Clariane SE (CLARI) Earnings Call Transcript & Summary

So ladies and gentlemen, I suggest we start. Obviously, some others might have some trouble in getting here, but we will try to start on time. So welcome. I'm really happy to have you here for our Clariane's Capital Market Day, and I'm delighted to have with me today all our group management board members. I mean Philippe Garin, Group CFO; Marion Cardon, Chief Brand and Engagement Officer; Professor Antoine Piau, our Chief Medical Officer; Anne-Charlotte Dymny, Chief Digital and Information Officer; Frédéric Durousseau, Chief Real Estate and Development Officer; and our 5 country heads, Nicolas Merigot for France, Rémi Boyer for Germany, Dominiek Beelen for Benelux, Federico Guidoni for Italy and Charles-Antoine Pinel for Spain today. Each will be presenting to you their priorities and road map for the next 3 years. And our meetings today should last until 5:00 p.m., including 2 hours of presentation as an opportunity for you here in this room to see firsthand a few of the projects that set us apart in the field of digital care robotics or training. And you will be able to meet with the specialists who are driving all these projects in our company, just next door. And I would like to welcome the wonderful teams that joined us today from our Marienia Clinic in Cambo-Les-Bains in the Southwest of France, the teams from the digital factory and the teams from the Clariane University. They are with us today, and they are eager to present to you their latest development. Before I begin, I'd like to say a few words on where we come from and where we stand as a company. Many things have happened since we held our last physical Capital Market Day in this very room, as some of you, there are a few here in the room may remember. Our company had to overcome a succession of shocks from the 2 years of Covid pandemics to the brutal inflation upsurge and the Orpea gate in '22 and '23. Thanks to the commitment of all the Clarianers along the last 4 years, our company has proven not only its resilience but also its ability to adapt and to reinvent itself to navigate a new care landscape, while remaining true to its values and to its mission. With our new corporate project and restructured capital, if the General Meeting of Shareholders decides so on the 10th of June, so in 2 weeks from now, we will enter a new chapter more motivated and mobilized than ever, supported by a dedicated leadership team, which I'm very happy and proud to have at my side. So here is the agenda we have prepared for the day. We will begin with a rapid focus on the dynamics that shape the care and healthcare landscape. Before moving on to analyze the levers that differentiate Clariane and will be driving our performance in the coming years. After the break, we will be presenting the road maps and trajectories by country until -- from '23 until '26 before finishing with the financial guidance for this midterm plan. Having learned from the previous crisis, we all wanted this plan to be both realistic and prudent in its assumptions, and we are confident we can deliver on its ambitions. Let us move now to the next slide, which reflects who we are as a company. In a nutshell, we, at Clariane are a purpose-driven care company, promoting an integrated approach to maximizing our impact on communities. As you know, we became a purpose-driven company 1 year ago with a strategy built around our demanding mission statement, taking care of each person's humanity in terms of vulnerability. Our activity leverage, the strong commitments we make to all our stakeholders and relies on a set of shared fundamentals. In addition, as you see on the left-hand side here, we have designed and are implementing the transformative corporate project, which is called At your side and which is built around 3 key pillars. First pillar, creating a new bedrock of trust that became indispensable after the Covid crisis and the Orpea scandal. Second pillar, strengthening our business fundamentals; and third pillar, accelerating the shift to personalized care throughout all our activities, and I will return to these various pillars later in the presentation. Let us move now to the next slide. You have here reflected the key elements of our investment opportunity. We are a major European care operator with a balanced footprint in Western Europe, operating in 3 complementary care segments and with a strong point of differentiation in our recognized medical expertise. We offer both best-in-class standards in terms of quality and Net Promoter Score as we strive to ensure synergistic extra financial and financial performance. Today, we operate on regulated markets where the needs are set to grow between 20% and 30% by the end of the decade. This provide us with strong visibility. We are also, as you all know in this room, in the process of overcoming the restricted access to financing that has plagued many in our sector, thanks to the EUR 1.5 billion refinancing plan, we have decided on the 14th of November. Last but not least, we see the inflation upsurge that started in 2022, gradually receding in all our markets from over 10% in 2022 to now around 2% to 3%. This will provide us with a solid footing to deliver over the next 2 years on the promises of a stable, profitable self-financing business that creates value with a 5% organic growth momentum, a partial margin recovery of 100 to 150 basis points and a solid cash flow generation. Before moving on to the heart of the plan, I would just like to stop for a moment to highlight the capital restructuring that we announced last Friday. We feel very lucky if our next shareholder meeting on the tenth of June decides so to welcome HLD Europe, Flat footed and Leima Valeurs as new cornerstone shareholders in our capital. together with our long-standing partner, Crédit Agricole Assurance. Their support in helping us execute our plan and support our corporate purpose, our values and strategy will be decisive. I now begin with a few words on our markets, starting with the #1 driver, which is the aging population. As we all know, in our markets, the population is aging, both in absolute terms and as a percentage of the total population. This triggers unprecedented growth in care needs. The number of people aged 75 and plus is already 30 million in our 6 geographies. And by 2040, there will be 70 million, more than a doubling. The second main driver in care landscape is the noncommunicable diseases, NCD or in other words, chronic disease, which the World Health Organization considers as being the major challenge worldwide for the health policies. NCD accounts for 75% of the diseases already. Prevalence rate is expected to grow around 30% by 2030, affecting aging population on the first place. As an example, in France, 20% of the people aged 65 and plus and 33% of the people aged 75 and plus suffer from several NCD. Tackling NCD require both increased prevention and early detection and adaptive post-acute treatment. And among the NCD, mental health issues become a specific area of concern as these are becoming increasingly prevalent and already impact around 15% of the European population. You can see here at the bottom of the slide, financial impact these combined trends are having on health spending in the countries in which we operate, especially in France and Germany, where the spendings are already above 12% of GDP. This is an extremely rapid evolution that many public health systems are struggling to cope with. And this brings me to the third factor that will fuel growing care demand, which is the shift in patient expectations toward individualization and the will to stay at home, if possible, as long as possible. What we are seeing is that the trends towards outpatient service will complement sustainably growing long-term care as evidenced in the 2 markets of France and Germany that you see on the right-hand side. Both markets in France and Germany are growing with remarkably stable proportion over time. Support for people who need help at home and in specialist centers is set to grow together, and we must be able as an operator to cater to both individually as well as provide mixed care offering in our facilities. On the next slide, you see that this growth in our various markets has already created a supply gap which is probably not what you have in mind. As an example, you have here reflected the current bed supply in elderly care as well as the additional beds that will be required by 2030, this was a stable combination of inpatient and outpatient care. And as you see on the slide, the shortage situation is the same everywhere. In France, for example, the IGAS, Inspection générale des affaires sociales, a highly respected French government body estimates that 150,000 more beds, meaning a plus 12% will be needed by 2030. That number reaches EUR 0.25 million in Germany, which means over 25% increase by 2030. Finally, I would like to say a quick word on the 3 main drivers of change that has started to impact the care landscape in Europe. First, the tailoring of care offers to increasingly address personalized needs from family members, acting as caregivers and asking for dedicated support from professionals to premium care services for the boomer generation, and tackling the challenges of isolation that plagued a lot of elderly, taking care of people in times of vulnerability will require increasing bespoke offers. This will, for sure, favor operators that have critical size and breadths of offering. Second driver, all eyes are on the potential of digital. The main area will, of course, revolve around improving the patient and the relative experience, but it will also spread to that of the caregiver. Creating, for example, physical education programs or helping in managing time and reporting. Data will also contribute a lot to care accuracy and quality, especially when it comes to NCD prevention. And last but not least, data and digital can also support care or case mix management and accurate pricing. Third driver. This is actually a private public partnership. Despite the recurring controversies on care and profit, or care against profit, which is actually pretty common in all geographies, I'm personally convinced that we will be seeing an increasing reliance of public authorities on private partners. Why? This will be especially true when it comes to investing in new capacities. And there, I would like to quote 2018 EU commission report that estimate that up to EUR 145 billion will be needed each year in terms of investment in new social infrastructure in the years leading to 2030. This is, of course, at the European level. And for sure, for profit operators will have to take their part in this global burden. They will also have to support local communities in upgrading the local care offering, which is most of the time, a public one. Of course, this contribution of private players can only be true if those private players are acting as reliable and trustworthy partners. Now I come to Chapter 3 of my presentation, which is actually where we stand and who we are. Today, Clariane is a pan-European group with a dense network that has a critical size to address the needs of over 30 million people aged over 75. We are established in 6 large countries: France, Germany, Italy, Spain, Belgium and the Netherlands. In each case, we are active in our 3 core business and segment and serving over 800 local communities. In addition, we have a scalable platform that is leveraging the strong local partnership of trust and developing synergies around brand preference and a shared corporate culture. Let's have a focus on our 3 complementary segments. The first one, as you know, is Long-Term Care which is currently serving close to 100,000 patients or resident with an occupation rate in our facilities that is now over the 90% threshold and still holds an additional 3 percentage point upside over the coming years. The second segment is about Specialty Care that now accounts for over 1/4 of our revenue, including mental health, and which helped over 100,000 people every month. And the third and final segment is Community Care, our most dynamic segment in terms of growth, led by strong brands and providing care to 80,000 patients a year, almost as many as in our nursing homes. So this is a pretty balanced portfolio that leverage solid Clariane synergies in the field of medical expertise, of quality, of training and HR, of innovation and data and of management of real estate. I now would like to shed the spotlight on our At your side corporate project. As I have mentioned at the beginning, a key pillar of this transformative corporate project revolves around our strategy to strengthen the core of our differentiation. We aim to achieve this by focusing much of our efforts on 5 drivers that are critical for our performance and risk mitigation approach. And Marion Cardon will begin with our quality and patient center experience and our training strategy via our unique Clariane University. Professor Antoine Piau will be presenting how we strive to continuously reinforce and enrich our medical expertise. As I've already said, another key area of focus is digital and data management and this is under the supposition of Anne-Charlotte Dymny. And last but not least, Frédéric Durousseau will conclude with a focus on our approach on real estate management and financing. And I would like to invite my colleagues to join me on stage. And Marion, if you accept, I would like to hand over to you.

