Ladies and gentlemen, thank you for standing by. My name is Emma, your Chorus Call operator. Welcome, and thank you for joining the Fresenius Medical Care Expert Call on Sustainability and Person-Centered Care. Throughout today's recorded presentation, all participants will be in a listen-only mode. The presentation will be followed by a Q&A session. If you'd like to ask a question, you may press star followed by one on your telephone keypad. Please press the star key followed by zero for operator assistance. I would now like to turn the conference over to Dominik, Head of Investor Relations. Please go ahead, sir. Thank you, Emma. We would like to welcome all of you to the Fresenius Medical Care Expert Call Series 2021 with Sustainability and Person-Centered Care. We appreciate you joining today. As always, I have to, and I'm happy to start out the event by mentioning our cautionary language that is in our safe harbor statement on slide two of the sustainability and person-centered care presentation. For further details concerning risks and uncertainties, please refer to this document as well as to our SEC filing. At Fresenius Medical Care, we are driven by our person-centered mission to provide holistic care for patients with kidney disease around the world. I'm pleased that we can give you deeper insight into our sustainability journey as a company, as well as how we are addressing global healthcare challenges while improving patient experience and care. I'm delighted to have Dr. Frank Maddux, our Global Chief Medical Officer, and Charlotte Stange. Furthermore, I would like to ask you for your kind understanding that we will not answer questions about COVID-19 situation, vaccination rates, excess mortality. Please, let's focus on the topic we are presenting today. We'll give an update on those topics with our Q4 results in February. I will now hand over to Charlotte to begin the presentation. The floor is yours. Thank you, Dominik. It is my pleasure to start with an update on how we drive integration of sustainability into our business around the world. Our actions are driven by our vision to create a future worth living for patients worldwide and every single day. Consequently, also our sustainability efforts focus on activities that support this mission for the long term. Putting our patients at the center of what we do has been our guiding principle since day one. This year we celebrate 25 years of Fresenius Medical Care, and while doing that, we also had a look at how we have come with our sustainability efforts and where we're heading. Turning to slide 4. Let's have a look at the strategic framework. Our approach to sustainability has developed into a broad global agenda. We are implementing a global sustainability program over three years to ramp up the integration of sustainability in our business worldwide. Here we have identified eight key sustainability focus areas, and our dedication to patients is on the top of that list. We measure how we're doing with a scoring model that evaluates more than 50 aspects. Also, we have implemented a global governance for sustainability, and as head of the company's Sustainability Decision Board, our CEO takes direct responsibility for the program and also for its progress. Also, the role of Lead Independent Director in our Supervisory Board is strengthening corporate governance in line with best practice. Here, since the launch of our global sustainability program last year, we have made significant progress, and we're happy to share some insights here today. We have defined some global sustainability standards for a number of areas, and we have also agreed on key performance indicators that measure success. We have also developed some global ESG goals, and we will also continue to do so going forward. Also, we have invested in global systems to measure our footprint even better because only then can we build on decisions, that are based on reliable data, and it helps us to identify areas for improvement and drive us to do so. We have also increased our disclosure along this road. You might have seen our publication on the GRI standards, on the SASB standards, and also on the recommendation from the task force on climate-related financial disclosures. Moving on to slide 5. Why do we have a global sustainability transformation program? Coming from a decentralized business model, it is key for us to build a solid foundation for managing our sustainability performance globally. That's why we are defining global ESG standards and quantify our progress on the sustainability program. We harmonize processes, and we also want to measure our impact most efficiently, and we also want to drive knowledge sharing and also best practice sharing among our colleagues around the world. This will be the solid base to have a global sustainability management that is integrated in the line after the completion of our sustainability program at the end of next year. Turning to slide six, please. Part of our sustainability journey is to strive for continuous improvement. To help us achieve this ambition, we establish qualitative and quantitative targets. We use these targets to measure how we're doing, and this also includes measurements which represent our commitment to deliver safe and high-quality care to a growing number of patients. Here on this slide, you can see that we continuously monitor and analyze the performance of our products and services. As a result of our global sustainability program, we can now measure, for example, the satisfaction of our patients with our services on a globally harmonized level. We also have defined key performance indicators that help us monitor our quality objectives. Here we disclose the audit score, which measures the performance in certification audits. It indicates the ratio between major and critical findings to the number of external audits. Part of our dedication to increase choices for patients is also our goal to increase the share of patients on home dialysis. Turning to slide 7. Here on this slide, you can see some key achievements in