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Earnings Call: Q4 2018

Apr 4, 2019

Operator

Welcome to the Humana Q4 Reports 2018. Throughout the call, all participants will be on listen-only mode, and afterwards, there'll be a question and answer session. I'll now hand the floor to CEO Rasmus Nerman and CFO Ulf Bonnevier. Gentlemen, please begin.

Rasmus Nerman
CEO, Humana

Thank you. Good morning, everyone, and welcome to this presentation of Humana's fourth quarter. I will start by sharing some of the financial and operational highlights in the quarter. I will also touch upon the political landscape in the Nordics, as well as our recently communicated acquisition of Coronaria Hoiva. Before I hand over to Ulf Bonnevier, who will take us through the financial details of the quarter, let's move on to the first slide, please. In the fourth quarter, operating revenue increased with 5% to SEK 1.7 billion. We also saw an increase in organic growth to a rather healthy 4.8%, the highest rate we have had as a listed company and actually also many quarters prior to our IPO. In the quarter, operating profits increased with 24% to SEK 82 million. This is up from SEK 66 million in the corresponding quarter of last year.

However, in the fourth quarter, we did have extraordinary high acquisition-related costs, and as we adjust for these, the underlying improvement has been greater, with an increase in operating profits of 42% to SEK 95 million, up from SEK 67 million last year. Subsequently, our margins improved to 4.8% compared to 4.1% last year, and the adjusted operating margin improved to 5.6% as we adjust for these acquisition-related costs. In the quarter, our operating cash flow was SEK 136 million, a decrease of SEK 61 million. Our net debt was lowered to SEK 1.38 billion, and our leverage is now 3.0, in line with our long-term financial targets. After the end of the period, the proposals from our board to the AGM 2019 is a dividend of SEK 0.7, a slight increase from last year. Next slide, please.

On top of a quarter and year with some rather solid numbers, we've also had an eventful quarter from an operational perspective, especially for our future growth prospects. In line with our strategy, we have in the fourth quarter increased our ambition when it comes to acquisitions. We have strengthened our presence in personal assistance in Northern Sweden by acquiring Vik Assistans, and we have also continued to grow in Finland through the acquisition of Mattila in the Birkaland region. In order for us to ensure continued strong organic growth, we've also invested in a number of attractive growth projects. In the fourth quarter, we started operations in two new contracted elderly care units in central Stockholm. We have also opened five new care units within LSS in Sweden and Psychosocial Care and Treatment in Finland.

Earlier this week, we signed agreement for a new own managed elderly care unit in Vallentuna, just north of Stockholm. In order for Humana to continue to grow and develop also in the future, it is crucial that we offer and continue to offer an attractive work environment. From that perspective, it is highly encouraging to see that our efforts are paying off. In the fourth quarter, Humana again received very high quality grades from the National Board of Health and Welfare's annual quality survey. We also received very good results in our 2018 employee satisfaction survey as well as our annual customer satisfaction survey in personal assistance. We also won the AllBright Award as the best-listed company for gender equality. We won it for a second year in a row.

In a Nordic labor market where there is a deficit of care professionals, these things are important. Last year alone, Humana received over 80,000 job applications. Next slide, please. Moving on to Individual & Family. Despite the anticipated improvements in performance and margin in 2018, the overall revenue development in I&F is still too weak. In the quarter, we experienced a lower demand for family home and open care services. Other segments in I&F continue to be fairly stable, and we do experience some strong momentum in our LSS division. We have opened four units over the past three months. Our ambition is to open several new own managed units in 2019. We do maintain a positive outlook for I&F in the long term, but our assessment is that the weaker market within parts of I&F will continue into 2019.

Going forward, our focus in I&F remains on activities to strengthen our growth, both organically as well as through acquisitions. Next slide, please. Moving on to personal assistance, we do continue to see stabilization in the market where the decline of individuals entitled to personal assistance continues to slow down, so does the number of withdrawn decisions. Humana continues to grow and gain market share both through acquisitions as well as organic growth. In January, the government LSS investigation was published. It has met with massive debate as well as harsh criticism. Our assessment is that the investigation as a whole will not be translated into new laws or regulations. We also note an increased willingness to ensure the right to personal assistance amongst most. Next slide, please. Moving on to elderly care.

