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GRI 3-3, 406/3-3

Fresenius’ long-term goal is to further develop the company’s position as one of the leading international providers of healthcare products and services. In recent years, we have expanded our company along our value chain – increasing the global availability of our products and services.

The constant development of our products and services allows us to take advantage of growth opportunities. We guarantee our patients high-quality, comprehensive healthcare with our products and in our own facilities, allowing them to benefit from medical progress.

Our core business focuses on ensuring that as many people as possible worldwide are able to participate in this progress. We consider health equity in our efforts to increase access to care worldwide and to support the development of sustainable healthcare systems. This means striving to make treatment and health education available to those in need, irrespective of age, income distribution, race or ethnicity, or education. This ambition is also reflected in our commitment to society.

In addition, we are also supported by medical initiatives and projects. For instance, the Fresenius Medical Care Foundation collaborates with several leading organizations to raise awareness and provide support to people living with kidney disease. We also cooperate with international organizations such as Médecins Sans Frontières (Doctors without Borders). A collaboration with Friedensdorf International makes it possible for Helios Germany to treat children from crisis regions free of charge in its clinics.

Integrated healthcare concepts

In recent years, healthcare providers, regulatory authorities and insurance companies around the world have been working to improve treatment outcomes for patients while simultaneously reducing healthcare costs. This benefits- and results-oriented concept is known as value-based healthcare.

This scientific approach confirms our long-standing strategy: systematic establishment of regional care clusters and interdisciplinary knowledge sharing among experts, from which all hospitals in our network can benefit. Patients benefit from the focus on technological advances, innovative treatment options and our investments in high-level healthcare infrastructure and technical equipment. With this approach, we are helping to tackle the increasing cost pressure for insurers and relieve the burden on healthcare systems.

Integrated healthcare at Helios Germany

In 2020, healthcare costs of more than €440 billion accounted for a total of 13.1% of Germany's gross domestic product. According to the German Federal Statistical Office, expenditure per inhabitant amounted to €5,298.1 As we explain in the Healthcare industry section of the Group Management Report, healthcare spending is highly likely to continue rising in the coming years due to demographic change and other social and technical developments. This raises the question of how people's health can remain financially sustainable, not only in Germany but also in other countries. As a healthcare company, we are determined to work strategically to combat the rise in costs, thereby increasing the value of the care provided. We use various tools to achieve this goal, which we will discuss in the following sections.

We firmly believe that combining healthcare facilities, known as cluster formation, can prove beneficial both for the quality of healthcare and when it comes to the potential for reducing costs. In the hospital sector, one of the ways we are pursuing this approach is through our choice of acquisitions in recent years. The aim with these choices is to link together the special care offerings of the individual hospitals, using joint cluster conferences, and thereby improve quality, for example in oncology care or stroke treatment. This type of networking makes it possible to offer expensive and labor-intensive treatments within a hospital cluster without having to provide them at every location.

1 Healthcare spending has risen to over €440 billion in 2020 – Statistisches Bundesamt

A wide range of tools for better and more affordable care
Since 2018, a further strategic tool for corporate development has been available in the form of the centralization of complex medical services. This approach makes it possible to concentrate services in a few locations where the number of treatments provided is known to have a material impact on patient outcomes. In Helios hospitals in Germany, the extent of the centralization goes beyond the minimum requirements of the Federal Joint Committee (Gemeinsamer Bundesausschuss — G-BA; the highest self-regulation body in the German healthcare system).

Helios Germany supports certain projects that involve deploying multidisciplinary teams following surgical interventions in order to help speed up and improve patients recovery. This includes, for example, the Ortho-Campus model, in which surgery and rehabilitation are brought closer together. Further examples include the Enhanced Recovery After Surgery (ERAS) initiatives and certification of endoprosthetic centers in accordance with the ENDO-Klinik standards.

Through the prizes awarded to publications, Helios Germany has been supporting the activities of chief physicians in both fundamental research and healthcare research for over 20 years. In addition, Helios Germany is the largest German service provider in the field of outpatient clinics with its Outpatient Care business unit and, as such, is committed to more comprehensive and improved integration of outpatient and inpatient services.

PROMs (Patient Reported Outcome Measures) are important for value-based healthcare. They make it possible to measure and compare patients' own perceived health status during or after treatment. PROMs can be generated using the Curalie healthcare app, developed by a partner company of Fresenius Helios.

The CUBE digital hospital
A key challenge for the future of healthcare in Germany and beyond will be caring for people in structurally weak areas. To address this challenge, financial incentives could be established, for example, to attract doctors to these regions — though this is costly. A more economical alternative is the CUBE digital hospital, which was unveiled in May 2022 at the Leipzig Heart Center.

This flexible digital, telemedical and physical unit connects people who have previously not had sufficient access to medical care to qualified personnel in a different location.

CUBE enables diagnostics such as X-rays, ultrasounds, and blood pressure and eye pressure testing. Under the guidance of specialists, patients can carry out the necessary medical examinations. Only minimal investment is required for the on-site technical infrastructure. For more information, visit the website of CUBE.

Helios Germany started measuring and publishing the quality of its own services at an early stage. The starting point for this was the quality assurance process using administrative data, which in 2008 led to the establishment of the international Initiative for Quality Medicine (IQM), which spans multiple providers.

Evidence-based quality medicine can be improved in a variety of ways for everyone, and follow-up costs can be avoided: through quality assurance using administrative data, cluster formation, centralization, the promotion of science, integrated care, PROMs and digitalization. These tools help to prevent the development of serious diseases and maintain or improve health. We help people live healthier lives while contributing to the reduction of spending on healthcare systems worldwide.