sustainability focus areas over the past couple of years. You see, next to quality of care and quality of products, providing excellent health care for us has many more aspects. We regularly collect feedback of our employees, for example, to increase engagement and evaluate their feedback. This year, 74% of our employees participated in our survey, which is an increase of six percentage points compared to last year. While our environmental footprint might not be that big as that of companies in other industries, it's still a key element of our sustainability agenda. To give you some examples, in 2020, more than 170 environmental initiatives were reported from our manufacturing sites around the world. They contribute to the reduction of greenhouse gas emissions on the use of water and also on waste management. Here, also the increasing digitization is important to have better data availability and to identify the biggest lever for improvement. When it comes to responsible business practices, we also put a focus on robust controls, and we are advancing our compliance program. Here we rely on our code of conduct and business ethics to make our employees aware of how they should interact with patients, with each other, with business partners, officials, and also with the broader public. One example of what we're looking at here is that more than 130,000 employees were enrolled in code of ethics trainings last year. We also did third-party assessments with more than 37,000 third parties. You'll see all of these sustainability aspects and more are important for us to be successful for the long term. They help us to increase our positive impact and also look at the biggest lever of sustainability there is for us, and that's addressing global healthcare challenges and providing the best possible care for a growing number of patients. For some deeper insights on this, I'm very pleased to hand over to our Chief Medical Officer, Dr. Frank Maddux. Charlotte, thank you for that. I think on slide eight, we recognize that our mission is, in fact, delivering health care in many, many diverse systems, and that the growing number of patients that require kidney-related care and advanced care continues to expand in both all sorts of different healthcare systems. If we can move on to slide nine, please. When we look at addressing global healthcare challenges, it's quite clear that our medical office global clinical and quality agenda that we develop annually is aligned with the United Nations Sustainable Development Goals and recognize that many of these aspects that you see on this slide are things that we deal with on a daily basis. The pressures within healthcare systems have many challenges to be overcome, some of which are global and some of which actually are translated quite locally. Next on slide ten. At this point, I think when we look at one component of our clinical and quality agenda, you recognize that our strategic initiatives are guided by these principles of creating sustainable healthcare systems in a variety of diverse environments, and recognizing that as we are committed to taking care of patients, we're highly aligned in how to improve healthcare delivery around the world through a continuous quality improvement framework, through recognizing that patient-reported outcomes and patients' experience of their care is critical to that, as well as the ability to, in fact, create not only access to healthcare, but continuous improvement in the level of that healthcare towards what some dynamic optimal degree of delivery occurs. We see that not only in the actions we do under our sustainability program, but in our relationship to the fields of medicine that we operate. Our clinical vision related to that is directly in line with these global strategic initiatives that support the education of patients, the education of healthcare providers in the collaborations that we do across the world. On to slide 11. When we look at our clinical agenda in detail, we have a variety of pillars that act as themes for the organization to pay attention to. Instead of strategically recognizing tactical elements here, we are really looking at those themes that we think need more attention, more conversation, more discussion, and ultimately more action. One of those key pillars has been person-centered care, recognizing that the ability within an organized framework of healthcare to understand the individuals that need that care and those people around them that are affected by that care gives us an opportunity to create the appropriate treatment for an individual patient at the appropriate time. Key partnerships and collaborations that we have are continually part of this, not the least of which is how we have evolved our look at patient-reported outcomes, symptom management, and the patient experience level. On to slide 12. If we look at how we're placing the patient and the person at the center of this care, it involves quite a few different systems that we have in place. All of this is around developing empowerment and choice for patients as they navigate their journey with a life-threatening disease and one that we can highly impact. Whether it's directly in coordination of their care with other healthcare providers, with their local environment and their family, that's involved, whether it's actually creating learning systems where they have the ability to be. have a higher understanding of the decisions that they make and the impact on their outcomes, or whether it's technology that begins to involve our, digital standards that give us a connected health environment, not only seeing them when they're right in front of us, but actually seeing them, when they're in their home environment. All of these are highlights of the kind of work that we're doing to enhance patient power and choice and to connect our sustainability goals related to patients to this person-centered approach that exists. If we can move to slide 13, please. One of the key things that we've evolved over the last several years has been the ability to get qualitative data