Auna (NYSE:AUNA) reported stronger first-quarter revenue and cash flow across its regional healthcare platform, while adjusted EBITDA declined as the company absorbed revenue adjustments in Peru and higher payroll costs in Mexico and Colombia.
Executive Chairman and President Jesús Zamora said the company “got off to a good start in 2026,” citing commercial momentum in Mexico, expanded risk-sharing arrangements in Colombia and continued growth in Peru’s healthcare services and plan memberships. Auna reaffirmed its full-year revenue and adjusted EBITDA guidance, with management saying it expected growth to be weighted toward the second half of the year.
Consolidated revenue reached PEN 1.2 billion in the quarter, up 10% year over year on an FX-neutral basis. Adjusted EBITDA declined 5% on the same basis, and margin contracted by 2.9 percentage points. Zamora attributed the decline primarily to “revenue adjustments and certain payroll increases.”
Cash flow improves despite EBITDA pressure
Chief Financial Officer Gisele Remy said Auna’s operating profit increased 11% to PEN 155 million, but that the gain was more than offset by non-cash foreign exchange losses tied to depreciation of the Peruvian sol below the protective range of the company’s hedging structure.
Free cash flow increased 2.6 times from the prior-year quarter to PEN 152 million, supported by a 45% increase in pre-tax operating cash flow, working capital management and supplier financing initiatives. Auna’s cash position rose 22% to PEN 409 million.
The company ended the quarter with a leverage ratio of 3.7 times. Remy said the increase was primarily due to non-cash FX effects. She also said Auna has generated about $8 million in annualized interest and tax payment efficiencies following last year’s refinancing, while reducing short-term debt by 40% compared with the third quarter of 2025.
At quarter-end, 55% of Auna’s debt was denominated in local currency, and 85% of its U.S. dollar-denominated debt was hedged to the Peruvian sol. The company also had about $175 million in revolving credit facilities, of which approximately $66 million had been drawn.
Mexico rebounds on volumes, payer changes and ISSSTELEON contract
Auna’s Mexico operations posted an 8% increase in revenue, driven by higher service volumes, stronger utilization and growth in higher-complexity services, particularly surgery and oncology. Remy said surgery volumes increased 15% sequentially and oncology volumes rose 32% sequentially.
Zamora said the recovery was supported by Auna’s preferred provider status with two major payers at Doctors Hospital, improved economics under a renegotiated ISSSTELEON contract, expanded B2B service packages and growth in out-of-pocket services.
Adjusted EBITDA in Mexico increased 19% compared with the fourth quarter of 2025 and rose 23% year over year. Management said margins improved by 3.5 percentage points sequentially. In response to an analyst question, Remy said Mexico’s margin recovery should come from both operating leverage and variable cost efficiencies as volumes and occupancies rise. She said the company continues to view 30% as a structural margin level for Mexico over time.
Zamora said oncology is a scale business and that chemotherapy and radiotherapy volumes should support future margin improvement. He also said Auna expects to bring a new radiotherapy facility and equipment online in Monterrey in about a month and a half.
Peru growth offset by revenue adjustments
In Peru, revenue increased 9%, supported by growth in healthcare services and Oncosalud plan memberships. Healthcare services revenue rose 7%, while Oncosalud revenue grew 12%, driven by annual price increases and B2B membership growth. Zamora said the company secured a new group policy covering 20,000 employees of the nation’s judiciary.
Healthcare plan memberships in Peru increased 6%, and oncology plans rose 3%. The oncology medical loss ratio remained below 50%, within the company’s expected range.
Adjusted EBITDA in Peru fell 3%, with margin contracting by 2.3 percentage points. Management attributed the decline to revenue adjustments related to payer reconciliation penalties, delayed rebate recognition and higher doctor compensation. Zamora said that excluding the revenue adjustments, Peru’s adjusted EBITDA would have increased 7%.
Remy said the revenue adjustments were tied to penalties applied by some insurance payers related to billing timelines and certain settlement agreements under negotiation. She said Auna has reduced its internal billing cycle materially over the past 12 months and expects that work to help mitigate the impact in coming quarters. On delayed pharmaceutical rebates, Remy said the rebates “have not been lost” but were delayed into the remainder of the year.
Colombia grows as payer mix shifts
Auna’s Colombia revenue rose 13% in the quarter as the company reduced reliance on intervened payers and expanded risk-sharing agreements. Revenue from risk-sharing arrangements increased to 21% of Colombia revenue, up 6 percentage points from the prior year. Revenue from intervened payers fell to 14% from 19%, while revenue from new payers increased 1.5 times and represented 12% of total revenue.
Adjusted EBITDA in Colombia increased 7%, while margin declined by 1.7 percentage points. Zamora said the lower margin reflected a higher proportion of risk-sharing contracts and increased variable costs associated with higher volumes in high-complexity care.
During the question-and-answer session, Zamora said Auna’s risk-sharing contracts bring greater revenue and cash flow predictability, although they can create an initial margin impact. He said the company expects margins to improve as it optimizes clinical pathways and scales covered populations. Remy added that Colombia typically has lower margins in the first quarter and said margins should be stable compared with levels seen in the second half of last year.
Management reaffirms outlook and discusses capital allocation
Zamora said Auna is reaffirming its annual revenue and adjusted EBITDA guidance because of improving trends in all three markets. He said the guidance had always assumed a softer first half and stronger second half of 2026, with Mexico improving, Peru normalizing and Colombia continuing to grow.
On capital allocation, Zamora said Auna’s board continues to discuss the best use of cash, including the possibility of a buyback program, but that no decision has been made.
Management also discussed the Torre Trecca project in Peru. Zamora said Auna had made substantial progress on designs and definitions, and that the construction consortium had been, or would be, awarded during the week of the call. He said construction would begin immediately and described the project as a 24-month construction process, though he said the company believes it could be completed in 18 to 24 months.
In closing remarks, Zamora acknowledged that items such as the Peru revenue reconciliations can surprise investors and said Auna intends to make its story “much simpler to digest.” He added that the company’s underlying business is growing and that management expects to scale operations and improve margins.
About Auna (NYSE:AUNA)
Auna, listed on the New York Stock Exchange under the ticker symbol AUNA, is a Peruvian integrated healthcare services company headquartered in Lima. The firm operates a diversified care network that spans hospitals, outpatient medical centers, diagnostic imaging and laboratory facilities, as well as optical and dental clinics. Auna's organizational structure is designed to support a continuum of care model, offering both general and specialized treatments across multiple touchpoints.
The company delivers a broad range of clinical services, including emergency care, inpatient and outpatient surgery, obstetrics, cardiology, oncology, orthopedics, and other specialized disciplines.
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