue growth. Marja-Leena explained really well the market dynamics, our market position, which basically supports that we can grow in these markets north of the 5%. At the same time, Minttu explained how we have access to people, how our people are happy and the people base is growing. We do know that the care gaps will require further efficiency from the whole supply chain, irrespective whether it is us or it's public sector, however our services are delivered. Ilari explained the digitalization journey and how we can improve the throughput.
We have tools, market position, market growth to support the growth journey and the profit journey. We have the profit improvement program in place, EUR 25 million delivered, 30 at least in our pocket in 2023 on the real P&L for the profit improvement. Our cash flow supports our growth journey if it requires investments, and it correlates highly with the margin, so cash generation also in there. With all of this one, it's pretty clear that we are on track to deliver the industry benchmark best margins. Just to highlight that we are comfortable with the track, we have issued Guidance. First time in Terveystalo history, we have given a guidance. It's 9.1%-10.1%. It's not a Nokia 7%-12% or whatever. We are fairly confident on where we are going. Thank you all. It's always a pleasure to talk about numbers.
Thank you, team. I hope everybody has today learned something about Terveystalo and also about healthcare. It's been super good insights also for myself, so well done, team. Just to wrap it up very shortly, we have heard today lot discussion about integrated care and integrated care delivery. That is really the focus of our strategy in going forward. That means for the shareholders and investors, best and optimum value capture for the patients, the best outcomes for professionals, inspirational, good possibilities to deliver care with their skills. That is really the basis of, for our future years.
As you heard, the team is laser-focused on year 25 and delivering the financial target of 12% in 25. With our program and improving underlying market, as you said and went through, we are on track to deliver that one. At the same time, we are building a even a stronger position beyond 25 to accelerate Terveystalo journey and development. With that one, I think it's time to move to Q&A. Thank you.
Thank you. With that, we'll move into first to audience questions. Then, we have the opportunity to take questions from the webcast. Please type them in if you have any left in the webcast audience. First, please.
Danske Bank. I have a question regarding the 12% EBITA margin target for 2025, where you're very firm. How does the math actually work? As you have guided for this year 9.6%, and then if we think about the Alpha program that is sort of bringing most of the margin improvement, you will still have EUR 20 million impact left maximum after this year, which translates to about 1.5 percentage point margin improvement. That takes us to 11%. Where does the missing 1% improvement come from?
Basically, first of all, we have not guided 9.6, we have guided 9.1-10.1, so let's clear that one off the table. Basically, we have further room in the efficiency program. We have also said that we will get at least a EUR 50 million run rate. It is correct that you have the EUR 20 million. EUR 20 million is kind of 1.5-ish if you put it on that one. At the same time, we have the normalization of the COVID-19 or kind of the underlying diagnostics that will play in our favor, and that is already part of that one.
The other way around, if you look our Q1 numbers and you look how it behaved cleaning out from the COVID-19 tests, and then you add it up what we had in Alpha program P&L impact, you see that there is a delta. You can take that delta and address it into our capability to price our services into our improved efficiency in the underlying operations. Not all of that one is part of the Alpha program either. We have an also a normalization agenda ongoing. That one will bring us there. I'm confident on the 25%, 12%.
Maybe a second question regarding guidance range for this year. You were at 10.7% level in Q1. I think messages today have been very positive regarding, you know, the outlook. What could be kind of like the negative drivers during the rest of the year that would bring the margin down to sort of your guidance range?
Well, there are always uncertainties in the guidance. We stated those ones out in the release also. Obviously we have the consumer confidence is one component. We have the consumers are bringing a fair share of our profits, and that one we do not know how the world will behave. We all know the shadows in the general economic outlook, and one part of our corporate and occupational healthcare delivery is the number of employed people. There are items that are to a certain degree beyond our control on a macroeconomic level, and those ones also can impact us unfavorably. That's why you always think about range 9.1-10.1. That's the most probable range with the different scenarios we can imagine at the moment. Of course, depending on your own probabilistic curve, you can widen it or basically tightening it as you see best.
Maybe just to add to that point, of course, the wage cost inflation will only kick in the second half of the year. That's gonna impact the latter part of the year.
Yes. If I may continue, one shouldn't of course too much dwell on risks, as Juuso said, they are always of course, in this diverse business, there are risks. The three main ones for our delivery are consumer business, consumer confidence, then supply of professionals, which Minttu basically covered, and then salary inflation, which also Minttu covered. We have been tackling all of this well. The consumer demand has not tanked, even though we are in unprecedented lows in confidence. We have not inflated our salaries, the supply keeps on ticking. These are the three areas where one in a way maps our risk.
Okay, thanks.
Thanks. Joni Sonn from Nordea. Maybe a question related to Sweden and portfolio businesses. There was a clear burden on margins last year. What's the outlook for this year? I see that you are expecting margin uplift then after 2023, how the outlook for these businesses is for this year?
If I start, we don't give segment-based guidance or outlook, we are confident on the 9.1 to 10.1. Obviously, as explained in the different presentations, there's a positive momentum in many of the portfolio businesses, obviously against comparables that have been negatively impacted by COVID. The same applies actually to Sweden, where the occupational healthcare model has been suffering from the COVID impact. We have a positive momentum, numeric guidance or outlook we don't give for those ones. We see that the current trading and the potential is there when going forward for improvement.
Okay, thanks.
Any other questions from the audience? If not, there's another question around the Sweden and Swedish business margin going forward. Jutta from SEB is asking about in relation to that 25 target of 12% EBITDA margin, where will Sweden be in that target? Is it around current levels that we're seeing in Q1 or something better from that?
Well, I can only reiterate from financial perspective that we don't give guidances on segments. We give guidances on Terveystalo. At the same time, you can assume improvement from the current levels. That's part of our strategy, but it requires the right step into the healthcare services part in the offering.
Any of you that want to add?
Well, nothing too much to add really. Really, we are on improvement track when it comes to Sweden. Our aim is to continue profitable growth during these two years.
Good. We don't have any further questions at the moment from the webcast. One more question from the audience.
Sami Sarkamies, Danske Bank. I would like to ask about financial leverage. Looking back, Terveystalo has been run with quite high leverage, two to three t imes net EBITDA. Do you feel that's a good level also going forward, or has something changed here?
Well, if we look our financial target, we have communicated, like you all know, 3.5, which in our industry is not aggressive, yet not conservative either. I think that the leverage ratio needs to be very well kept under control vis-à-vis the market conditions, investment opportunities, and the cost of capital. Obviously we will take these ones into account when going forward, but formal guidance is to be below 3.5. There is asset with our cash flow, there's room to deleverage if the conditions are not favorable for investing.
Good. Any other questions from the audience? If not, I read the room that people are satisfied with the questions already answered. Thank you everybody online and both in room for joining us today. Hope you found it valuable and useful, and looking forward to speaking you with you soon again. Thanks.
Thank you.
Thank you.
Thanks.