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GRI 3-3

Product and service portfolio

There were no significant changes in the Fresenius Group’s product and service portfolio in the reporting year. Under the influence of the ongoing COVID-19 pandemic, the primary objective was to ensure patient care and access to our products, services and healthcare facilities.

In 2022, Fresenius Medical Care provided home therapy to around 58,000 peritoneal and hemodialysis patients worldwide, or 14% of the segment’s total patient base. Globally, the number of its home 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. patients increased by about 7.5% in 2022, compared with 2021. In 2022, 15% of treatments in the U.S. were performed in a home setting. The company has set itself the aspirational target of increasing this value to 25% by 2025.

In the United States alone, Fresenius Medical Care informed about 57,000 people living with chronic kidney disease or end-stage kidney disease about home dialysis options in 2022. The business segment did this with the support of more than 190 internal kidney care experts.

Fresenius Kabi continued its efforts to secure the supply of healthcare facilities with drugs and medical devices for treatment and intensive care of patients in the reporting year. As in the previous year, the local pandemic situations were closely observed and measures, training, or information mat­erial adapted to the respective developments.

The business segment is constantly expanding its product range to provide high-quality and affordable healthcare to more patients. It is expanding product availability in established markets as well as in new and emerging markets and launched new products in 2022. For example, in 2021 a cooperation between the business segments Fresenius Kabi and Fresenius Medical Care in Poland expanded the availability of a clinical nutrition product. Many patients with chronic kidney disease now have access to Fresenius Kabi’s product Ketosteril, which is used to treat insufficient protein metabolism in their indication. The cost of the treatment has been reimbursed by the Polish Health Fund since 2021, which significantly improves access for patients in Poland. In 2022, Fresenius Kabi continued its efforts to provide more patients access to this product in Poland.

In 2022, Fresenius Kabi and the U.S. based company Cerus Corporation extended their agreement on the manufacture of medical devices that inactivate pathogens in blood com­ponents. The collaboration will help expand access to pathogen-reduced blood components for patients. Cerus and Fresenius Kabi have collaborated in this area for many years.

Further, the business segment has established a partnership with Bio-Manguinhos / Fiocruz and Bionovis to provide access to the adalimumab biosimilar in Brazil. This partnership will expand treatment options in the Brazilian public health system for several autoimmune diseases.

In 2022, Fresenius Kabi also introduced KabiConnect, part of the KabiCare patient support program in the United States. KabiConnect offers eligible patients financial support covering more than 30 different generic oncology medicines. The program can lower out-of-pocket costs for eligible patients.

Fresenius Helios focused on the improvement of therapeutic measures based on clinical studies outcomes and the increasing use of telemedical services. More information can be found in the Digital transformation and innovation chapter. The approach to integrated and value-based healthcare was supported by the presentation of the digital healthcare concept CUBE in 2022.

In 2022, Fresenius Vamed expanded access to offers and services, especially in the rehabilitation division. Outpatient offerings are easy to access and enable in-service utilization of medically necessary rehabilitation services, complementary to the inpatient care of patients. In 2022, 15% of the therapeutic services were provided on an outpatient bas­is, while 85% were provided on an inpatient basis.

With SMAPP – Smart Health Posts and App – Fresenius Vamed brings healthcare to regions where it is only available to a limited extent. This overall concept also offers high-­quality medicine to people who previously had no access to it. SMAPP makes this possible with an intelligent hybrid healthcare offering that digitally links physical points of contact and global medical expertise. Telemedical services and IT-supported diagnosis based on data analysis are combined by a virtual network, software solutions and artificial intel­ligence. This technology makes it possible to offer patients in remote areas access to enhanced primary and secondary healthcare services. SMAPP’s physical infrastructure – the Smart Health Posts – consists of prefabricated modular units. They provide space for consultations, examinations, trea­tments, and laboratory and other clinical services. With information, communication and registration functions, the SMAPP app ensures that patients have direct access to the healthcare system. In the reporting year, a prototype of the overall SMAPP concept was installed in Vienna. It serves on the one hand as a showcase for interested parties and on the other as a training unit. The business segment carried out evaluations for possible market launches in 2022. For example, initial preparatory steps were implemented with the relevant ministries of Ghana.