Hello, everyone, and good afternoon. So I'm in charge of engagement, brand and quality. And first of all, let's talk about quality. At Clariane, Quality Care is nonnegotiable and is the reflection of an approach to a care culture that permits the whole of the organization. At Clariane, we define quality through 4 related dimensions. First, expected care quality. This encompasses both the implicit and explicit expectations that our patients and stakeholders have from our services. These expectations are continually assessed through direct customer feedback mechanisms and internal review processes. Second, wanted quality. This is more aligned with the regulations and the standards we set for ourselves, extending beyond the expectations of our patients. Then delivered quality that corresponds to what our operations actually provided to the patients measured against our Clariane standards through rigorous management reviews and processes audits, both internal and external. And finally, perceived quality is the patient's personal evaluation of our services, which can vary widely, captured through an external survey aimed at gauging the gap between delivered and perceived quality. Each category plays a crucial role in shaping our quality standards and ultimately, patient satisfaction. Our continuous improvement is driven by all these insights and tools. In terms of ambition settings, the fact that we have better results in audits done by external authorities than internal ones show that our level of expectation is even higher than what is required. In addition, and building into the maturity acquired for the first ISO certification cycle, we are committed to extending this certification to all our facilities and services while enhancing our alert and claim management systems. Our final KPI is to achieve to remain above an ambitious 40 NPS, Net Promoter Score and above all competitors when benchmarks are available. As a reminder, we reached 44 last year, a number we strive to maintain. Central to our strategy of strengthening our core, our people. They are the most important part of who we are and what we do, and they are at the center of our strategy. First, we need to provide them with the right training, creating adaptive paths within our company. This is why we are enhancing our training systems and developing Clariane Universities in all our countries, increasing drastically the number of qualifying trainings, ensuring our team not only growth in size but also in competency and dedication. At the same time, we are developing our Clariane management culture, that embodies our mission, values and care philosophy, fostering trust and care quality as the key to our success. By doing so, we offer a development path to the people who join us while ensuring we have the right values with people to fuel our internal needs of qualified jobs. Finally, we take care of our employees in line with our purpose. Their health and safety are the one of our key priorities. This comprehensive approach is captured in our employee value proposition, Your Place To Make A Difference that reflects our commitment to each individual's carrier and well-being, a crucial element for attracting and retaining top talent in such a tight labor market. So this employee value proposition. The promise is at Clariane, you have your place to make a difference. In a very simple and effective way, fully aligned with our DNA -- with our [indiscernible] and mission. It illustrates how our HR strategy is being shared to answer employees' expectations and ways to grow within our organization. In the spirit of our positive care approach, we take care of our employees in the same way that they take care of their patients and residents. We provide them with the support they need to succeed in their professional carriers. From daily work, with topics as important as health and safety, social dialogue, one-off financial assistance, from the Clariane Solidarity Fund or diversity and inclusion, to professional evolution with our Clariane Universities embodying skill developments and qualifying paths, to also their impacts in local communities with our purpose-driven commitments. Our employee value proposition shape an ambitious road map to offer the best Clariane experience to our employees. It will also reinforce our differentiation from our competitors as recruited. We will be able to measure through different KPIs as well as through our yearly employee survey, the effective implementation and positive impacts of this employee value proposition. And as an illustration of this promise, let's discover our Clariane Universities. [Presentation]

So hello, everyone. I'm Antoine Piau, Professor in Geriatrics from the Toulouse University Hospital and also associate researcher at Oregon, Portland, Health & Science University. So I'm in charge of the medical strategy of the group and also ethical research and innovation department. And I'm going to tell you who we are in terms of expertise and how we do care for people in a very differentiating and proprietary approach, namely positive care. So positive care is our common and shared philosophy all over Europe, all over our network. And we have a really common definition perfectly in line with the company mindset. The first point is that we do care for people, not for disease. And we have a very ethical approach, but not the easy world, not the meaningless world. We have an operational pragmatic ethical approach, meaning that we do respect patient and resident wishes and we do propose a very tailored and personalized care plan but also personalized care pathway. For example, when it's relevant and only when its relevant, we can propose phygital approach mixing face-to-face and remote care for some people and not from others. We also promote the use of nonpharmacogical intervention to promote again, less invasive care, for example, for BPSD, behavioral disturbance of dementia, but also in mental health. So what is really important to understand is that we have a long-standing expertise and knowledge in long-term care. So for vulnerable very old poly pathological people. And in fact, it's the future of health care, not only of long-term care. So we want to leverage this competitive advantage to be able to propose at the same time, very expert, very specialized health care, but also a comprehensive long-term care approach to life planning to prevention through positive care. So we encourage ethical questioning at psych level, again, in a very operational manner. Second point, we adapt day-to-day care to each people to each resident to each patient, and we can measure it. For example, we are designing a European grid to evaluate resident rhythm of life. It does not exist. It will be a very first, and our goal is to implement it in at least 80% our facilities by 2026. So it's very challenging, and it's a very first again. We want to promote NPI, nonpharmacological interventions. We already disseminate all over the network, all over Europe, at least 3 different NPIs in each nursing homes. Now the next step is to monitor the real life implementation to be sure that the team appropriates itself the tools and that all patients benefit from it on a long-term perspective. So we did set up rigorous KPIs to be sure that the philosophy shares, so the definition is common, but that it's really done in the field. The second lever that we have is our own expertise who we are. So what we have, what we already have is a highly integrated, strongly integrated community of specialists all over Europe. So every academic center would dream of that. And in fact, every health professional wants to be part of a specialized network because we want to share, we want to be able to learn even if we don't have time for it. We want to be able to teach even if we are not a professor, but it's possible in the Clariane network. And we also give access to reserves, to high-level research even if it's applied research, even if we are not a senior researcher for the benefit of everyone for the benefit of patients, as professionals, and it's exactly the same for innovation. We give access to innovative tool, we give access to innovative pathway and is attractive for everyone, for both patients, residents, health professional. It's also a very strong signal for [indiscernible] because we want to be the only high-level partner in Europe in terms of research and innovation. So last but not least, we seek to develop our own expert university courses, certified cases, labelized courses. It's a complement to university courses, but we want to give access to much more people to a broader target because it's more flexible. And we don't -- everybody doesn't have time to perform university courses besides this work. So we want to do it and to get it labelized by scientific authorities. And for example, we seek to labelize our cases by the French National Geriatric Society before the end of the year. It would be an industry first and at the beginning, it will be recognized inside the network and probably one day outside the network. So all these actions allow us to be able to say more and more in each territory. We do have a very clear differentiating offer very highly specialized offer and serving to an unmet need. So again, it's very attractive for health professional, and it's a very good signal for authorities. And this expertise is very well reflected by our clear KPIs. For example, when it comes to a [indiscernible] we have best-in-class rate, and we want to maintain it despite the fact that people, residents are older and older, have more and more disabilities and more disease. So it's quite a challenge to maintain this rate under 5%. So second very good result is passive restraints, which reflects the fact that we do promote less invasive care, both in nursing home and in psychiatry, and we want nursing home to reduce the rate of passive rate trends year after year. And again, despite the fact that more and more people have dementia, despite the fact that the prevalence of BPSD, behavioral disturbance is higher and higher. And last but not least, in accordance with the positive care approach, we want a near perfect adoption of the personal care project in all our facilities by the end of 2026. So to go a bit further, we decided in 2023 and 2024 to launch 3 European specialized committee: Psychiatry Committee, Rehabilitation Committee, Neurogeriatric Committee. And the kickoff of the Rehabilitation Committee last April was a great success with more than 150 specialists from all over Europe with key opinion leaders from the academic sector with industrial promoting their robotic rehabilitation tools, and we want to disseminate this approach to all specialty all over the group. So last but not least, the ethical governance. What we did is exactly the opposite of the others. We don't want to set up a fancy committee of key opinion leaders about ethics in a weightless bubble. We want to disseminate it in all levels of the group from the facilities to the top management, to the GMVs. And in fact, ethics is not only about care. It's also about how you behave with collaborators. So it's also about HR, it's also how you behave with your partners, with your clients. So it's also about business ethics and compliance. And everything is under the animation of the medical functions because we do care for people. We don't sell apples. And we do have, of course, have a charter, an ethic charter, and we strictly applied it. We do have a full month dedicated to values, and we do have an ethical alert platform in addition to the complaint platform, in addition to the fact that we monitor serious adverse events. So in conclusion, we really believe that we have a unique approach. And we have a pragmatic expertise of care, a pragmatic approach of ethics and we also base all these things on evidence-based medicine. Meaning that, for example, for NPI, we don't use fancy esoteric tools, but only evidence-based tool. And to finish, we are able to measure it for all this aspect. So maybe we have the time to see a little video about our approach to rehabilitation and our special Rehabilitation Committee. [Presentation]

