Auna S.A. Resets Path With Mixed Earnings Call

Auna S.A. Class A ((AUNA)) has held its Q4 earnings call. Read on for the main highlights of the call.

Auna S.A. used its latest earnings call to frame 2025 as a reset year, balancing solid progress on cash generation and refinancing against pressure on profitability. Management stressed that strong results in Peru, better financial discipline and ample liquidity leave the group well positioned, even as Mexico and Colombia weighed on margins in the short term.

Consolidated Revenue Growth

Auna’s top line expanded steadily despite regional volatility, with consolidated revenue up 6% in Q4 2025 on an FX‑neutral basis and 4% for the full year. Growth was powered by Peru, where quarterly revenue climbed 11%, and Colombia, which delivered 6% revenue growth in the quarter despite operational headwinds.

Material Improvement in Adjusted Net Income

Profitability at the bottom line showed marked improvement, with adjusted net income jumping to PEN 136 million in Q4 from PEN 36 million a year earlier. For 2025, adjusted net income reached PEN 336 million, helped by noncash FX gains and tighter financial discipline, underscoring the benefits of the revamped capital structure.

Peru Outperformance and Margin Expansion

Peru remained the growth engine, posting 11% revenue growth and 14% adjusted EBITDA growth in Q4 and for the full year. Oncosalud revenues rose 10%, memberships grew around 4%, and the oncology medical loss ratio hit a record low 48.5%, reflecting both pricing power and improved cost control.

Free Cash Flow and Liquidity Strengthening

The company highlighted a strong cash story, with free cash flow increasing 35% to PEN 582 million in 2025. Year‑end cash rose 42% to PEN 335 million, giving Auna greater flexibility to fund strategic projects, support Mexico’s recovery and continue reducing leverage over time.

Debt Refinancing and Capital Structure Improvement

Auna executed an approximately $825 million equivalent refinancing that management called transformational for its balance sheet. The transaction extended maturities, boosted short‑term liquidity, freed revolver capacity and reduced blended interest costs by more than 100 basis points, leaving leverage at 3.6x and a medium‑term goal of 3.0x net debt/EBITDA.

Positive 2026 Guidance

Management issued upbeat 2026 guidance, targeting 12% FX‑neutral revenue growth and 12% FX‑neutral adjusted EBITDA growth. Capital expenditures are expected to run at about 4% of revenue, signaling confidence that disciplined cost control and operational improvements can restore margins while funding selective expansion.

Mexico Operational Stabilization and Oncology Momentum

Mexico remained a soft spot but showed signs of stabilization, with Q4 revenue flat sequentially though still down 3% year over year in local currency. Oncology was a clear bright spot, with revenues up 35% quarter over quarter and out‑of‑pocket revenues reaching 12% of Mexico sales in December, supported by new commercial wins expected to lift 2026 volumes and pricing.

Strategic Growth Opportunity — Centro Ambulatorio Trecca

The group underscored long‑term upside from Centro Ambulatorio Trecca in Lima, a large ambulatory facility to be refurbished and operated under a public‑private partnership. Operations are expected to begin in the second half of 2028, and at maturity the asset could represent roughly 20–25% of Auna’s Peru business, with construction expenditures reimbursed over time to limit capital risk.

Decline in Adjusted EBITDA and Margin Compression

Despite revenue growth, profitability was under pressure, with consolidated adjusted EBITDA down 14% FX‑neutral in Q4 to PEN 220 million and margin contracting 4.5 points to 19.5%. For 2025, adjusted EBITDA slipped 3% FX‑neutral to PEN 917 million and margin fell about 1.7 points to just under 21%, reflecting regional challenges and extraordinary items.

Mexico Profitability Weakness

Mexico’s profitability deteriorated sharply, as adjusted EBITDA fell 36% in Q4 and 18% for the full year. Management cited lower volumes, higher costs and an unfavorable mix under the prior ISSSTELEON plan, while utilization remained under pressure despite sequential stabilization, making Mexico the main drag on group margins.

Extraordinary Refinancing and Noncash Charges

The refinancing that improved the balance sheet also carried short‑term P&L noise, with about PEN 170 million of extraordinary and noncash refinancing costs in Q4. These included tender premiums and derivative unwinds and rollovers, which added volatility to reported results and income tax effects but are not expected to recur.

Receivables Impairments and Payor Risks

Credit risk management also weighed on earnings, as Auna booked higher impairment losses on trade receivables. Colombia remained a concern, with conservative provisions against intervened payors and no near‑term reversals anticipated, while Peru saw elevated impairments linked to prior‑year reconciliations and technology lags that management expects to normalize in 2026.

Lower Capacity Utilization

Operationally, capacity utilization in healthcare services dropped 2.3 percentage points to 64%, driven mainly by Colombia. Auna intentionally reduced exposure to intervened payors there, trading some near‑term utilization for lower credit risk, which weighed on operating leverage but aligns with the group’s risk‑management stance.

Unfavorable Year‑over‑Year Comparisons in Colombia

Colombia’s financial performance was hurt by tough comparisons, as the prior year’s Q4 benefited from one‑time price adjustments and procurement rebates. While revenue still grew 6% in the quarter and 4% for the year, EBITDA and margins lagged, constrained by these one‑offs and a higher share of risk‑sharing contracts.

Forward‑Looking Guidance and Strategic Outlook

Looking ahead, Auna’s 2026 outlook leans optimistic, built on 12% FX‑neutral growth targets for both revenue and adjusted EBITDA and CapEx near 4% of sales. Management expects Mexico’s recovery, disciplined costs, the benefits of the $825 million refinancing and stronger free cash flow to support gradual deleveraging toward 3.0x net debt/EBITDA.

Auna’s earnings call painted a picture of a company in transition, absorbing near‑term EBITDA and margin pressure while building a stronger financial foundation. For investors, the key takeaway is that Peru’s robust performance, improving cash metrics and a cleaner balance sheet may outweigh temporary headwinds in Mexico and Colombia if management delivers on its 2026 growth and margin ambitions.