Patient support in crisis and emergency situations

GRI 204/3-3

As a healthcare Group, we have to be crisis-proof and respond flexibly in all areas: it is our task to enable unrestricted access to our services and seamless care for patients even under difficult conditions. To ensure this, we have established high-performance as well as resilient emergency systems and programs in our business segments.

Fresenius Medical Care considers it its responsibility to provide access to healthcare even under difficult circum­stances, for example in the case of a health crisis or natural disaster. The business segment has dialysis clinics in many regions of the world with diverse geographic, social, and economic conditions. These clinics serve a vulnerable population of patients who need dialysis treatment multiple times a week. To allow the business segment to continue treating its patients in extreme conditions, it has developed an emergency response system comprising disaster response teams at local level. Before the onset of Hurricane Ian in fall 2022, local disaster response team members from facilities in Florida were dispatched to provide patients with emergency kits and instructions on how to touch base with their care teams. Of the roughly 100 facilities that were closed on the day before the storm hit, all but one were fully operational within three days and all affected patients were accounted for.

The business segment regularly tests the emergency response procedures to assess service safety. Furthermore, it continues to donate dialysis machines, and medical supplies to organizations that require support.

Fresenius Kabi has a crisis team for emergency situations which is summoned immediately after an event that could lead to a crisis occurs. The crisis team comprises members of the Management Board, key staff units, and other relevant functions of the business segment. It coordinates the activities and monitors the measures initiated specifically for this purpose. Crisis situations are considered to be unforeseen events that may have an impact on the company or the public, such as COVID-19. Another crisis team was set up to coordinate measures and humanitarian aid in response to the war in Ukraine.

In the hospital sector, there are legal requirements for how care is to be organized in the event of an emergency for the hospitals and healthcare facilities of Fresenius Helios. They have dedicated emergency plans to respond immediately to incidents that might be critical for patients. These encompass, among other aspects, evacuation plans, emergency systems in case of interruption of power or water supply, and plans to respond to impacts on local infrastructure, e.g., due to flooding. Emergency power generators ensure that operations or vital therapies, such as artificial respiration, can continue even in the event of a power failure.

At Fresenius Vamed, a structured crisis management system takes immediate effect in critical situations. It comprises the Management Board, key staff units, and the management teams of the lead companies. The crisis team meets as soon as an incident becomes known and initiates all necessary measures. Like Fresenius Helios, Fresenius Vamed’s facilities have emergency and outage concepts as well as crisis communication plans in place, which have been drawn up together with the local emergency units. Beyond that, Fresenius Vamed ensures all necessary prerequisites to ens­ure the safety of systems and infrastructure, not only for its own facilities but also for those hospitals, for which the company provides facility management services.

All business segments of the Fresenius Group took measures in the reporting year to support those affected by the war in Ukraine. In doing so, the business segments primarily deployed their core competencies and used existing medical care infrastructures to provide assistance.

For example, when it became impossible for the patients of Fresenius Medical Care to safely travel to the dialysis clinic in Chernihiv, patients and their family members were invited to move into the clinic. During this period, clinic staff provided patients with food and medicine. Fresenius Medical Care also strives to increase access to healthcare with partnerships. For example, the business segment invests in the biotechnology company Humacyte, which is working on a project to develop bioengineered blood vessels for vascular repair and replacement. Humacyte has provided these blood vessels to surgeons across the Ukraine, who use them to repair traumatic blood vessel injuries suffered during the war.

Fresenius Helios has been supporting the organization Friedensdorf International with the free treatment of children from crisis and war zones for many years – since 2022 specifically Malteser Ukrainehilfe. Through their mediation, war wounded in Ukraine and seriously injured children from Mariupol were treated in Berlin-Buch. Fresenius Helios also donated drugs worth around €40,000.