In 2022, we treated more than 5.5 million patients at our hospital sites across Germany, including more than 4 million outpatients and more than 1 million inpatients. We achieved 87% of our quality targets. For more information, please see the Patient and product safety chapter, section Evaluation of the Group Non-Financial Report 2022.

Fresenius Medical Care

Fresenius Medical Care recognizes the importance of improving access to healthcare and is working to provide affordable treatment to a growing number of patients worldwide. Fresenius Medical Care considers, for example, barriers to access such as cost and ease of travel to the dialysisDialysisForm ​of ​renal ​replacement ​therapy ​where ​a ​semipermeable ​membrane ​– ​in ​peritoneal ​dialysis ​the ​peritoneum ​of ​the ​patient, ​in ​hemo­ ​dialysis ​the ​membrane ​of ​the ​dialyzer ​– ​is ​used ​to ​clean ​a ​patient’s ​blood. clinics, and lack of education on kidney disease and treatment options. The business segment aims to increase the number of patients on home dialysis as well as those who receive kidney transplants. Additionally, Fresenius Medical Care has improved the digital offering to make it easier for patients to access their clinical information and the business segment’s services. Fresenius Medical Care also has global crisis preparedness processes in place so that patients have continued access to treatment during disaster and emergency situations.

Health equity

Fresenius Medical Care prioritizes health equity in its efforts to increase access to care worldwide and to support the development of sustainable healthcare systems. The company believes that every patient, regardless of their ethnic origin or race, nationality, age, ability, gender identity, sexual orientation, religion, or socioeconomic status, be given equal opportunities and support to maintain and improve their health. This also means striving to make treatment and ­kidney health education available to those in need. As part of its efforts to promote health equity, Fresenius Medical Care currently analyzes care opportunities and health outcomes in the countries in which it operates. For instance,­ in the U.S. the company has developed digital dashboards to identify inequities that arise in the home dialysis and kidney transplant settings. These include, for example inequities relating to age, race, language, and gender. In 2023, the company intends to set health equity targets and track their progress.

In 2022, Fresenius Medical Care developed a Global Health Equity Statement that outlines the commitment to expand knowledge and services in ways that advance equity in care. The company has also created a Health Equity Committee in the U.S. This committee is dedicated to sharing best practices and accelerating our progress in addressing healthcare inequities. Fresenius Medical Care plans to expand these activities outside of the U.S. in 2023 as it develops a global health equity roadmap.

Fresenius Kabi

Fresenius Kabi is committed to improving patients’ quality of life. The business segment’s product portfolio targets critically and chronically ill people.

With its comprehensive range of generics and biosimilarsBiosimilarsA ​biosimilar ​is ​a ​drug ​that ​is ​“similar” ​to ​another ​biologic ​drug ​already ​approved. products, Fresenius Kabi provides access to modern, high-quality, and affordable therapies for patients. Generics and biosimilars are cost-effective alternatives to originator drugs. They help to lower the price of treatments and thus reduce the burden on healthcare systems. Further information is provided in the Group Management Report 2022.

Fresenius Kabi is in regular exchange with the Access to Medicine Foundation with regard to the Antimicrobial Resistance (AMR) Benchmark. In this benchmark, selected manufacturers of generic drugs are regularly evaluated in the categories Appropriate Access, Stewardship, and Responsible Manufacturing. Fresenius Kabi is evaluated in the AMR Benchmark as an important manufacturer of generic antibiotic products. The business segment scores consistently highly in this and performs above average in the category of generic drug manufacturers. This recognizes the business segment’s efforts with regards to AMR, in particular its performance in the categories Stewardship and Responsible Manufacturing. No AMR Benchmark by the Access to Medicines Foundation was conducted in 2022. For more information on Fresenius Kabi’s environmental engagement in the AMR Industry Alliance, please refer to the Water management section.

Fresenius Kabi is also engaged in the Medical Nutrition International Industry Group (MNI), which focuses on raising awareness of the need for clinical nutrition, e. g., for cancer patients. Malnutrition can have a negative impact on patients’ health and well-being. This can result in increased costs for healthcare systems. Clinical nutrition also plays a role in the treatment and recovery of COVID-19 patients. In 2022, Fresenius Kabi further extended its online offering of relevant information on nutrition and its effect on the recovery of COVID-19 patients. Further information can be found on the United for Clinical Nutrition website. In the biosimilars sector, Fresenius Kabi engages with Medicine for Europe, the Association for Accessible Medicines (AAM) and the biosimilar Forum to raise awareness of the benefits of biosimilars for patients, healthcare professionals, and national healthcare systems.

Fresenius Helios

Fresenius Helios’ acute care hospitals, outpatient clinics and other healthcare facilities offer the full range of medical services. Our international hospital network enables Fresenius Helios to transfer knowledge between healthcare systems in Germany, Spain and Latin America with regard to affordable healthcare of high-quality, and with very high standards of service and patient experience. This international network also enables an intensive knowledge exchange on the treatment of COVID-19 patients in order to improve treatment outcomes.

Fresenius Vamed

Fresenius Vamed is active worldwide in the service of patient health. This includes acute care, prevention, rehabilitation and nursing as well as improved access to healthcare services. The value chain of Fresenius Vamed encompasses the full life cycle of a healthcare facility. This high level of internal service integration and expertise enables us to offer access to healthcare globally at all levels of care.

Patient safety is directly dependent on the quality of the treatments, care, or products used and indirectly on the provision of operational management services. Fresenius Vamed’s main goal is to give people around the world access to healthcare services at all levels of care.