Good afternoon, everyone. My name is Anne-Charlotte Dymny. I'm Chief Digital and Information Officer for Clariane Group, and I'm really pleased today to present your Clariane digital strategy. It's always very hard to speak after Antoine because he's so energetic and passionate. But at the same time, I think he really embodies the reason of why I joined Clariane 4 years ago. I would like just to share with you this reason because I think this is very symbolic of the community we are representing. Four years ago, when I joined Clariane, people were asking me, but what kind of digital transformation are you going to do in the elderly care sector? These 2 worlds were a perfect oxymoron. At that time, so Antoine was not there yet, but it could have been one of the reasons, but my answer was lying in 3 points. The first one is that in this sector, the land of opportunities for digital is really vast and everything was still to be built. The second point was that Clariane already at that time and still today was leading the way and was really building the future of care and health care. And the third point as Antoine really emphasized, is that we are not doing it like any other player. At Clariane, we have a strong sense of ethics and responsibility. And 4 years later, these points are still valid. So let me walk you through our digital journey. First, we leverage digital to enhance care quality. Marion just said it at Clariane, care quality is not negotiable. And that is why the digitization of our patient medical records is the cornerstone of our care quality improvement. It enables better care coordination, better traceability and therefore, it improves the outcomes for the patient. And I'm proud to say that each country has its own digital care records, and I think Federico will say a few words on it later. Technology is also a game changer to address the risk #1 in our facilities [indiscernible]. In that respect, we are enhancing care security, thanks to an AI-enabled for prevention and detection devices in our major geographies. Second, at Clariane, we are literally transforming our employee experience by bringing them a mobile in their hands. As we speak, in France we have Nicolas Merigot, we are deploying Koala, a one device experience. From a caregiver to a nurse or a doctor, everybody will be provided with a smartphone on which they can access all their softwares at a fingertip. The initial uptake of this project is very encouraging, and I'm quite confident to say that Koala will redefine the standards of the care employee experience. The third point, patient experience, and that's where medical and technology meets. Because yes, indeed, today, technology enables new conforms of pathways, new forms of [indiscernible]. But before going to the medical part, we have to reinvent, to reenchant the patient experience from a administrative side. It's kind of boring, but I'm sure that when you are going to the hospital, you're asking yourself, well, you have to fill in so many papers. So at Clariane, we are making strides to ensure that all patients have access to mobile app and digital portal, which offers personalized information and administrative documentation, enhancing their daily interaction with our facilities. And the second step is really, as Antoine said, to reinvent the care pathways with telemedicine and telehealth. The fourth pillar of our digital strategy is operational performance. We want to improve dramatically our processes to make them more efficient, thanks to a harmonized IT landscape. We are focusing, in particular, on transactional services, processes such as HR administration, procurement and accounting. And thanks to automation, we will strengthen our efficiency across the board. And the last pillar of our digital strategy is revenue generation. We are digitizing the patient journey and enriching our service and care offerings through digital advancements. We are creating a seamless experience across our services from long-term care to health care, and we want to do it, as Sophie mentioned in her introduction with the power of data, in particular, to reinforce our fair pricing approach. But to achieve these objectives, we really need to strengthen our tech foundations. We need to rely on the strong tech foundations to use data more effectively while we are leveling up our infrastructures to strengthen our cyber resilience. So let's take a moment to see all this strategy into motion. [Presentation]

In this movie, you saw the concrete hallmarks of our digital transformation. You had full detection for care quality, the Korian family app to enhance patient experience, Koala to provide a mobile employee experience. And last but not least, you saw also data at the service of our operations. And let me focus on this very last element, data. Data is at the core of our transformation. As we continue to digitize our operations, a robust data strategy becomes paramount because yes, indeed, we are a data company. Every day, we produce a vast amount of data in care, obviously, but also in HR, in customer services, in maintenance, et cetera. Our main challenge today is to use to consume really this data beyond the mere reporting in dashboards. In other words, our ambition is to operationalize our data to better serve our patients and residents, our employees and more widely our stakeholders. Let's discuss our advancement in data infrastructure and governance. We are building a state-of-the-art tech ecosystem that treats data as a critical asset. It means speaking the same language across the group by building common data referentials, you would be surprised that the square meter is not the same in France and Germany. So we had an interesting discussion about it. It means also to leverage the same technology by using the same data platform to make sure data is accurate, timely and complete. And finally, it means developing actionable insights by leveraging advanced analytics and machine learning to drive decision-making and improve patient outcomes. As you saw in the movie, we leverage data to better know our customers and to design real patient pathways. This is the result of our data operating model where teams are really integrated between business and data engineering. And this operating model is instrumental to address our next frontier, AI. AI is a paradigm shift for all industries, and care and health care sectors are no exceptions. Its applications are tremendous for care operation, in particular, to free up medical TAM. And at Clariane, we see also a big potential in the field of noncommunicable diseases prevention. AI will empower Clariane as a care provider to provide more effective and personalized treatment while improving patient outcomes, reducing relapse and hospital readmission. Here also, the land of opportunities is really vast. As you know, we deal with personal health data and therefore, we must act with caution before applying LLMs on our systems. Indeed, as we said several times, ethical consideration are the core of Clariane and are at the forefront of our data strategy. We have established a data ethics committee to devise a Clariane doctrine on health data and to oversee its ethical use to benefit our residents and patients. In conclusion, our approach to data management and ethics is comprehensive and integral to our midterm strategy. By embracing these principles, we are not just complying with current standards. We are preparing ourselves for the future of health care, which will increasingly rely on digital and data capabilities to deliver personalized, efficient and ethical care. I thank you for your attention, and I now hand over to Frédéric Durousseau for a deep dive on real estate.

Good afternoon, everyone. My name is Frédéric Durousseau, and I'm the Chief Real Estate and Development Officer at Clariane since 2016. Today, I'll be discussing our real estate management and financing strategy. As a reminder, the main goal for us is to ensure a high-quality well-renovated network that meets the modern demands of health care and provides superior care environments. In the long-term care facility segment, we have successfully transformed 1/3 of our network into modern and digitalized facilities fully adapted to high-dependency needs. In the Specialty Care segment, we have made significant strides by integrating more than half of these facilities into their local environments, while also bolstering them with specialized and outpatient services. This integration not only improves patients' accessibility, but also allows us to offer tailored health care solutions. Finally, in the Community Care segment, we have made the most progress with 70% of the network transformed to align with current demand trends. This segment is rapidly growing. On the map, to your right, you can see the distribution of our network transformation across Europe. It's important to highlight that 45% of our group facilities built or innovated since 2016 are not equipped with the latest technology and facilities standards. Furthermore, all new sites developed since 2020, known as greenfield projects have achieved high environmental quality or equivalent certification, underscoring our commitment to sustainability and high-quality standards. Moving to the next slide, before switching from asset light to asset smart, Clariane used to act solely as an operator. Clariane then began to act as a developer to better manage the evolution of the network's operational needs, where innovation of the network was made possible through relocation of beds to sites offering greater utilization potential, modernization and expansion of existing sites with single rooms and the hospitals, standardization of concepts, digital equipment, environmental friendly buildings. We have also acted as a selective investor in order to remain flexible and to benefit from value creation. Today, Clariane owns 26% and therefore, leases 70% of its operated staff -- sites. Our asset-smart strategy enabled us to negotiate better terms for our leases, lower rents, indexes protections, shorter lease duration, CapEx sharing with owners. On the next slide, the following graph plots the weight of Opco rents that is both external and internal rents against our revenues. Over the past 8 years, we have succeeded in reducing the real estate rate and operations so that our operational activities are now less real estate intensive as they were before. On the next slide, we look at the monetization of our real estate portfolio over the past few years. Over the 8-year period, the value of our own assets has increased by almost EUR 2 billion from slightly less than EUR 1 billion in 2016 to EUR 2.8 billion pro forma 2023 after the sale of U.K. activities and shares in the Aedifica real estate joint venture. More than half of this EUR 2 billion increase was invested by minority shareholders with whom we made long-term partnerships via real estate joint ventures. In other words, while Clariane controls about 3x as much real estate as in 2016, it has no more equity tied in real estate than in 2018. Moving on to the next slide. Our pan-European portfolios successfully closed in December 2020, in December 2021 and in June 2023, have managed to secure long-term loans at low fixed interest rates. These vehicles represents almost 3/4 of our total real estate ownership. The one with highest interest rate closed in June 2023, still displays an average fixed interest rate below 3% as most real estate debt was secured in the 2 preceding years. Our last joint venture closed in December 2023 with Credit Agricole Assurance remains debt-free. Our over owned assets are not all to be monetized in the short term. Some of them could be sold in sale and leaseback, others could be included in future pan-European real estate trans, and the last ones will continue to be held as is. On the next slide, finally, looking at the future, the increase in the bed pipeline over the next 4 years is expected to be less than the number of beds realized in 2023. This decrease in the beds pipeline is in line with our commitment to reducing our leverage. Greenfield developments in foreign countries simply reflects past commitments for instance in Spain through the acquisition of Grupo Cinco. All development in France will take place through joint ventures with long-term trusted partners such as La Banque des Territoires. Thank you for your attention. I now give back the mic to Marion Cardon, Chief Engagement, Brand and Quality Officer.