In 2022, Fresenius Kabi focused on supporting patients in Ukrainian hospitals in order to provide rapid on-site assistance. The business segment was committed to providing people there with life-saving medicines. Fresenius Kabi worked with humanitarian organizations, for example in cooperation with the German Federal Office of Civil Protection and Disaster Assistance (BBK) and Polish or Portuguese authorities to send roughly 500 pallets of urgently needed medicines and medical equipment to Ukraine. Medicines to be administered intravenously, such as antibiotics, anesthetics, volume replacement therapies, and medical equipment were donated. In addition, the division joined Blood Centers of America (BCA) and America’s Blood Centers (ABC) in a nationwide campaign in the U.S. to collect blood and transfusion supplies as well as financial donations and make them available to those affected in Ukraine. In total, roughly 50 pallets of urgently needed blood bags and transfusion material were donated through this initiative in 2022.

Fresenius Vamed provides capacity at its rehabilitation facilities for the accommodation and medical care of people affected by the conflict in the Ukraine. Furthermore, the business segment has created job openings, of which more than 70 have already resulted in employment.

Healthcare delivery during the COVID-19 pandemic

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The COVID-19 pandemic again posed continued extraordinary challenges to the global healthcare system in 2022. For Fresenius as a healthcare Group and as a company with many employees along with a great deal of patient contact, pandemic protection and prevention is essential. Emergency management plays a key role in this: it enables us to maintain the care of all patients in the healthcare facilities and ensure the supply of medicines. Based on the legal requirements and regulatory recommendations for the COVID-19 pandemic, our business segments implemented various measures in response:

During the pandemic, Fresenius Medical Care was able to continue producing and delivering life-saving products, even when the operations and supply chains were hampered by global restrictions. Throughout the course of the pandemic, the business segment has also continuously looked at ways to improve its care. The ongoing COVID-19 research focuses on vaccination and treatment effectiveness and response.

The need for some of Fresenius Kabi’s drugs and med­ical devices, which were in high demand during the COVID-19 pandemic, normalized in 2022. Fresenius Kabi’s crisis team, which was set up at the beginning of the pandemic, continued to monitor the situation and to coordinate the efficient manufacturing and supply of essential drugs needed for the management of critically ill COVID-19 patients in the reporting year.

Measures taken at our Fresenius Helios’ healthcare facilities and hospitals in 2022 were carried out in close, ­continuous consultation with each other. The business segment’s respective crisis teams work closely with the task forces of the clinics as well as the central and local hospital hygiene departments. Since June 2021, the number of COVID-19 patients in our German clinics has been published on the website of the division (German language). Further information is provided regarding the intensive care capacity and treatment of the patients.

The use of social media to educate and inform about COVID-19 has been successful in Germany and Spain. For the German sites, Fresenius Helios published messages on the pandemic, testing procedures and vaccinations, which were widely shared. Helios Spain uses its social media channel to provide written information or videos on the most urgent questions, such as hygiene, vaccines, or the impact on family life, as well as information regarding the impact on hospital appointments and the availability of COVID-19 tests in our centers.

For all managed and owned healthcare facilities, Fresenius Vamed created catalogs of measures in which the pandemic experiences in Austria, Germany, the Czech Republic, the United Kingdom, and Switzerland were collected. These catalogs are updated regularly. As a result, the healthcare facilities were able to remain open, subject to the respective regulatory requirements. The experience gained will continue to be incorporated into risk management in the future and will help Fresenius Vamed to continuously improve its processes and actions. Furthermore, a 24 / 7 information hotline as well as comprehensive and continuously updated information on the Fresenius Vamed intranet Corona Infocenter are available to the staff of the business segment.

Fresenius Vamed wants to increase the importance of rehabilitation in political decision-making processes in order to make it easier for patients to access rehabilitation measures. For this reason, the business segment is involved in various industry initiatives in Germany and Austria. Against the backdrop of the effects of the COVID-19-pandemic, the political focus was again on the acute care sector in the reporting year. To ensure follow-up rehabilitation for those affected, Fresenius Vamed worked with national interest groups in 2022 to ensure that rehabilitation clinics receive the same level of funding as acute clinics.

Please refer to the Notes on page 328 for further information on assistance programs provided by various governments in the form of reimbursement payments and funding in connection with the COVID-19 pandemic.