In elderly care, the good demand for Humana's elderly care services continues. We see very high utilization in all our units, combined with strong organic growth. All new units under own management are now fully up and running satisfactory. Although some work, of course, remains before we achieve full operational excellence. In 2019, we will open two new own managed units, Staffanstorp in the first quarter and Kungsängen in the third quarter. We have also recently communicated that we aim to open a new unit in Vallentuna next year. The ambition for 2019 is to accelerate our future growth. The current pipeline supports beyond two to three own managed units per year from 2020 onwards. We will, however, continue to be selective in order to ensure high quality and short ramp-up times. Next slide, please. Moving on to Other Nordics.

In Other Nordics, the solid performance and sequential improvement continues, with a strong momentum in both Norway and Finland. In our Norwegian operations, we continue to see the good effects from our measures, and we are very pleased with the performance that has exceeded our expectations for the full year. Also important is that we do see stable demand in several of our business segments, which is a prerequisite for our future organic growth. In Finland, the high demand for our services continues, and focus for the first half of 2019 will be to start a number of own managed units, as well as integrate Coronaria Hoiva. With the acquisition of Coronaria Hoiva, Other Nordics has now formed a strong third pillar in Humana, equaling both I&F and personal assistance in importance for the group. Next slide, please. A few words on the acquisition of Coronaria Hoiva.

We signed the agreement in January to acquire Coronaria Hoiva. It is subject to approval from the Finnish competition authorities, but we do expect to close the transaction in the first half of 2019. This is a very important step for Humana, and it is also fully in line with our strategy. Coronaria Hoiva has revenues of approximately SEK 560 million and adjusted EBITDA of SEK 45 million. After this acquisition, we will be one of the leading care providers in Finland, with roughly SEK 1.2 billion in sales and nearly 2,500 employees. Moreover, we will also be a full service provider as we complement our very strong position in I&F services with Coronaria Hoiva's position in elderly care, mental care, and disabled care. This combined entity will provide us with an excellent platform to drive organic growth, quality development, and operational excellence in Finland.

A few words on the political situation before I hand over to you, Ulf. In the fourth quarter and in the beginning of 2019, we have seen some rather important changes in the political landscape in the Nordics. In Sweden, the newly formed government has decided not to proceed with the proposal for profit restrictions that was voted down in Swedish Parliament in June. This was highly expected, but it does increase stability, and it decreases political uncertainty in Sweden. Also important is that following the general election, more than 240 municipalities in Sweden are today governed by party constellations that are positive towards private provision of care. As commented earlier, the now-published LSS investigation has met with rather severe criticism. We find it highly unlikely that the full investigation will result in changed laws and regulations. Even if it did, it would be manageable for Humana.

Instead, our view is that there is currently quite a strong consensus to ensure the right to personal assistance amongst most political established parties. In Finland, we currently see an intense debate regarding private provision of care. This is after quality deficiencies have been revealed for some private and some public providers. Positive, though, is that there is also discussion around the terms and conditions under which elderly care is provided in Finland. We do expect the debate to continue in 2019, especially as there are upcoming elections this spring. Also in Norway, there is a searching debate around Barnevern and usage of consultants. As communicated earlier, a public inquiry has been launched after a proposal to limit privatization was voted down in Stortinget, so Parliament, last year. I think with this said, I will now hand over to you, Ulf.

Ulf Bonnevier
CFO, Humana

Thank you, Rasmus. I will now give a brief summary of some more details about the numbers, performance overall and per business area, as well as balance sheet and cash flow-related information. First of all, let's turn to page 10 in the presentation, where we see the operating revenue. In the fourth quarter 2018, our operating revenue grew to SEK 1,700 million, up 5.2% from SEK 1,616 million the previous year. For the full year 2018, revenue grew to SEK 6,725 million, up 2.6% from SEK 6,556 million last year. Adjusted for the divested home care service business, which contributed SEK 178 million to revenues last year, the yearly increase in revenue was 5.4%. Next page, please. Organic growth.