Let's talk about CSR. Over the past 4 years, we have moved forward rapidly on the ESG front. Building a solid bedrock for ESG throughout the company. Our efforts were focused on 3 pillars aimed at each of our main stakeholders. And I will not go through all the figures but some of them are more important than others. First one, growing and protecting our employees. This has resulted in this year in Clariane being named a European top employer. The second pillar has revolved around providing unparalleled care to our patients and residents. And I talked about it earlier, that the 44 NPS is an eloquent testimony to our work in that field. Finally, our focus on environment, where the key KPI here is the 29% decrease since 2019 in Clariane's carbon intensity. Thanks to the maturity achieved for this road map, being a purpose-driven company was the obvious next step. A step we reached last June when we claimed that taking care of each person's humanity in times of vulnerability was our purpose. Guiding our ambitions and setting us apart in our level of ambition. Let's talk about inclusive governance and road map. As we look forward, our ESG road map is now fully integrated and at the service of our mission. This mission is composed of our purpose and of our 5 commitments embodied by 5 key words: Consideration, fairness, sustainability, locality and innovation. This slide shows how our fully aligned ESG strategies and initiatives, and you will see some of them, some of the topics that were discussed by Antoine, by Anne-Charlotte. The colored announcements highlight the specific initiatives that are tracked closely by our Mission Committee. What is important for us is that integrated and strategic approach ensures we not only continue to meet our goals, but exceed them in a consistent and impactful way. Let's talk about performance and impact. Our ESG strategies are specifically designed to yield tangible positive benefits on our operational performance, but also on the overall quality we deliver to all our stakeholders. But by focusing on improving efficiency, we also expect to see lower overheads, reduce recruitment costs and an increase in average occupancy rates. This is critical for being sustainable in the long run, while maintaining the highest level of quality, enhancing our financial performance and securing our position as a leading care provider. Turning to the future. You have here some of our key outcome-based initiatives with ambitious 2026 targets. This builds on our 3 main categories: first one, train, protect and retain our employees, ensuring highest care and positively impacting our local ecosystem. First, let's focus on our employees. We are dedicated to securing and growing the quality of our own workforce with more than 7,000 qualifying paths that will be created to facilitate carrier progression, thanks to the Clariane universities you discovered earlier. We expect to have 3 out of 4 site managers positions to be filled internally, demonstrating our commitment for internal development. And additionally, we aim to reduce absenteeism to under 11% and our turnover rate to 18%. This aligns with our goal to retain top talent through enhanced care and support mechanisms. Second, regarding the care we provide in all our activities. Dr. Piau explained to you what we are saying about positive care. We want to extend this positive care approach to all our activities. We are convinced that this is the best way to ensure that every patient received the highest standard of care, systematically tailored to his or her individual needs. We also believe in governance. To bolster it, we are securing empowered stakeholders' governance at all organizational levels, facilities, countries, group. And we will also use the maturity we acquired through the ISO certification as a key enabler of quality across all operations, expanding it to all our facilities and to all our activities. Lastly, our efforts to positively impact our local ecosystems that are robust. We have committed to energy decarbonization trajectory that aligns with the Paris agreement. It has been validated by the SBTi. Furthermore, and it was also presented by Dr. Piau, we want to contribute in the medical field with over 80 centers scientific and health studies annually, enhancing the medical community knowledge and practice. And finally, we are local. So we also aim at ensuring that at least 75% of our purchasing is national, supporting local economies while reducing our supply chain footprint. These initiatives are not just strategies. There are practical actions that we are implementing to drive our company forward responsibly and sustainably while daily demonstrating our commitments.

Thank you very much Marion, Antoine, Anne-Charlotte and Frederic. You see with their presentation, when we say strengthening the core, this is not -- these are not only words. This is really the very heart of our strategy, and this is the channels which we can really provide best quality in all our facilities. Now I suggest that we take this short break and that you have the opportunity to meet in the next room with the team that are working currently on robotics used in care, rehabilitation. So this is [indiscernible] teams mentioned by Antoine that you have also opportunity to discuss with the team who is currently deploying this [indiscernible] device project. And last but not least, the teams of our corporate university, Clariane University that can present you on what we are doing on training and qualifying paths. So let's meet in 15 minutes from now, at 3:25 p.m. for the one that are connected through digital. Good break. [Break]

So I hope you could all benefit from a break and have the opportunity to discuss with our teams there. So welcome back. We will now move on for the second part which is actually dedicated to the road map by country with a new set of colleagues. I would like to call now on the stage with me, Nicolas Merigot; Charles-Antoine Pinel, Rémi Boyer, Dominiek Beelen and Federico Guidoni. And last but not least, in the second part, we will have also Philippe Garin, our CFO, to outline the financial guidance for the period of the plan. So before we begin our focus by country, I would like to insist on the common challenges and levers that will contribute to improving our operational performance and these 3 levers are active in all our geographies. With 3 levers, I mean, actually, as you see here on the slide, volume, pricing and revenue management and synergies. So let's have a few words about volume contribution. Our fourth goal here is to maximize the use of our current platform to enhance service delivery and patient outcomes. This is definitely crucial as we navigate the recovery phase post-COVID in the elderly care segment, while demand dynamics are shifting as we have seen in the first part. Our recovery strategy in this elderly care segment, which is critical, definitely for Clariane is centered on 2 pillars, quality and brand reputation, as Marion explained earlier. These elements are fundamental as they reinforce trust with our clients and position us as a first choice for health care service. We see, as I said before, a potential of an additional 300 basis points in the occupation rate in the long-term care segment, and Philippe will touch on this later. When it comes to the business model, we are developing, especially in the Specialty Care and Community Care segment, an asset-light strategy that is focused on outpatient and also home-based services. This approach not only reduces our capital intensity, capital expenditures, but also aligns with the evolving preference of our patients. We are increasingly favoring the least invasive care settings. Last but not least, on this volume recovery, we aim also to create more synergies between our different care offering to build integrated care pathways at a very local level. This integration contribute to efficiency and also to better patient experience and leads to better health outcomes and better operational performance. Let's now say a few words on the second lever, which is the pricing and the revenue management. As you may imagine, we are continually adjusting our pricing model, especially on the regulated segment to better match the level of service and care and case specialization we provide. This includes also on the out pocket component of our revenue, a more segmented offer that caters to diverse patient needs. So it applies both to the regulated part, the largest one and the nonregulated part. And the third and last lever is definitely about efficiency. And we have currently launched a dedicated operational efficiency program that will include developing more integrated purchasing platform at group level. Digital transformation on the main transaction and overhead function and processes and that will also contribute to reduce the energy consumption in alignment with our SBTi CO2 reduction road map. So here, you have the 3 levers that my colleagues will explain geography by geography. Leveraging to increase the volume, moving to an asset-light model, adjusting our pricing and realizing operational efficiencies. They are the levers that will be driving Clariane's improvement in performance over the coming years. And I'll now hand over to Nicolas Merigot for France. Nicolas, floor is yours.