from our patients. That qualitative data is frequently listening to their voice and recognizing that there are key performance indicators that allow us to support sort of more proactive management of the kinds of initiatives that will help patients and their families make good decisions. This feedback loop is part of the continuous quality improvement program, and it relates very highly to this performance agreement that we have with physicians and providers of care that we work with. There are three elements to that performance agreement. One, we recognize we need to measure ourselves on both quantitative and qualitative inputs on the care that's delivered. The second pillar of this performance agreement is that we look to identify where we have a best practice and how do we scale that best practice. The third is, if we are falling short in some area, we look at how to learn from that and don't accept that that's the best it can be. We have a belief that there's always room for improvement in these areas. When we look at the sustainability program and the patient pillar in this, we look at the quality of care and education, the excellence in service, and the ability to individualize that care, that all relates to the patient experience that we see in the measurements, whether they are through the patient survey, whether it's through looking at our Net Promoter Score or whether it's through other detailed practices that we've identified that need to be enhanced. If we can move to slide 14, please. Promoting access to healthcare is really critical around the world. Not all patients have access to healthcare for kidney disease today. The person-centered care approach that we have is educating and making treatments available, recognizing the economics, and trying to make sure that we are as cost-conscious and value-based in the way that we look at that, as well as making physical accessibility for all patients, patient groups, and recognizing that there are markets around the world that are underserved and populations and communities that still need to be reached. Our aspiration is not just to recognize that it's about the number of clinics or the number of markets, but to realize that as access to care becomes standard in a healthcare delivery system, we then begin to look at how do we offer greater choices in the treatment modalities, the journey that occurs, the affordability of that care, and the ability to look at, in different cultures and environments, the health equity component of this. As we educate people and we look at how they look at the journey of life that they will have with a chronic advanced disease, it recognizes that there are some areas that we want to promote in a larger way. Some examples of that include we have this target for giving people the option to do therapies outside of the traditional healthcare facility. Our home therapy targets have distinct opportunities for peritoneal dialysis, for home hemodialysis, and for making sure patients are educated and exposed to all of the available modalities that they may be able to participate in. We have a variety of technologies that help engage patients in that activity, and as an example, throughout the U.S., we have a PatientHub that provides an opportunity for patients to be engaged in and directly invested in understanding the level of care that they need at that time and the type of care that they have. In 21 countries in other parts of the world, we have what's called the myCompanion app. This application is for patients that also gives them an opportunity to recognize what are the health behaviors like exercise and movement and such things that can actually keep them in the best physical condition to take on the challenges of advanced kidney disease. Finally, as we've looked at themes in our annual medical report, I'll simply recognize that there are technologies that are evolving into our standards of care that include our ability to look at patients and be connected to them not only when they're on treatment, but also during times when they're in their own environment, and utilize that data to help us understand kidney disease, the progression of this disease, and the things that might impact it, going forward. We have active activities looking at the impact, and this is a highly topical topic, especially in the U.S., as there have been distinct discussions on the use of a race-based estimated GFR assessment and the issues around race, ethnicity, geography, and education become prominent. For us, these are all topics that we are actively discussing today and looking at how do we create an environment where we are actually looking at how we are bridging that gap, first identifying health equity challenges, and then secondarily, what are the things we can do to impact those and affect those. If we can go to slide 15, please. Medical education is a core component of the activities that we do, and our global initiatives to expand medical education have occurred not on just the provider level with regard to medical education of healthcare providers and nephrologists to make sure they're staying current with the standard of the science. There is lots of that going on as an example through our Advanced Renal Education Program, where this year there will have been more than 40,000 e-learning opportunities and over 13,000 live seminars and two large events that we have sponsored, like, the LIFE/2021 events that occurred earlier this year. We've educated more than 55,000 youth in our Kidney Kids program in trying to understand the impact that kidney disease has on their life if they make wise or unwise health choices as they're growing up, and recognizing that our direct patients that are referred to us for care, there's a tremendous amount of education to try to work with those individuals to make sure that they understand the impact of the choices that they make in their life. This year, we recognized that we had a gap in our ability to participate more actively in the conversations related to the journey in kidney disease for patients with