As you can see on the graph on page 11, Humana's during the financial year improved the organic growth rate per quarter, ending the year on a respectable 4.8% for quarter four, highest level since our IPO in 2016. In quarter four 2017, organic growth was negative with -1.7%. For the full year 2018, the organic growth was 3.4%, and the prior full year number was -1.3%. Considerable improvement also for the full year. The organic growth is driven both for the quarter and full year, primarily from new openings in elderly care in Finland, as well as improved occupancy in Norway. Also personal assistants contributed. Next page, please. The graph on page 12 gives a perspective on organic development per segment over recent quarters. Individual & Family is operating in a continued tough market in some sub-segments, dampening the overall growth rate there.

Personal assistance is outperforming the market and taking market share in a declining market. Elderly care is improving growth through strong occupancy development in recent openings and tender wins. You can also see the Norway turnaround in Other Nordics. Moving to page 13 for more details and graphs on our profitability development. Our operating profit improved 24% in the quarter to SEK 82 million, up from SEK 66 million in quarter four last year. However, excluding acquisition-related costs, which were high in the quarter, SEK 13 million versus SEK 1 million last year, operating profit increased by 42% to SEK 95 million compared to SEK 67 million in quarter four last year. The margin ended up on 4.8%, and the comparable number is 4.1% last year.

For the full year, operating profit is up 24% to SEK 391 million versus SEK 360 million last year, with a full year EBIT margin of 5.8% compared to 4.8% last year. Excluding acquisition-related costs, the margin would be somewhat higher for the full year and in line with our financial targets of 6%. The reasons for the improvements, and we're clearly satisfied with the development in the year, is driven by the Nordics, with the turnaround in Norway completed successfully, as well as a strong momentum in Finland. The fact that elderly care also turned this year into profit from a loss has contributed well. This was driven by good occupancy in recent openings and improved operational efficiency. Moving to page 14 and the segment performance, starting with Individual & Family.

The revenues for the quarter reached SEK 540 million, a decrease of 2% versus prior year's SEK 553 million, with a negative organic growth of -2.6% versus -2.9% prior year. The decrease is mainly due to low demand for family home and outpatient solutions for children and adolescents. Operating profit decreased with 15% to SEK 37 million compared to SEK 44 million for the fourth quarter prior year, and the margin reached 6.8% for the quarter compared to 7.9% prior year. Profit did increase for the full year with 3%, we reached a margin of 9.0% versus 8.6% the prior year, which was a satisfactory improvement. The low profit for the quarter is driven by low demand, and the increase in the profit for the full year stems from implemented action programs lowering the cost base.

Going forward, we're not expecting the weak market in some sub-segments to change in the near term, we rather need to continue to adapt our operations accordingly to the current market conditions. Personal assistance. We now move to page 15 in personal assistance. Revenues for the fourth quarter were up 6% to SEK 689 million compared to prior year of SEK 653 million. SEK 22 million was added to revenue from acquisitions. Organically, the growth was 2.2% and exceeded the reimbursement level of 1.5%, we're now experiencing some real volume growth in a declining market, which means we continue to gain market share. This, even though it is rather small, is a good step in the right direction. Operating profit for the quarter decreased with 11% to SEK 41 million, down from SEK 46 million last year, this comes from the margin squeeze on staff cost increases versus reimbursement levels.

The margin ended up at 5.9% versus 7.8% prior year for the quarter. For the full year, the operating profit held up well versus prior year with only a small decline. Overall, a very good year where our competitive position has strengthened gradually, we are ready to continue to consolidate the market and start to take even further market share. Now moving to elderly care on page 16. The revenues grew well in the quarter with 41% organically and reached SEK 129 million versus SEK 92 million prior year. Operating profit reached SEK 4 million versus -SEK 8 million prior year, the operating margin was 2.9% versus -8.7%. A significant improvement in profitability. That's very pleasing. This performance improvement is driven by units, specially owned, managed, but it's true for all, now being fully operational with high occupancy and good efficiency.