Thank you, Sophie. Hello, and good afternoon. My name is Nicolas Merigot, and I am Head of Clariane's business for France, which represents 45% of the group revenues, 657 facilities in France and 27,000 employees and a strong NPS plus 45. Today, following this question of volume, we will begin by examining the critical transition affecting health care in the demographic and epidemiological because these factors are pivotal to understanding our strategic priorities for '24. The demographic transition firstly. We are observing significant increase in the elderly population with the number of people aged over 95 expected to rise from 100,000 in 2013 to over 400,000 by 2040. At the same time, we are witnessing an epidemiological transition from infectious disease to chronic, degenerative and mental illnesses. The French paradox is that we live longer but not necessarily better. The French -- the average French individual over 65 now lives approximately only 10 more years without severe limitations. In addition, multi-pathologies affects really 1 in 3 individuals aged 85 and over. Focusing on mental health, about 20% of French population suffers from mental disorders, yet only a small fraction is diagnosed and even fewer receive the necessary care. And do you know that in France, psychiatric illnesses are the second leading cause of work stoppage. It's projected that clinics should need to manage an additional 3.3 million days of care between 22 and 27 to cope with this rising demand. These transitions define the backdrop against which our services must evolve. Clariane France with its 4 strong brands of Korian, Inicea, Petits-fils and Ages & Vie is strategically positioning itself to respond effectively to the diverse and expanding care needs of our elderly and vulnerable population. In the field of elderly care, Clariane proposes a wide range of services in a geographic dense network. The largest is the nursing home operated by Korian, which is the first network in France with 269 facilities. We are also in a leading position as operator from home services with Petits-fils and its 263 agencies that serve more than 20,000 families. At last, with 323 homes Ages & Vie offers accommodation for elderly people who need security, social life and day-to-day assistance. Of course, this solution is not adapted to people suffering from dementia who are treated in our nursing home. But I would like to shine the light on a specific area that has been the source of confusing messages. As many of you may know, the current policy framework on aging well in the French current political debate is focused on promoting home care. This aligns with a strong preference from 9 out of 10 French to grow old at home. Good news. These are correspond to reality. Today, over 4.1 million French aged 80 and plus and the population living in nursing home is only of around 600,000 people. Moreover, the proportion of people living at home versus those in nursing home hasn't changed significantly over the last 15 years. However, it's important to bear in mind that the reality of a full home solution for everybody present several challenges as laid out in a very interesting report issued by IGAS that Sophie mentioned. At first, the home environment, while familiar can become a place of isolation for many. It could also become a place of lack of care and a place of under nutrition. Additionally, the number of caregivers relative to the population is decreasing, making home care job less attractive due to factors like isolation, lower wages and the requirement for travel. At last, and it's very important, for a mid to a high level of dependency staying at home is a more expensive solution for families and society. These elements underscore the complexities of relying solely on home care solutions. It is also important to note that contrary to popular belief, there has been no significant cultural rejection of the EHPAD model despite the well publicized crisis. This proves there is a continued and growing role for such facilities. That's why we are confident that our approach must be multifaceted acknowledging the preference for home care, while enhancing the way to welcome people in long-term care homes, both from a medical and from a hospitality perspective. Our conviction remains that we need priority of solutions to address the challenges and realities faced by the aging population. Moving to our strategic priorities in Specialty Care. Our focus in this area is on enhancing rehabilitation and mental health services areas with significant impact potential. In medical rehabilitation, our priorities remain. First, continue to structure our offering around promising specialties. This is an ongoing effort that began 3 years ago and that involves refining our offering to better meet growing demand and improve our territorial positioning. Secondly, continue our outpatient care roadmap. We have outlined in the graph below the 100% and 90% growth in their hospital activity we have recorded since 2019. This increase results partly from the acquisition of mental health clinics but essentially from our internal development plan with openings of the hospital in 19% of our clinics. We consider that our development in this activity has been twice as fast as the public one and 1.5x faster than the other private operators. Finally, the last levers of growth in the field of the medical rehabilitation is strengthening of partnerships. These partnerships will achieve 2 objectives: the first contribute to integrated innovation faster. And secondly, secure activities within medical pathways further enhancing our service delivery. After this focus on the medical rehabilitation, our mental health strategy involves 3 pioneering elements. First, focusing on emerging psychiatric disorders and addressing the core pathologies with modernized treatment option as disclosed by Antoine. You can see how our current service mix perfectly matches the pathologies that are growing fastest like mood disorders, anxiety disorders and eating disorders. Two, developing autonomous psychiatric outpatient center. We currently manage 10 centers that are located downtown and are perfectly adapted to mid to moderate psychiatric disorders. This solution combines the efficiency of care provided in a traditional clinic by a multidisciplinary team and the preservation of the social links. And three, incorporating advanced therapies and technology utilizing digital tools, virtual reality, rTMS and other nonmedicinal intervention like deprexis to enhance patient outcomes. All these initiatives are designed not only to meet immediate needs of our patients but also to position Clariane as a leader in specialized health care services, promoting long-term sustainability and growth. Turning now to our '24 to '26 strategy. I will begin with the long-term care recovery, a segment in which we aim for an increase of the occupancy rate of 93% by '28. This includes developing short stays that will represent 45% of the total number of entries and a very interesting 20% conversion rate of short stays into long stays, which translates into a strong positive contribution to business. In Specialist Medical Care, we are expecting an increase of the occupancy rate in full hospitalization of around 93%. We will also be accelerating the development of ambulatory care services and aim to nearly double the number of outpatients. Finally, we want to strengthen relationships with patients and other health care professionals through the digitalization of patient pathways. Lastly, our community care development strategy is robust, focused on expanding our network with Ages & Vie and Petits-fils. By the end of '28, we plan to double the number of Ages & Vie homes and increase Petits-fils agencies by 30% compared to June '24. More generally and in accordance with what has been disclosed by my colleague in the first session, we will continue to focus on quality, medical excellence, productivity, commercial efficiency and maintaining fair prices. This expansion in our 4 brands are designed to meet the growing demand and enhance service levels across regions. And it's on the solid footing that we expect to record a 5% in revenue CAGR for the period '23 to '26. To conclude this focus for France, let's take a look of a short movie on Ages & Vie. [Presentation]

Good afternoon, everyone. My name is Rémi Boyer. I am the CEO of Korian Germany since October of last year. And I'm also the Clariane Group Chief HR Officer. As you know, our HR performance is a key component of our recovery in particular, in this country. Let me begin by saying that I'm very happy to bring you some good news today on Germany since we see encouraging results from our transformation program of last year. So let me briefly introduce you with some market dynamics and market demographics before explaining you how we are recovering from a very challenging post-COVID situation. First of all, we should always remember that Germany is the Europe's largest market for the elderly. We were market size of more than EUR 50 billion in terms of health care market. It's 85 million inhabitants has today the highest proportion of elderly people with 22% of the population aged more than 67 years. And in the next 10 years, this proportion will grow faster because more elderly people were born in Germany before the baby boom and the number of people in need of care will continuously grow by 20% in the coming years in this country. These demographic trends drive the growing demand for inpatient care and specialized living accommodations, guiding our strategic focus and expanding and enhancing these services. Korian Germany today operates 227 long-term care home facilities with an exceptional Net Promoter Score of plus 45, a clear indicator of patient satisfaction and care delivery quality, one of the strong assets of Korian Germany. Compared to France, we are a mono platform of long-term care homes with some assisted living and home care activities in what we call mixed platforms. Representing 23% of Clariane Group revenue, Korian Germany has dramatically increased its occupancy rate in the last 8 months, bringing the country progressively back to pre-COVID levels. Today, our 2/3 of our facilities have occupancy rate more than 90%. We recorded in the last week, the highest occupancy rate ever achieved in the South region, more than 95% occupancy rate and reached almost 93% occupancy rate in the West region, one of our 3 regions in Germany. So I can confidently say today that we are on the way to reach pre-COVID levels. Let me now come back on the main market challenges and the way we have been able to turn the situation around in the last months, paving the way for a more sustainable and profitable future in Germany. As many of you know, years '22 and '23 presented unique [indiscernible] effect challenges to German businesses in the sector, including a regulated salary cost increase of minimum 25% to overcome inflation and market needs, namely staff shortage and the end of massive COVID-19 subsidies in Germany, which both considerably impacted our financial value outlook, especially our cash balance. These elements were compounded by a series of additional regulatory reforms on the personnel, namely [indiscernible] with immediate or deferred FX on the sector. That is why today, around 8% of the care homes in Germany became insolvent in the last 2 years. And we now see that the authorities are trying to limit these insolvencies just to be able to respond to the strong and increasing social demand. In this adverse environment, we were and we are very confident in the quality of our assets. Korian Germany was and remains a sound and solid platform to address the current demand and also serve the increasing market needs in a market, largely dominated by big nonprofit operators, such as Caritas, Jikoni or the Red Cross and a few private operators such as Korian or [indiscernible] that have, as Sophie said at the beginning, their entire place in the market. The quality of the German platform comes first with strong extra financials. Germany was the first country within the Clariane Group to be certified top employer 4 years ago and is also, of course, certified ISO 9001 with strong German quality referentials as well as CSR indicators. In particular, quality of care is at high level in our country, according to the numerous quality indicators that Germany develops permanently in care. These elements form the foundation for our recovery. The difference maker is a completely new program called TRAFO or Transformation Office. Launched in November last year, and is fully supported by the German Executive Committee as well as strong support from the company -- from the group. It is a comprehensive 360 degrees plan to jump start the recovery and fast track increase of performance in all fields of the German P&L. It's an enabler to revisit all fields that impact performance both at the top line and at the bottom line level. With weekly steering of performance, we recovered the pricing gap from last year, year '23. And we are now setting up a safe ground for higher prices, renegotiation in '24 by pricing better our services by invoicing for the actual quality of services. This is what we call, like Nicolas said before, fair pricing, which means invoicing at the right level, what we do to recover our margins. We are also aiming through the TRAFO program to achieve significant cost reductions through better CapEx control, a new approach to procurement costs and a significant reduction in overhead costs. In parallel, we revisited our rents base with my friend and colleague, Frédéric, to renegotiate and directly impact the regulated prices negotiation since in Germany, the rents are included most of the case in the overall regulated prices. Finally, we revisited our assets portfolio in Germany, targeting the exit of 10% approximately of the sites, those that are particularly underperforming. So thanks to this program TRAFO, we are, therefore, today on the way to improve drastically our results in Germany, including a renewed cash generation for the company. Through this TRAFO program, we are also preparing a sound basis for further growth in Germany, leveraging fully our renovated asset base. If we now look forward to the future from years '24 to '26, we expect to grow at a compound annual rate of approximately 7% and restore margins to normative levels. Our strategy to grow profitable revenue includes maintaining high occupancy rate up to 95% to meet the growing demand, while in parallel, exiting the low performing sites. We will be continuously adjusting our pricing models to sustainably reflect the value of care and real estate costs to substantially and sustainably increase our margins. In parallel, we will continue to expand nonregulated revenue streams, such as comfort rooms or elective services and push for further digitalization across all core processes. These steps are part of a broader initiative to establish a ultra lean organizational structure and implement new care models in Germany, particularly in ambulatory services to better serve the strongly dispersed German health environment. So in conclusion, our plan and transformational initiatives position Korian Germany to navigate current challenges and accelerate our recovery by capitalizing on emerging opportunities. We are quite confident today that we are on the right path to long-term recovery and determined to restore Germany's strong margin contribution to the Clariane community. Thank you very much for your attention. And I hand over to my colleague, Dominiek Beelen for Belgium and the Netherlands.