regard to using transplantation as their method of kidney replacement therapy. We added a Global Head of Transplant Medicine who is very well known within the transplant community to both educate ourselves and raise the questions of how we can become more relevant in understanding the components of transplant and the issues of transplant that need to be improved in the course of our healthcare delivery. This is one of several areas where we think our quality performance and quality improvement model recognizes the full renal care continuum, as Charlotte described it, earlier in that prior slide. Turning to slide 16. At this point, I would simply say our global management of quality performances is looking at several primary themes. It's looking at not only the traditional measures of quality of care that are typical physiologic measures we've had for patients with end-stage kidney disease on a particular dialysis treatment. It also includes the recognition that there are lots of issues related to access to care around the world where we want to make sure that we are promoting smart policy decisions around the world to try to recognize the health equity deficits that occur around the world and how we might be able to make more care available and affordable, as well as recognizing that the patient experience and their opportunity to grow in their choices and the power that they have to understand what is the experience that they'll have in interacting with us are quite important. These are topics that we're still maturing into, and this sustainability program that Charlotte described is a key component to focusing our attention on many of the aspects that I've just discussed that I think we have made tremendous progress in, but still have, a long way to go on that journey, in my opinion. We're looking continually to improve and to highlight both our improvement and our achievement of these results as we look at a balanced perspective of how kidney disease is cared for throughout the world, and we perceive our role as leaders in that particular care. With that, I'll conclude my remarks and turn it back over to you, Dominik, for our Q&A session. Thank you, Charlotte. Thank you, Frank, for the great presentation. I think this was very comprehensive, insightful, and also detailed. I'll hand it over to Emma to see if we have any questions. Thank you. Ladies and gentlemen, if you'd like to ask a question, you may press star followed by one on your touch-tone telephone. If you wish to remove yourself from the question queue, you may press star followed by two. Anyone who has a question may press star followed by one at this time. The first question comes from the line of Oliver Metzger with ODDO. Please go ahead. Oh, hi. Good afternoon and good morning. One question is, I'll jump in later, but on the medical education, where it's clearly a great initiative, and I think it should have some interesting side effects as basically many patients of CKD are not aware of their disease. It's more about also it's not an immediate financial question, but what's your guess how much education among population is needed that at the end CKD might be identified earlier? If this is the case, it should lead to a bigger market initially for PD. Can you share with us your views how the underlying, let's say, market for U.S. dialysis provider could be expanded if this education translates to a higher awareness? Thank you. Yeah. I'll take that question, Oliver. Thank you. It's chronic kidney disease is certainly part of this continuum that depending upon the source of the injury to the kidney can be identified relatively early. It's frequently identified in the general healthcare population. Part of the education that occurs and is occurring is identification of instances of kidney disease that need attention and thought at an earlier stage. The opportunity within the value-based care environment is quite great to try to have impact on the recognition that CKD is so highly associated with cardiovascular disease that the earlier you identify it, the greater your opportunities are to protect the heart as the kidney disease progresses at whatever rate it will progress based on the underlying disease. I think the pool of patients with CKD is as heavily influenced by the progression of chronic kidney disease. It's as influenced by the progression of cardiac disease as it is by the progression of the chronic kidney disease as to the number of patients that will progress. Our belief is that we have to insert ourselves at an earlier stage, especially in our value-based care arrangements, to recognize that the more we can in fact begin to connect and work with patients at an earlier stage, the better opportunity we have to keep their hearts healthy, to keep them healthy and help them make good decisions as their journey will continue. Because once you have chronic kidney disease, there are relatively few instances where it just completely goes away. It almost always has a progressive nature, and that progression can be delayed and slowed by certain actions. It certainly is one of the things that I think we have a responsibility to participate actively in. The education of our general healthcare providers to the need for identification of early-stage kidney disease, the opportunities to treat that at various stages and the ability, if there is progressive disease, to adequately prepare for those choices that patients have that will certainly help drive the adoption of home therapies and therapies that patients may need as a key part of their therapy, as well as the opportunities for people to be good candidates for transplant. I think it's an important question, and I think that the population remains quite large that has CKD, and that population has continued to grow both in the U.S. and certainly outside the U.S. Okay. Thank you for this answer. One follow-up. Is education already part of some value-based plans or ideas, or do you expect that to come in future? No, it's already part of the plans. There's quite a bit of work that is done both through our