We're very pleased with the year, we're looking forward to our next two units being opened in 2019 and an exciting pipeline of further projects for 2020 and beyond. Next slide, please. On page 17, we've now moved to Other Nordics. Revenues for the fourth quarter amounted to SEK 341 million compared to SEK 319 million prior year, an increase of 7%, organically at constant currencies, the growth was 12.8%, a strong performance. Operating profit increased fivefold to SEK 37 million versus SEK 7 million prior year, with a margin of 10.7% for quarter versus 2.2% prior year, which we're also very pleased with. The Finnish operations showed continued strong growth, organic and acquired, and stable margins. Norway has improved significantly versus prior year, the work to stabilize and increase capacity utilization and efficiency has really paid off. A very good quarter and year for Other Nordics. Next slide, please.

We now move to slide 18, central costs. Here we can see the items affecting comparability. In the quarter, we had SEK 13 million of acquisition-related costs in the overheads and only SEK 1 million in Q4 2017. The underlying quarterly central costs are SEK 23 million versus SEK 21 million prior year in the quarter. For the full year, you see the detail at the bottom of the slide, but this was reported on before. Moving on to page 19 and our cash flow. Cash flow from operating activities for the quarter was SEK 191 million versus SEK 238 million last year. The decline was due to changes in working capital. This relates to calendar effects between quarters only. Looking at the full year, working capital is stable and in line with prior year. Cash flow from operations increases in line with operating profit improvements.

Our CapEx investments are broadly in line with last year and driven by real estate investments for new units in Other Nordics, mainly Finland, and Individual & Family. The main change is the M&A activity this year versus prior year's low M&A activity as well as divestment of home care and the real estate sale and leaseback transaction. On page 20, I end up showing our financial position. In the graph, we see the gradual improvement of leverage to our target level of 3.0 times. This will, of course, however, change post-closing of Coronaria. Back to you, Rasmus, with a now stronger balance sheet.

Rasmus Nerman
CEO, Humana

Thank you. That will come in handy. To summarize the quarter and the year, we are fairly pleased with the overall development in the group. Throughout the year, we've seen the effects of our implemented change management efforts and as a result, a notable improvement in operating profits. We also continue to see some rather healthy organic growth and a positive development with regards to our financial position, improved cash flow, reduced debt, and improved leverage. Equally important for the future is also our abilities to invest in staff and quality. That is paying off this year. Worth highlighting, finally, is also the notable development in Other Nordics. With the acquisition of Coronaria Hoiva, Other Nordics has formed a strong third pillar in Humana, equal in I&F and personal assistance in importance. In summary, 2018 was actually the strongest year to date in Humana's history.

We do, of course, face a number of challenges going forward, especially the weaker markets within parts of I&F. We do enter 2019 as a stronger group than ever before. With that said, I think we can now open up for questions. Thank you.

Operator

Thank you. Ladies and gentlemen, if you wish to ask a question, please dial zero one on your telephone keypads now to enter the queue. Once your name is announced, you can ask your question. If you find your question is answered before it is your turn to speak, you can dial zero two to cancel. In the interest of fairness, please limit yourself to one question per turn. You can rejoin the queue to ask follow-up questions. Once again, that is zero one to ask a question or zero two if you need to cancel. Our first question comes from the line of Karl-Johan Bonnevier of DNB Markets. Please go ahead. Your line is open.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Yes. Good morning. Congratulations to a good turnaround during 2018. That is good to see it confirmed considering the challenges you had during 2017. Just a question on I&F going into 2019. It sounds like you are playing down the organic opportunity there. There is going to be still a year of transition and efficiency improvements rather than growth in the Swedish I&F operation. Is that the right way of looking at it? Does that imply any risk to the margins that you are now getting out of that operation?