Good afternoon, everyone, and welcome to the lowlands of Belgium and the Netherlands. I'm Dominiek Beelen. I'm head of the Benelux platform. End of '23, we represent 16% of group revenue with Belgium being the largest country since it was founded in 2005 as opposed to the Dutch market where we entered only since 2019. The good news here is that despite some headwinds in political and public opinion as to the role and the impact of private operators. In fact, everyone understands that private initiative will be indispensable to meet the future challenges. We face solid growth expectations in both countries. And we have a long-term care spend amongst the highest of Europe, especially in the Netherlands where the system has always been in favor for chronic disease and prevention. In both countries, the expected increase in elderly care homes is set at around 20% by 2030. However, I should say that the structure and the dynamics in both countries do differ. In the Netherlands, privately operated elderly care homes, mostly in small scale and the more luxury setting, they are quite recent. In fact, they only developed since 2010. Government is really supporting this kind of activity since it brings an affordable alternative for the waiting list of more than 20,000 elderly people and also as an alternative for the intramural traditional elderly care homes, where government not only financially supports care, but also the real estate and the living dimensions. Since 2010, the government support largely home care solutions and our extramural care pillars are considered as clustered home care. So the expected growth by 2030 will mainly come from this home care or clustered home care settings, leading to probably 25% of the global market being operated by private operators by the end of 2030. In Belgium, on the other hand, the elderly care sector is split 1/3 public, 1/3 charity and 1/3 private. And new licenses have been frozen since 2012, all strongly limited up until 2026 in Flanders for new greenfields, new developments. We are now waiting for a new licensing calendar for 2027 onwards, which is expected before summer. This to support the needed 18,000 additional units. We have a solid position in both countries with approximately 9% of the global elderly care sector in Belgium and in the Netherlands, approximately 10% of the private part of the global sector. Unfortunately, Clariane's strategy of diversification is not so easy to accomplish, due to, on one hand, regulations, mainly in Belgium, and on the other hand, low-margin activities such as the pure home-based services in the Netherlands. Nevertheless, we will be further developing regional home care activities in the surrounding of our existing nursing homes or service residences as a complementary service to our core activity. Since 2019, we moved towards integrated Belgium and Dutch shared platform for back office and supporting functions such as ICT, legal, finance, real estate and quite recently, also data management. We are currently developing our university platform. And also, we are mutualizing the training modules and the onboarding processes for new staff over both countries. We started to implement operational best practices in both countries by implementing the Dutch small scale personalized care approach into the larger Belgian facilities and by opening 5 new integrated care campuses in the Netherlands since 2021. Our historical Belgium M&A and growth culture led to the opening of 12 new facilities since 2022, representing 23% of organic growth in the Netherlands. As to our strategy for the upcoming years, it also differs in both countries. Since Belgium is quite consolidated and we already have a large market position, in the Netherlands, we primarily want to grow our market position, which is currently only 1% of the global market. In Belgium, we are currently closing the loop on the Brussels restructuring -- on the restructuring of the Brussels network that suffered a lot since COVID and where we are consolidating our presence and our performance by the end of 2024. Secondly, we are also optimizing our portfolio by closing 6 older facilities all to be replaced by new ones and with the opening of 4 new greenfields in the upcoming 2 years. We are waiting for the announcement of the new licensing calendar for 2027 onwards. But also here, we have already 3 grand positions in scope for the next years. Occupancy has evolved well in Flanders and Wallonia after COVID with a targeted occupancy rate of 97% by the end of 2027, which would mean an increase of 5% compared to '23. It is our aim to develop our existing home care activities, currently 5% of the revenue and also our pharmacy -- internal pharmacy activities within as well as outside our own perimeter. Furthermore, diversification can come from our candidacy to the public tender for 2 forensic psychiatric centers to be realized by 2027 in Wallonia, totaling 500 patients. In the Netherlands, on the other hand, we face exceptional opportunities in our organic growth by maturing the existing network towards an occupancy rate of 90%, where currently, it's only at 80%. We opened 3 new facilities in '24. We secured 3 new facilities in '25, and we have an active pipeline of potentially 30 new greenfields for 2026 onwards. We're also confident that we can achieve new M&A bolt-ons in the midterm. So we strongly believe there is the opportunity to double, even triple our current market position in the Netherlands for the upcoming 5 years. Besides this growth in our core activity, we aim beyond the business plan to deploy our experience in public-private projects in Belgium, also in the Netherlands towards the traditional intramural care operators. Further diversification can come from subcontracted management services, that can be provided in the high-growth segment of elderly service residences and also by deploying the home care activities and the surrounding of our existing network. We are currently well on track to grow in both countries combined with a budgeted revenue CAGR of 8% in the upcoming 3 years. Let me end by saying that we're expressing our proudness being part of Clariane since 2014 and also with what we have achieved together, despite what the future may bring us. So I thank you for your attention, and I pass the floor to my dear colleague, Frederico.

Thank you, Dominiek. Good afternoon, everyone. It's -- I'm Federico Guidoni, CEO of Italy. And of course, let me say that it's a pleasure to be here today to represent the Italian network of Clariane and give you, of course, some detail about the context in which we are operating about our group plan and as well answer any questions you may have. When we look at Italy, what matter is to understand that Clariane can today boost best-in-class diversified network that is perfectly [indiscernible] to capture evolving opportunities in the market. And looking at the market, it is extremely important to understand the context in which we move and we will move in the forthcoming years. You can see on the left of the slide, the growth in the other population with the rapid rise also in Italy as in the rest of Europe, by 2028 in the share of the -- over 75 years old and especially those who are no longer autonomous. Their growing needs will be complemented by significant increase in chronic disease as well as outlined in the blue table, and most of them with at least more than 2 chronic disease. On the other hand, because of the considerable debt concern in Italy, public resources dedicated to the health care are expected to decrease as a percentage of the GDP. These 2 macro trends, the demographic one on one side and the finance ones on the others are already generating a significant growth in the out-of-pocket and private insurance spending. This is a movement that is already underway. And by the end of 2025, there will be over 21 millions of Italians covered by health insurances, which for some years has also been included in collective labor agreement. That's up from EUR 11 million in 2016. The Italian network, which represent today, the around 12% of the overall volume of Clariane's activities is preferably [ positioned ] today and prepared to leverage those changes. First of all, this is -- thanks to the diversification of services that we have built in the recent year. Indeed, we are the only group in Italy that covers needs from prevention to care up to the end of life. With a strong balance between pure and complex health care activity and social care activities to simplify the bid between clinic and ambulatory on one side and nursing home on the other between specialized specialty care and long-term care. As you can see in the chart below, with the split of 2023 revenue result. This diversification has also allowed us to manage over the 0.5 million of patients every year, and this is an extra asset in our hands, thinks that it is double than all the patients managed by the rest of the group in Europe. So between growing needs, scarce resources, a new form of financing, we have structured the perfect network to be successful in this context. So looking at the private health opportunity, which is well represented in this slide. We expected out-of-pocket health expenditure to grow faster over the next 3 years, with additional EUR 9 billion, sorry, of spending from 2024 to 2026. As you can see on the left of the slide, both in absolute amount and as a percentage of the GDP, while the public spending, as I said before, is going to decrease from the 7.5% that was in 2020 to 6.2% in 2026, being one of the lowest rate in Europe. The growth of the private market will be driven by some of the outpatient activity like ophthalmology, dental, dermatology and all the diagnostic checks and follow-up. So moving away from the hospital environment and from the public area to the private patients. In this case, the key to success here is to have already moved ahead with agreement with over 50 insurance company of various kind at a national level. And we will complement this partnership with agreements and with local company and the factories in industry that are located near to our facility, fully aligned with our CSR commitment also. All in all, we expect to see a clear uptick in the private share of our activities that now stands at around 39%. This evolution will be driven by specialty care network and by clinics, diagnostic and surgical activities. These ambitions is supported by our performance of the last 2 years, marked by a growth of 19% in 2022 and 20% in 2023. So let me conclude with some ambitions regarding our plan for the coming years. As you may know, the Italian network and the elderly care segment returned to its full potential last year in the summer 2023. And today, we stand at an average occupancy rate above 97%. Nevertheless, we have targeted to be over 98% by 2028. And of course, we have planned a regular adjustment of prices aligned with the expected inflation. We need also to take into account that this increase will be valid in Italy only in those regions where we have the possibility of raising the price since in Italy, this is not possible everywhere. Another key element of growth will be the development of new care solution financed by out-of-pocket and covered by insurance. In surgery, it will mean focusing on robotic assisted need, orthopedical surgery, spine surgery, urological areas and ophthalmology. On the neurorehabilitation front, we will focus on Parkinson's disease, ALS, Alzheimer and dementia centers. Finally, the third level for growth will be the automatization and digitalization of processes, which are key for the business model evolution. And in this field, we have many strategic projects underway, such as the complete digitalization of the medical rate, as [indiscernible] mentioned before, that is already reality in our nursing home network, and it will be soon reality also in the health care market. And this will considerably facilitate the customer channel between our service and as a consequence of that, it will boost the activities again. In addition, automatization of the cost fees and administrative processes are underway and will continue to enable us to optimize staffing and execution times, which is key in the fast world in which we are living. Finally, some game-changing innovation. And to give you a concrete example of what we are doing, I'd like to record this [indiscernible] which is a game changer in the way we work in the long term care center, with optimization of resources, improvement of quality as well as a reduction of risk, reduction of cost in terms of materials, cleaning and laundry, already tested in 2 nursing home in Italy. And as soon as possible, it will deploy it throughout the full network. These 3 levers are key to ensure a growth rate between 2% and 3%. As forecast in the plan, full organic and without any public budget increase. And this is, let me say, a good result for a mature network in a market where pricing is strictly controlled and blocked even for years by the authority. Thank you, and I hand over to Charles-Antoine Pinel.