medical office, our operational teams, and certainly our value-based care teams to work with the physicians that we see in practice to both identify patients that have CKD and with that identification to begin to look at how they are educated so that they become well prepared as their CKD progresses. Our whether we are doing it through written communications, live events through webinars, live events in person when we've had the opportunity to do that in the past or broadcast live events, we have quite a few opportunities to get these messages out to our constituent providers and the healthcare systems that we work with, whether they're acute healthcare systems and hospital systems, or whether they're actual nephrologists and providers in the community. We've also supported through the National Kidney Foundation and other groups, this recognition that identification and the early appropriate treatment of chronic kidney disease is quite critical. As you know, there have been some newer medicines that have come onto the market that help improve the cardiovascular health and the kidney health of patients with certain types of kidney disease. I think we're quite supportive of making sure that the medical community is well aware of those opportunities. Okay, great. Potentially one very last follow-up on how do you get access to these patients? Because just from a layman's perspective, many patients sit at home in front of television and so don't move that much and don't go to a nephrologist. How do you think is the best way to approach these potential patients? Yep. It's a good question. I would tell you most of the patients that come into the network that we have are identified in a couple of ways, but they are predominantly related to having had a routine lab test that people will get at their general physicians. The serum creatinine test is a blood test that measures kidney function. Today, in many countries and certainly throughout the United States, every one of those tests is associated with the recognition of what the kidney function is. It's this estimated glomerular filtration rate or GFR. As that is reported, it identifies to the doctor that's ordered the test, whatever kind of doctor they are, whether they're a general practitioner, an internist, obstetrician, it could be any type of physician. The recognition of whether this person's kidney function is reduced from what would be expected for their age and so forth. This is probably the trigger that gets most patients identified as something should be looked at. There are other tests that are seen in the urine and other methods of referral that are part of, again, routine screening. If protein is seen in the urine or blood is seen in the urine, they are frequently referred. Patients come to us predominantly through identification and referral from the general healthcare system. The other source is payers themselves. Payers are watching what's happening to the people that they are financially responsible for. There are a number of programs that we have engaged with payers that recognize and identify CKD patients. These CKD patients then begin to come into this evaluation and assessment period, as well as educational opportunity. Okay, great. That was very helpful. Thank you very much. Thanks. Next question comes from line of Tom Jones with Berenberg. Please go ahead. Oh, good afternoon, good morning. I had one question maybe for Frank and one for Charlotte. Frank, I was just thinking about the slide you put up on enhancing patient power and patient choice. When I'm thinking about site of provision of dialysis, we still tend to talk about it in terms of home or clinic. I remember a couple of years back, you know, there was more of a discussion around site agnostic care plans with a kind of more fluid movement between clinic, hospital, home and maybe even including skilled nursing facilities in the spectrum of sites where patients could receive dialysis. I was just wondering, kind of, you know, what's happened in the last year or two in terms of moving patients from a more sort of siloed approach to a more site agnostic approach to their dialysis. My question for Charlotte, I think, you know, we can all see the metrics that you publish on your website. We can look at the incentives of senior management. But the question for me is, you know, with 100,000+ employees, how do you drive sustainability right down to the bottom of the organization? Because unless the nurses, the techs, the drivers, and everybody else plays ball, then it's going to be very difficult for the company to achieve its goals. I was, you know, wondering how you incentivize or what policies you have in place to really, you know, ingrain these sustainability targets right to the bottom of the organization. Charlotte, do you wanna go first, and then I'll answer Tom's first question? Happy to do so. Thank you, Tom, for that question. Very true. There is a reason that we call our sustainability program a transformation program, and that we say it's a sustainability journey. Right now we have our ESG progress linked to the management board targets. In the future, we're also looking into how we're gonna link ESG to the long-term incentive plan for our top managers. We invest internally a lot into also awareness initiatives. Overall, for the program, for example, we onboarded more than 300 people explaining why we're doing it, what we are planning, what the benefit of the activities are. We increased the internal communication for our employees to report on progress, to explain the why and also to explain how they can contribute. We have some very nice example also from individual employees who come up with idea that really help improve our sustainability performance. But it's certainly something that is part of a longer journey and that we continuously have to invest in to explain what sustainability means for our company and how it can help us long-term success. Okay. Great. Tom, to you. Sorry. I'll come to you, Frank. I'm sorry. No, I was just gonna ask a brief follow-up to Charlotte. How are