Rasmus Nerman
CEO, Humana

Karl-Johan, you know that there has been turbulence a few years within I&F. We consider this to be the new normal. I think when we look at I&F, when I look at I&F, I am very optimistic in the longer term. Also, looking at 2018, we do improve margins as well as profitability in absolute numbers. We outperform our peers, and I think equally important, as you can see now in the fourth quarter, and I think that is important for the Humana group is that we are also diversifying the business somewhat. The elderly care is performing really well. Other Nordics is coming across really strong. Of course, our ambition is to have organic growth within I&F. There are challenges within parts of I&F, especially the family home and outpatient care segment, as well as parts of the youth segment. This we have had throughout 2018 as well.

On the other hand, the adult segment is well and stable performing, and the LSS division is performing really, really well.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

If you sum it up, looking at 2019, it's basically the same kind of scenario as you were talking about heading into 2018.

Rasmus Nerman
CEO, Humana

I think it's. Yeah. That would be my simplified answer to the question. Yes. This is the new normal, and we have a strong belief that this will also wash out. We've seen this historically, looking back earlier years as well, looking back at 2012, 2013 as well. I think the underlying demand, unfortunately, in I&F is still very strong. We do also see a lot of structural changes on the supply side, especially in terms of what municipalities and municipality-owned companies are offering. There are positives as well there that I think will wash out during 2019.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

When I look at the client, say, drop that you still see in that operation, and you also compensated very well with higher revenue per client, so to say.

Rasmus Nerman
CEO, Humana

Exactly.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

It is more difficult cases that you are taking care of to some extent.

Rasmus Nerman
CEO, Humana

That's exactly what you see happening. Humana has always had a focus on the most complex clients there are in society. We've seen that increase even further during 2018. What municipalities today need help with is highly complex clients, which is reflected in the fact that we work with slightly fewer clients, but obviously average prices are much higher as well.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Excellent. I'll rejoin the queue. Thank you.

Operator

Thank you. Our next question comes from the line of Viktor Forssell of ABG. Please go ahead. Your line is open.

Victor Forssell
Analyst, ABG

Hi. Good morning. I have a question regarding Coronaria Hoiva. Can you tell us more of what you see in terms of organic growth for that unit or the units there, and how it looks in units under construction and utilization rates, et cetera, compared to the group per se?

Rasmus Nerman
CEO, Humana

Sure. Coronaria Hoiva is a growth-oriented quality company. They've had extraordinary growth in the past. They've done a number of acquisitions, but also had some healthy organic growth. If we look at their pipeline for 2019, we do have at least four planned openings of new own managed units. On top of that, we do also see a significant upside in increasing average utilization in the unit. The units that they have fully up and running have a very good utilization. Due to the fact that they've opened a number of units within the past 18 months, there is an upside there as well. Our ambition is, of course, to strengthen that organic growth pipeline together with what we already have in Finland. We view organic growth positive in Coronaria.

I think the other, for us, quite exciting thing is that we know these operations exceptionally well from Sweden and Norway already. The interesting thing with Coronaria Hoiva is that it is a perfect complement to our already existing strong operations within I&F for children. Now we get the great foothold in elderly care, disabled care, and mental care as well in Finland, which are highly attractive segments for us.

Victor Forssell
Analyst, ABG

Okay, excellent. Would you say that the 8% margin is sustainable, or how do you see that play out there moving forward?

Rasmus Nerman
CEO, Humana

Well, we see that as sustainable. I think over time, we have a very strong operational excellence in Finland. We will obviously work on that as well, but I definitely see it as sustainable.

Victor Forssell
Analyst, ABG

Okay, perfect. I'll get back in line.

Rasmus Nerman
CEO, Humana

Thank you.

Operator

Thank you. Our next question comes from the line of Kristofer Liljeberg of Carnegie . Please go ahead. Your line is open.

Kristofer Liljeberg
Analyst, Carnegie

Yeah. Hi, it's Kristoffer from Carnegie. My question is partly related to Individual & Family. The fact that you did see the margin improvements for the full year 2018, but looking at the fourth quarter, it seems the trend is a bit weaker. Do you think you could keep a 9% margin for Individual & Family in 2019, or do you even see possibility to further improve that?

