Aging Population And AI Will Reshape Dialysis Care

Key Takeaways

• Structural cost reductions and clinical innovation are improving operational efficiency, patient outcomes, and margins, mitigating risk from volume fluctuations.
  
• Strategic international expansion is driving diversified growth and presents opportunities for further revenue and margin gains.
  
• Persistently high mortality rates, slow innovation adoption, operational disruptions, reimbursement shortfalls, and declining ancillary revenues all threaten DaVita's growth, margins, and cash flow.

Catalysts

Provides kidney dialysis services for patients suffering from chronic kidney failure in the United States.

• The aging population and rising rates of diabetes and hypertension continue to fuel steady underlying demand for dialysis, and management reaffirmed their belief in a return to 2% annual treatment growth over time, suggesting upside to revenue as volumes recover from temporary disruptions.
  
• Ongoing investments in technology, AI, and data analytics are driving structural cost reductions through improved operational efficiency and enhanced clinical outcomes, which management expects to support margin improvement even in periods of flat or negative volume growth.
  
• DaVita's focus on supporting clinical innovation-specifically around new dialysis modalities and integrated care pathways-positions the company to benefit from industry advances in personalized CKD management, which should help reduce long-term patient mortality and support patient retention, positively impacting both revenue and earnings.
  
• The company's disciplined cost management and improved labor productivity have led to lower patient care costs per treatment, and with higher employee retention and training efficiencies expected to continue, this trend provides ongoing tailwinds for net margins.
  
• Strategic growth through international acquisitions, particularly in high-growth regions such as Latin America, is beginning to supplement domestic performance, providing an avenue for diversified revenue and potential margin expansion as these international operations scale.

DaVita Future Earnings and Revenue Growth

Assumptions

• Analysts are assuming DaVita's revenue will grow by 4.4% annually over the next 3 years.
• Analysts assume that profit margins will increase from 6.4% today to 6.5% in 3 years time.
• Analysts expect earnings to reach $970.4 million (and earnings per share of $13.77) by about August 2028, up from $836.3 million today. However, there is some disagreement amongst the analysts with the more bearish ones expecting earnings as low as $843 million.
• In order for the above numbers to justify the analysts price target, the company would need to trade at a PE ratio of 11.3x on those 2028 earnings, down from 11.5x today. This future PE is lower than the current PE for the US Healthcare industry at 21.0x.
• Analysts expect the number of shares outstanding to decline by 7.0% per year for the next 3 years.
• To value all of this in today's terms, we will use a discount rate of 7.73%, as per the Simply Wall St company report.

DaVita Future Earnings Per Share Growth

Risks

• Persistently elevated patient mortality rates-remaining above pre-COVID levels and not showing meaningful improvement-are dampening treatment volumes, potentially posing a structural headwind to DaVita's long-term patient growth and thus limiting revenue and earnings expansion.
  
• Slower-than-expected adoption and limited near-term impact of new clinical innovations (such as advanced dialyzers, HDF technology, and increased use of GLP-1s), coupled with gradual protocol changes, mean that benefits to patient outcomes and corresponding financial upside are likely to unfold over multiple years, delaying potential margin and volume improvement.
  
• Recent declines in treatment volume and a higher missed treatment rate-partly driven by operational disruptions like the cyber incident but also reflecting underlying challenges-have led management to lower full-year guidance on total treatment growth, directly affecting revenue and operating income projections.
  
• Annual reimbursement rate updates from CMS (e.g., the 2% ESRD proposed rate) continue to lag actual inflation experienced by dialysis providers, signaling ongoing and future margin compression as government reimbursement rates struggle to keep pace with rising costs, threatening net margins and cash flow.
  
• Increased patient utilization of over-the-counter or alternative sources for phosphate binders, coupled with heavy pill burden and adherence challenges, has led to lower dispensing volumes and revenue per treatment from this revenue stream, constraining near-term topline growth and the associated contribution to overall operating income.

Valuation

• The analysts have a consensus price target of $153.5 for DaVita based on their expectations of its future earnings growth, profit margins and other risk factors. However, there is a degree of disagreement amongst analysts, with the most bullish reporting a price target of $186.0, and the most bearish reporting a price target of just $137.0.
• In order for you to agree with the analyst's consensus, you'd need to believe that by 2028, revenues will be $15.0 billion, earnings will come to $970.4 million, and it would be trading on a PE ratio of 11.3x, assuming you use a discount rate of 7.7%.
• Given the current share price of $134.69, the analyst price target of $153.5 is 12.3% higher.
• We always encourage you to reach your own conclusions though. So sense check these analyst numbers against your own assumptions and expectations based on your understanding of the business and what you believe is probable.