you finding, you know, driving out these initiatives across your business? You have a very global business, and different countries tend to have very different views on ESG matters. I just you know, some countries are very, you know, forward-thinking, other countries a bit less so. I was just wondering how you deal with that, you know, in a business like yours, which has, you know, clinics in 40+ countries and sells products in 140-odd countries. Again, very true. That's the reason why our sustainability program is set up the way it is. The activities we're doing are developed bottom up. For all our focus areas, we have project teams, and all the project teams are with people from all regions on all global functions. They jointly agree on the way forward, and then we have steering committees deciding on the activities before they are presented to our Sustainability Decision Board and our management board. We wanna make sure that we actually have the buy-in from all regions and all from global functions, and that we develop activities that are also implemented by everyone in the end. That takes some time, because obviously it's an alignment with many people with different agendas, and we also wanna make sure that their views are represented and also their local demands and local regulations have to be considered. For us, it's the best way to come to results that actually are implemented later on and that actually will bring the progress we're hoping they will. Perfect. Very clear. Great. Tom, I'll address your first question. I appreciate you having recalled that prior conversation that we may have had in the past, recognizing sort of the potential for site-agnostic care. In our view, in my view right now, I continue to think that although we call it home dialysis, it's really about dialysis that is directed in great part by the patient and their family members or their friends that are supporting that particular care and the power and choice that they have to design, you know, with their provider and the nephrologist, the regimen that they undergo. I do think there's been progress tremendously, especially during this time of the pandemic, where we've advanced our connected health offerings, our telehealth offerings, and our ability to support essentially the provision of this type of care in a nontraditional healthcare setting. That nontraditional setting, there are examples, whether it's nursing home or whether it's a more communal environment that patients may go to for that or literally in their own home. I think all of those have advanced somewhat. We have been able to achieve the penetration of patients that are selecting a home-type therapy, whether it's peritoneal dialysis or home hemodialysis, towards. I think recently Helen reported that we had met one of our targets recently. I continue to think that this is really important. One of the models that I've been very interested in and continue to follow closely, and we wrote about it in one of the chapters of our annual medical report this year, is, comes out of the U.K., and it's called the shared care model. The shared care model begins to break down a hemodialysis treatment into many component parts and identify what are those parts that a patient can be engaged in directly and what are those parts that can't. We continue to see examples of where some of that activity is expanding and growing. I still believe it's a key component of developing a more holistic strategy that fits into our home strategy. Yeah. I guess the follow-up to that. It's partly an allied question is dialysis frequency. It's sort of been creeping up with more- That many more of those patients, their physicians and the patient feel like they benefit from the potentially some additional dialysis treatments a week because it protects their heart to some degree. When we see a medical debate that goes on right now about incremental dialysis starts, that people should start and build up to the full force of what the traditional three treatments per week is. I've been very involved in trying to continue a discussion both internally, the three day per week regimen. There's no physiologic basis for that. It was a convenience that occurred as part of the payment system many decades ago. This long interdialytic interval that occurs over the weekend for people that are in center is a risk to them. It is a risk because it changes the rate at which they have cardiac remodeling because of the volume changes that occur on such a routine basis for them. I think the issue of cadence in dialysis is a very topical one right now and under a fair amount of debate. I don't think, you know, I have a number in mind, but I'm not sure it's appropriate for us to report the number of treatments on aggregate proportion per week. I would tell you that I think it very much fits into a physician and patient working together to try to figure out what's the safest treatment, most reliable, gonna deliver the best outcome for them. For some, it will be more than three treatments per week. For some, it may actually be less. Yeah. Sure. You know, when we often talk about more frequent dialysis, the discussion often quickly moves into the whether on home or in center or whatever it may be. Is there any kind of technological shortcoming at the moment or challenge or barrier towards doing more frequent dialysis? I mean, there are things with the setup, process that patients have to go through, the cleaning that you can address, not just through the way the service is provided, but actually with the product side of the business as well. I would say the barriers that exist primarily today are barriers in the payment system, the service delivery, the logistics, and to convince them that it's in their best interest to avoid a potential problem by dialyzing even more often than that is quite difficult. I would tell you the technology could support whatever the current technology can support, whatever the frequency is that's prescribed by a doctor. That technology is not the limitation on an ongoing basis. I do think there is more