Rasmus Nerman
CEO, Humana

I think we did the guidance for 2018 because it was necessary, Kristoffer, given the turbulence that we saw end of 2016 and 2017. I think what will change in I&F for 2019 is that we do have a number of organic growth projects, especially within the LSS division, but also in the adult division. As you know, these projects typically cost in the beginning until you're up and running. That will also be a balance to what we saw in 2018 as well. On the other hand, the market is positive. It is positive in the longer term, and we have a fantastic position in there. We should really continue to grow in the segments where there is a high demand for our services. We will open a large number of units in 2019 compared to what we did in 2018.

Kristofer Liljeberg
Analyst, Carnegie

Looking at the units you will open, how much sales do you see them having in 2019 and forward?

Rasmus Nerman
CEO, Humana

Obviously it depends on our fill rate. It does depend to a certain extent on conditions that are out of our control, especially within the LSS segment. We have quite the attractive pipeline there, but depending on building permits, et cetera, and permits from IVO, it is still a little bit unsure how many units we will open. We surely see them contributing to sales, especially towards the second half of the year.

Kristofer Liljeberg
Analyst, Carnegie

Okay. You talked a little bit about Other Nordics before, much better improvement than I think most had expected beginning of the year. How sustainable do you think this is? Is there anything extraordinary in the results there this year that will not be repeated next year?

Rasmus Nerman
CEO, Humana

I think my view, Kristoffer, is that this is highly sustainable. Not only have we increased operating profits, but we've also changed the service provided in especially Norway. We do not any longer have this highly volatile business. One should, on the other hand, be aware of the fact that we've had a very good year, especially in Norway, and also that we are still slightly fragile in Norway. We do not even have close to as many clients as we have in, for instance, individual family care in Sweden. It is actually quite hard to say. What I can say is that the improvements are sustainable, so they're not one-offs or extraordinary things. We had a very good year in Norway, and we need to maintain the number of clients we have and also hopefully grow that.

Kristofer Liljeberg
Analyst, Carnegie

Looking at the entire Humana group then in 2019, it sounds like there will continue to be decent, at least organic growth and then maybe flat margins. Do you think that's a fair assumption?

Rasmus Nerman
CEO, Humana

I think we would fall back to now to our financial targets. We've set targets of 8%-10% growth and also margin targets of 6%, which we achieved this year if we exclude for the, I would say, extraordinary M&A costs. Maybe you're not totally wrong, no.

Kristofer Liljeberg
Analyst, Carnegie

Thank you.

Operator

Thank you. We have a follow-up from Karl-Johan Bonnevier of DNB Markets. Please go ahead, your line is open.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Thank you. Just looking at the acquisition related costs in the quarter, were those forward-looking, so to say, related to Coronaria Hoiva, or was it the old one?

Rasmus Nerman
CEO, Humana

These costs were not forward-looking.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Looking at the

Rasmus Nerman
CEO, Humana

Historical costs.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Excellent. How should we look at those kinds of costs going into 2019, then assuming that you're now done your biggest acquisition since the IPO, basically?

Rasmus Nerman
CEO, Humana

As always, this will depend on the projects that we look at and close. Of course, the small bolt-on acquisitions that we have a number of, they don't consume so much M&A costs. The bigger projects do. Coronaria Hoiva is a big project that there will be some considerable costs. Of course, with that said, a big acquisition will put a lot of focus and management time, et cetera. Right now, until we've closed the deal, the focus is on making this work as well as we can and get off to a good start. Of course, this will increase our leverage in the short term. There will be, at least initially, limited possibilities to do a lot of midsize or strategic, but we can still do a couple of bolt-ons. That's sort of the scenario I can see right now.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Excellent. I tried to deduct from your statement how IFRS 16 is going to, say, change the reporting structure of the company. Please, Ulf, could you give me a little elaborate on that area, how it will affect your balance sheet cash flow, and the net impact on the profit and loss accounts?