Thank you, Federico. Good afternoon, everyone. My name is Charles-Antoine Pinel, and I am in charge of Spain and Business Development for group level. So I'm very pleased to provide you today an update on Clariane's strategic initiative and achievement within the Spanish market. So our dedication and strategic positioning have enabled us in 4 years to establish a robust and fast-growing platform. Firstly, with a comprehensive network deployment. In 4 years, Clariane has successfully established a network of 150 centers in the 15 region of Spain out of 17, and support already over 128,000 patients and residents. This platform reflects our high level of expertise and quality as evidenced by one of the highest Net Promoter Score and [ PAS ] within the group, with 58, 1 point below Federico and Italian teams, but Spanish teams are really focused on that. Secondly, by turning to focused Specialty Care leadership. Specialty Care activities represent 80% of our revenue in Spain, with our recognized brands ITA and Grupo Cinco, positioning Clariane as a market leader in this segment. As you can see in the graph on the left, the demand for mental health services in Spain is anticipated to increase by 20% until 2030. Last but not least, our elderly care services under the Seniors brand. We have a significant footprint with 21 facilities and today, with an occupancy rate of 90%, and we are ready for further growth anticipating a demand surge, as we saw before in the introduction of 150,000 new beds by 2030. Let's say now a few words on our most recent acquisition, Grupo Cinco. Grupo Cinco with its successful track record illustrates perfectly the organic growth road map we are putting in place. It operates in our 6 men activities with minimal competitive pressure using a platform focused on public contracts and stringent cost control. It's an operating model that has enabled Grupo Cinco to double its revenue in the last 4 years, and it has the capacity to double again through the new public tenders. And you can see on this slide, on the left, our activities breakdown is relevant and in line with the market demand on the recent tenders on the left -- on the right, sorry. And this amounts to EUR 1.4 billion in 2023. And we have potential growth areas on elderly care, which represents 51% of the total amount of the tenders in leveraging the well-established reputation of our Seniors brand, but also in mental disability care in [indiscernible] Grupo Cinco deep expertise through market expansion. Finally, the next chapter for us is clearly driven by our asset-light development model. Our approach is a mix of owned and managed center. Typically, these management contracts span an initial 2 years period with an option for a subsequent 2-year extension. The management contract model ensures positive EBITDA from the first month of operation. So no ramp-up phase. And the EBITDA generated is around 10% to 12%. And currently, roughly 40% of our revenue is coming from public contracts, and we anticipate increasing this share to 50% in the upcoming years. So all in all, for the period of this midterm plan, we expect revenue CAGR above 15% in Spain, of which 3/4 should be generated via management contracts. So let me conclude. Clariane is perfectly positioned to capitalize on growth opportunities within the Spanish market, leveraging our brand expertise and quality and focusing on asset-light model and robust public private partnerships to enhance our market leadership and financial performance. So thank you for your attention, and I hand over to my colleague, Philippe Garin.

Good afternoon, everyone. So I am Philippe Garin, CFO of the group. Today, I will be presenting to you the status of our refinancing plan, and we'll be sharing the main financial KPIs for the period. I begin with the rapid -- no, it's not this one, sorry. I begin with a rapid overview of our financing plan. As you know, we have designed a 4-step refinancing plan to bolster client liquidity and strengthen our financial structure. The first 2 steps have been completed end of '23, with the help of Crédit Agricole Group. We have moved ahead with our EUR 230 million real estate equity partnership. And we have secured EUR 200 million in a bridge in real estate debt. On the right, you can see the 2 ongoing steps of the EUR 328 million capital increase that we announced last week. And finally, our asset disposal program, we have already secured around 40% of our targeted EUR 1 billion in asset disposal. These steps correspond to the EUR 1.5 billion refinancing plan announced in November. I'd like to focus on the detail of the underwritten capital increase of EUR 328 million that we announced last Friday. It's a 2-step process that has been approved by the board and will be proposed to the General Meeting of Shareholders on the 10th of June. The operation is composed of EUR 92.1 million reserve capital increase to be proposed to the General Assembly at a price of EUR 2.6. EUR 236 million preferential subscription right capital increase fully secured with the commitment from key shareholders. You have here the shareholding rate of each main shareholder before and after the operation. Bearing in mind that in all instances, no shareholder will have a final share above 29.9%. Looking now at our disposal plan. Our approach is guided by the twin objective of reducing the number of geographies and maximizing the deleveraging impact. We only proceed with a disposal when a satisfactory level of valuations obtained and if it is provided -- and if it provides, sorry, a substantial deleveraging effect of the group balance sheet. We have multiple options such as WholeCo [indiscernible] we did in the U.K. PropCo such as it was in Netherlands or simply noncore activity with any way of focus on reducing the number of geographies. The aim is deleveraging to ensure refinancing capability and achieve an OpCo leverage ratio below 3x end of '25. Before we move to our financial outlook for the period, a quick word on our assumption, the outlook numbers we present to you are all post disposal. As we wanted our KPIs to remain valid across all potential disposal scenarios, some of our outlook numbers are those ranges. This means that all ranges for '23, '26 outlook will remain valid regardless of final scenario pursued by the group. If we turn to our revenue growth for the period, 3 key elements come into play. As Sophie pointed out, we are at the beginning of a large increase in demand. Occupancy rate should continue to rise across almost all group geographies. This will be coupled to significant growth in outpatient entries. The good news is that our network is modernized with available capacity in residential facility and in our existing clinic network to welcome this increase in new patient. And finally, we have also considerably moved forward with the development of bespoke offering that correspond to the changing need and desire of this patient. These shared dynamics across all segments led us to expectation of an organic compound annual growth rate of around 5% for the payer. Our strategy for margin improvement is also quite simple. It's [indiscernible] clearly identifies levers, 3 of which will be driven by margin accredited volume, and 2 by increased cost absorption. Indeed, on the accretive margin side, we expect the increase in occupancy rate, the expansion in outpatient services as the German recovery plan that [indiscernible] to all provide positive tailwind to our margin. On the cost side, margin gain will come from the Trafo plan in Germany once again, and from performance plan initiatives such as optimizing round contract and reducing energy consumption. All in all, this led us to a 100 to 150 basis point increase in our EBITDA margin by '26. So next slide show how our bottom line profitability should improve. I have just pointed out that we are projecting, sorry, an increase in our EBITDA margin by 100 to 150 basis points by the year '26. We have faced some nonrecurrent expense due to restructuring efforts and the cost associated to our refinancing plan. From now, we anticipate a decrease in this field despite remaining [indiscernible] in Germany. In terms of D&A, we expect to see the level of stabilized due to the reduction in CapEx. As you know, CICE has already started and should continue over the period. Finally, net debt should be reduced by approximately 1/3, and this will result in reduced interest expense in '26 despite the increase in interest rates. On this basis, we expect a progressive improvement in our net result. But I remind that in line with our financing agreement, no dividend payment are allowed, while the group financial leverage is above 3x. Turning to our operational free cash flow. We will be ensuring strict discipline in managing our working capital, boosting our EBITDA conversion rate to around 40%, keeping around EUR 100 million of maintenance CapEx. Over the period, we expect to allocate approximately EUR 100 million to EUR 150 million toward high-value digitalization and network modernization project further allocation up to EUR 50 million in residual earn-out and equity injections, mainly in our real estate vehicle with [indiscernible]. This disciplined investment strategy will contribute to a positive net free cash flow over the period. Now on the debt front. We have here the main metrics involved. Post refinancing, our total net debt is projected to be cut from a pro forma EUR 4.1 billion before the financing plan to between EUR 2.7 billion and EUR 3 billion in '26. On the real estate front, our debt is expected at EUR 1.4 billion by '26, which will also reduce our LTV ratio to a normalized 55%. This take into account a much lower real estate valuation with a higher capitalization rate of around 6.7% in '26. From an OpCo perspective, we are looking for a reduction in debt to between EUR 1.3 billion and EUR 1.6 billion depending on the call of the British pound hybrid loans, sorry. Regardless of what we determined to do with the hybrid, our leverage will be anyway below 3x. Finally, to conclude on our outlook for '24 and '23 to '26. As you know, our '24 guidance remained unchanged. Looking at our growth trajectory, we anticipate organic revenue to grow at a compound annual growth rate of about around 5% for the period '23 to '26. During this period, we aim to improve our EBITDA margin increasing by between 100 to 150 basis point. And we commit to reduce operational leverage below 3x by the end of '25 this time with LTV at 55%. In terms of our corporate social responsibility, [indiscernible] has outlined our clear KPIs in terms of qualifying pass, NPS, frequency rate and endeavoring our [indiscernible] based target initiative SBTi. This concludes my presentation. I will now hand back to Sophie for the last chapter of our presentation. Thank you.