observation that we could continue to look at hemodynamics and cardiac physiology related to treatments, and our ability to manage some of those parameters might actually select which patients need more frequent treatment than others. That's work that's still sort of in process at this point to try to understand what are the best techniques to look at that and try to make that assessment. Perfect. That's all very helpful and very interesting. Thank you very much. There are no further questions registered on the phone, but I hand back to Dominik. Thank you, Emma. We have actually two questions from Gemma, from Veritas Investment, via email. She was on the webcast. Frank, both are for you. The first one is, can you talk about Fresenius Medical Care's expertise and ability to influence health policy globally as they look to improve affordable access? That would be the first one. Okay. Our ability to influence health policy obviously is dependent upon a whole variety of things, and I would tell you that the first among those is that we have to be credible within the field. We have to be not opinion-driven, but data-driven. When we are both data-driven and we pull the clinical evidence together, that allows us to present a case to policymakers wherever they are. They are obliged to respond to that, and they may respond and say, "Well, we just can't do any more than we can do." But if we can actually represent to them what organized healthcare can do in the benefits to society and a population, it gives us the opportunity to help some healthcare delivery systems recognize ways in which they might be able to mature their system. I would tell you, I think, the influence is a very long-term strategy. This is not something where you can say, I can go in and convince somebody of something, and they're suddenly gonna change the way we do it. I think we've got to bring to bear the larger picture and the longer-term picture of how we bring innovation in healthcare to recognition that it's valuable and it's a fundamental change in the way delivery can occur. I think one of our unique propositions as a company is that because we have both a focus that includes devices and products and medications that we're directly involved with and interested in bringing innovations to market, and we have a network of patients in which they get access to those innovations early, we can, in fact, move the field a little quicker than it might move naturally on its own, I believe. I think we've seen that in a number of things that we've done related to anemia management. I think we've seen it in how we've advanced the sophistication of value-based care in the U.S. I think we have good relationships with many governmental and regulatory agencies, and we have good relationships with many policymakers that are willing to actually listen to an honest conversation about what's happening in the field. Individually, can we go out and influence that policy to where we know what the end is gonna be? Probably not. I think we can, in fact, make a good, transparent, and honest state of what is the affairs, what is the standard of care and the state of affairs of medicine in this particular area. I think we are fairly credible in that area. We publish scientifically. Last year, we had 162 peer-reviewed publications in the middle of a pandemic. It's a substantial effort that we have to try to make sure that we are seen within the field, not just as an industry participant, but something relatively unique. I think in various parts of the world, the affordability side of that is challenged because the healthcare delivery systems are constrained by what the, either the government payment system or the private payment system allows for. It's our job to try to demonstrate what it could be for them and make sure they're aware of that. Thank you, Frank. The second question from Gemma is, I'd like to hear more about the plan and transplant under the new Global Head of Transplantation. How does that fit in? Including the federal programs as well as private payer programs. There is distinct interest in understanding that transplant is a component part of that journey for a patient that has advanced kidney disease and ultimately develops end-stage kidney disease, available or used more effectively in the transplant process and programs that exist. Our Head of Transplantation, Dr. Hippen, recognizes that there's a lot of tangible things we need to do, both on the organ availability side and the organ procurement processes. We have been quite interested in following the work that's happening in xenotransplantation. We've recognized that there are a number of drugs in the pipeline that might actually impact acute kidney injury from cold ischemic time that occurs in the stage of identifying where the baseline is of our involvement. It's both on the delivery side of care for people with transplant, making sure that the wait list management and patients are well prepared for that as a treatment option. If we can support a deeper interest in organ procurement and the ability to advance organ availability both technologically and practically as a service. All of those need to be part of the conversation and part of bringing that field closer together with the areas of medicine that deal with patients with chronic kidney disease and end-stage kidney disease for the other types of therapies. I think there have been good advances over the last five years in programs, organ procurement executives and certainly the transplant surgeons. Thank you, Frank. That was actually quite helpful. I think we have no further questions right now. With that, I would say thank you to both of you that you dedicated the time, Frank, Charlotte, for today and helping us to give a further detailed insight into person-centered care and our sustainability journey. This was actually Deval. Thank you for joining and have a good afternoon. Thank you. Thank you all. Ladies and gentlemen, the conference has now concluded, and you may disconnect your telephone. Thanks for joining and have a pleasant day. Goodbye.