Rasmus Nerman
CEO, Humana

How long time do you have?

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Up to you. No, do the sweet and short.

Ulf Bonnevier
CFO, Humana

I'm just joking. This will have a small impact on the P&L for us. We have SEK 1.5 billion approximately in effect in the balance sheet. We will try and guide and make sure there's a pre and post adjustment reconciliation so everyone can understand the detail as we report through 2019. Not a major impact.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Looking at the SEK 1.5 billion, what kind of average, say, duration would you calculate on that so we can deduct the impact on EBITA and similar things?

Ulf Bonnevier
CFO, Humana

Yeah, there's a mix. If we look at the longer end of the contracts in the elderly care segment, they're typically 15, and then we sort of have a range of smaller I&F units, which range between, I know, five and 15. I don't know where that round. Around 10 years on average, I would assume. Approximately.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Excellent. We look forward to seeing how that plays out in your Q1 statement then, sir.

Operator

Thank you. Our next question comes from the line of Viktor Forssell of ABG. Please go ahead. Your line is open.

Victor Forssell
Analyst, ABG

Thank you. Yeah. Can you elaborate a little bit on how we should look at increased volumes for you in personal assistance in 2019 and not only increases in reimbursement?

Rasmus Nerman
CEO, Humana

I think, Viktor, we are at, I would say, an interesting point in time now. I really strongly believe in what I said, that I'm actually looking more positively towards personal assistance than what I've actually done for 45 years now. We see a big change in how the government is reducing the number of clients entitled to personal assistance. It was a withdrawn decision. It's basically more than half compared to what it was a year ago. There is also an intention, but we want to obviously see that converted into action to fast-forward a legislative change that would allow personal assistance again for probe feeding, et cetera. Some modeling that would. Our ambition in personal assistance, obviously, to continue to grow. With the current market conditions, we would aim for an organic growth a bit similar to what we've seen this year, I would say.

On top of that, there is ample opportunities for this very attractive smaller add-on acquisitions. I think the ambition in personal assistance for 2019 is to grow both top line and bottom line in absolute terms.

Victor Forssell
Analyst, ABG

Yeah. Okay, perfect. Thank you.

Operator

Thank you. Once again, if there are any further questions, please dial 01 on your telephone keypads now. We do have a further follow-up from Karl-Johan Bonnevier of DNB Markets. Please go ahead, your line is open.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Yeah. Just curious, Rasmus, you mentioned during the call related to personal assistance that you saw great opportunities for digitalization of the business. Is there a big opportunity for deploying these kind of tools for you still, and basically then drive efficiency to another level?

Rasmus Nerman
CEO, Humana

Over time, I think it definitely is. I think if you look at what we do in-house, we are fairly digitalized already today. What we do need, however, is to extend that further to our personal assistants as well. There are 10,000 of them. On top of that, we do see improvements on the other side, if I say so. The social insurance board, Försäkringskassan, there we've seen some improvements this year as well. That is part of the reason why we have improved cash flow significantly within personal assistant after we moved from pre-payment to post-payment. I think we have quite a large undertaking there, which is an overview on how we perform personal assistance, how we introduce digital tools. It's a project we will start this year, but we will implement it over time. It probably will take a little bit more than a year.

It's not a major investment, it's more of a change of ways of working, however. I do see potential in this, and I see it also necessary in the future. The good thing for us is that very few providers can do this right now. I would say Mon is perhaps the only one, so it will also strengthen us towards competition going forward.

Karl-Johan Bonnevier
Research Analyst, DNB Markets

Excellent. Sounds very interesting.

Operator

Thank you. Once again, if there are any further questions, please dial 01 on your telephone keypads now. Okay. There seems to be no further questions at this time, I'll hand back to our speakers for the closing comments.

Rasmus Nerman
CEO, Humana

Actually, no more further closing comments from us. Thank you very much for your attention and excellent questions, and we look forward to starting 2019 together with you. Have a fantastic day. Bye.