So thank you very much, Philippe and all the colleagues that have presented. Maybe just one comment on the outlook that Philippe just presented. Let's make it very clear. This is all subject to the vote that is requested from our General Shareholder Meeting on the 10th of June on the final structure of the execution of the capital increase. Of course, as we say in France, [Foreign Language]. So I really want to outline this, the overall guidance is very much based on the execution of the capital increase of the EUR 328 million that we are proposing to the -- to our shareholder in 2 weeks from now. So coming to my conclusion. And before we come to the Q&A session, I would like to leave you with this last slide that recaps actually. So if I -- yes, this is the last slide I wanted to show. It recaps actually the 4 key takeaways of the day and remind you what truly sets Clariane apart. First, we a leading European operator with a clear purpose, as you have heard from all the presentation, strong ESG credentials that are at the very heart of our strategy and leading position in well-structured and regulated European markets. We are balanced geographically with 3 complementary businesses well served by a synergic platform that we are permanently constantly reinforcing. The second takeaway is that our markets are growing sustainably, with private sector players becoming increasingly essential to meet growing care needs. This provide us, as a company, with a very strong long-term visibility despite the current volatile environment we are navigating. The third takeaway is that we have moved ahead at a rapid pace on our refinancing plan. And again, subject to the General Shareholder Meeting approval on the 10th of June, our ongoing shareholding structure provides us with a solid footing for our next steps. And the fourth and last takeaway is that our '23, '26 plan for sales finance profitable growth is both ambitious and realistic, supported by very clear operational drivers. So I would like to thank you all for your attention and interest in our very strong and nice client community. And I will now open the floor your question. Thank you very much.

So I see that we have already some questions coming from the people that are with us online, Sarah? I'll give you a little bit more time to reflect on your question here.

I'm sure there'll be lots of questions in a minute. On the webcast, we already have a few questions coming through. And the first one is, how do you expect the mental health segment to develop in the next few years? And what about ambulatory care, what developments do you see here?

Regarding mental health specifically, we have given an overall increase of health care activity from 4% to 6%. And when we focus on the [indiscernible] country, which should be more around 10% in Spain where clearly, we have a stronger growth and the opening of a number of new agency. And when in France, it would be on the low side, more around 4%, where we have mainly residential activity regarding Montalez in France.

And we are pretty cautious on the assumptions on the public budget, which is critical for France. That's the difference between Spain and France, for sure.

Laurent Gelebart from BNP Exane. On your return plan, you target different level of occupancy rates by 2027 or 2028. So France is 93%, Germany 95% and so on and so forth. Is it due to the fact that you are going to open capacity in some countries and not in others?

That's a very relevant question. Actually, if you look at the supply of the various markets, there are really different environment. Italy, for example, is definitely an undersupplied market, Federico, yes, I'm looking for Frederico. And this is why in Italy, we are navigating close to 100% occupancy everywhere. So I would say we are already at the very maximum. We can -- we have included a 1 percentage point of improvement that's really the maximum we can do there. The situation is different in Germany where actually also, there is an undersupply versus demand, but we are very much dependent from the undersupply on the care staff and very much relying on the [indiscernible], so the so-called [indiscernible] regulation, which is going to alleviate the constraint on producing assistant nurse to complement the nurse offering. So our assumptions in Germany are very much dependent from our ability to get more assistant nurses to complement the qualified nurses there. And this brings us to this 93%, '26, and we expect to be above 95% looking forward, more looking directionally to '28. And in France, definitely, the situation and the iGAS report is very -- is telling on that. There are local markets with very different underlying drivers. There are some regions such as Santander or there are some places where actually the offering is already too tight versus the needs. And there are a lot of areas where currently, and it will change by 2030. The offering locally is above the needs. So they are local markets and this brings us to this target of 93%, which actually is a mix of a region where we will be and we are already above 95% in region, especially the more urban ones, where we are navigating below 90%. And we try to do the best out of the local market situation and to make sure that we are actually, in some places, providing more respite stay. So short-term stays with a higher churn. And this is also reflected in a higher case mix management, and there are places where we are more with the long-term stays and navigating above 95%. So that's how we see the trends. And of course, we are constantly adapting the way we drive this.

David Cerdan from Kepler. I have a few questions regarding the recovery in Germany. What is the value of a cost of unprofitable or underperforming facility? Is it easy to close some underperforming facilities? And what is the risk related to the rents as you supposed to be engaged for several years? So do you have to compensate the facility owner?

That's actually a very good, very relevant question. The way we drive it actually is based on the facilities where we have early exit options. So coming to the end of the rental contracts. And this is where we arbitrate. So the 10% that have been presented by Remi are actually reflecting the sites where we see that we are short-term -- very close to the end of the rents, the contract end and that we already know that we are going to exit. So not ask for any renewal. Are there costs associated with the exit? Yes, they are. We have to make sure that our teams find new position. And of course, if we have neighboring facilities, we transfer them to those facilities. This is also the way we drive it. And we have to make sure that we give the sites the facility back in good shape. So this means that there are some 100 cases associated with that. This is fully reflected in the assumptions that have been shared with you. But in most of the case, we have very good facilities. We have to overcome the [indiscernible] effect Remi presented, and this is mainly through the renegotiation of regulated price, and we are very confident that we will manage in bridging the gap '24, '25. But it takes time.

There are a few questions, Sophie, Philippe coming through on the capital increases that we have been talking about and that could potentially happen. And the questions are often around the same themes, but the share price has evolved significantly over the last few days. How are we going to reconcile this with the price of the reserve capital increase? What are the risks that still lie ahead of us to execute the capital increases? And finally, what are the conditions of the rights issue? And will the price be lower than the reserve capital increase? So this is a question from Christophe-Raphael Ganet.

Thank you, Christophe. I guess there is a link between the investment and the current level of our stock. So we have taken the [ VMAX ] for the last few months. We have used many approach to find the right value, as you can -- we have not, the experts have done so. And at the end of the day, this value has been confirmed, the value given by the expert is slightly below the 2.6% as a reasonable value for this reserve capital increase. We will have -- first, you will have no deduction for the second capital increase. And this capital increase will allow any other shareholders to participate with a significant decrease of the value, probably between 40% and 50% as it has been announced. I've seen also some question regarding debt. You will find Page 69, the current profile of our debt. Of course, nothing to hide, but we don't have a lot of new item on this topic. The 2 next year, as you know, '24 and '25 are mainly with some real estate maturity and some [indiscernible] maturity. The dark blue on '24 is revolving factoring. So no clear maturity and the light blue in '25 includes a fair state bridge. In '26, for sure, we have a very significant maturity with the overall bank loan and RCF maturity. Regarding the cost of debt, it's still not very expensive because we are quite well hedged, but it is increasing. I don't have in mind the precise interest rate for '25. But regarding '24, we certainly be still below 3%.

And maybe one additional question, which is also coming from [indiscernible] is actually related to the risk associated with the capital increase. So very clearly, and this is why I have been very clear on that. The reserve capital increase is subject to approval of the shareholder meeting on the 10th of June. And this is a 66% of votes that are required to approve this reserve capital increase. [indiscernible] have already said that they would vote for the capital increase. And I think overall, this is securing the complete restructuring and refinancing plan for the company. So this is definitely quite of the framework.

There are a couple of other questions on the debt. One is how we expect to manage the hybrid GBP bond? And the other one is a question on the cash sweep or the obligatory reimbursements that we have in place with our syndicated facility, how do they work? And is it sweeping 100% of any proceeds of sales?

It is true that as long as we are above 3%, a significant part of the proceeds go to reimburse as the term loan as it is 75%. As soon as we are below 3%, this threshold is reduced to 1/3, which is quite different. We will see that in the months to come. And regarding [indiscernible]

If we may -- that there is a question on there, maybe updates on the disposal processes? Any color that you can provide notably on the Belgium and Netherlands process that has obviously has been mentioned.