Frauenshuh HealthCare Real Estate Solutions HealthCare Real Estate Solutions The National Resource...
Transcript of Frauenshuh HealthCare Real Estate Solutions HealthCare Real Estate Solutions The National Resource...
Prepared For:
Telluride Medical CenterSeptember 28, 2015
Confidential
Introductory Overview
Frauenshuh HealthCare Real Estate Solutions The National Resource for Physicians, Hospitals and Health System Leaders
Our Experience
• We are a healthcare real estate development, financing and
management company with a 31 year operating history and over 75
completed projects nationally.
• We have been re-hired 48 times by 15 leading healthcare systems.
• We focus exclusively on the development of healthcare facilities that:
− Align physicians and hospitals
− Reduce costs and advance quality
− Transform the delivery of ambulatory care
− Anticipate the management of population health
• Our financial strength:
− We have funded and developed in excess of $3 billion in healthcare assets
and have never defaulted on a project
− We have long standing bank and permanent lender relationships in
addition to a successful 8 year capital partnership with Health Care REIT
(NYSE: HCN) with access to a $3.5 billion unsecured line of credit
− We can fund 100% of your project costs
2
Greenfield Medical Campuses
Community Health & Wellness Centers
On-Campus MOB Acquisitions
On-Campus MOB Developments
Off-Campus Ambulatory Destinations
Our Clients
3
The Transition from Volume to Value
POPULATION FOCUS
APPROPRIATE CARE
PATIENT PREFERENCE
COST & PRODUCTIVITY
QUALITY & HEALTH
• Unrelated facilities dispersed
throughout communities in various
types of real estate
• Independent and employed
physicians in “silo” practice models
• Independent encounters fragment
perception and create “leakage”
risk
• Operational performance
constrained by fragmentation
• Volume and profitability as primary
metrics of success
• Destinations organized around
community need and centers of
excellence
• Collaborative care delivery models
that integrate physicians and
programs
• A common patient experience defines
brand and influences preference
• Provider efficiency, patient
throughput and cost reduction drive
strategic and operational results
• Measurable quality and clinical
outcomes
CURRENT FUTURE
4
Developing Effective Ambulatory Destinations
• We utilize medical home, collaborative care and Triple Aim
principles to develop facilities that:
− Improve the patient experience
− Reduce per capita costs
− Enhance quality and clinical outcomes for population health
• We provide a multi-disciplinary team of professionals that:
− Challenge status quo thinking
− Introduce best practices from other health systems
− Ensure that clinical processes drive functional programming
− Engage physicians throughout the process
5
Implementation & Financing Model
Ownership Structure
• Developer owned – 3rd party capital
• Combination of Owner equity and flexible debt
• TMC would have long term control of the project through a long term land lease
• To include purchase options & competitive restrictions
• TMC could own up to 50% of the project and partnership
• TMC would invest into the partnership upon commencement of the lease
• Investment would be based on actual cost of the project. No developer mark up.
• All financing guarantees would be the responsibility of Frauenshuh
• TMC would have an option to acquire 100% of the partnership after an agreed
upon initial hold period
7
Single Asset
Limited Liability
Company
Telluride
Medical
Center
Partnership Ownership Structure
8
Bank Debt
50%
Telluride Medical Center
50%
Frauenshuh
HealthCare
100%
Land Lease
• Strategy • Services• Expansion• Branding• Purchase Options
TMC Controls:
19
Lease and Economic Models
• 2 economic options were modeled for this presentation
1. Master Lease Option
• TMC leases the entire project including the shell space
• Gives TMC ultimate control over programs and future space
• Favorable credit lease treatment resulting in lower rents
2. Multi-tenant Lease Up Option
• Frauenshuh takes the risk on lease up
• TMC would not be responsible for any operating or rent cost related to the
shell space
• Tenant Improvement Allowance
• Frauenshuh would provide a standard allowance of $50 per square foot or
• Full turnkey buildout and funding is available
• Allow for future payback of Tenant improvements with a corresponding
reduction in rent10
20
21
22
23
Financing Partners
15
• Will provide construction and permanent financing
• Flexible pre-payment structures
• Assumable debt
• To provide competitive rates and terms
Our Commitments to You
• We ensure the timely and effective implementation of your strategy.
• A dedicated principal is your primary contact and decision-maker.
• Our approach is transparent (100% “open book” economics).
• We create ambulatory projects with highly competitive rental rates.
• You retain long-term control over your ambulatory facilities.
• We maintain a long-term commitment to the communities you serve.
16
A Sample of Our Projects
Lenexa, Kansas
Free Standing Ambulatory Care Center
Developed 2008
80,000 Square Feet
Health System Strategy:
• Respond to rapidly emerging demographics in a highly competitive market
• Attract and align community-based physicians
• Create a new free-standing ambulatory facility that will evolve into a full-service hospital campus over time
Results:
• Established significant Health System branded presence
• Created hospital licensed free standing E.D.
• Expanded existing Surgery JV to new market and enhanced physician relationships
• Relocated bariatric services from main campus to create a “destination feel” for the program
Shawnee Mission Health – Prairie Star I
Includes:
Ambulatory Surgery Bariatric Care
Bariatric Surgery Urology Care
Diagnostic Imaging Wound Care
Emergency Department
18
Health System Strategy:
• Create a programmatic “Center of Excellence” to compete regionally
• Co-locate and re-locate specialists, programs and diagnostics in a Class “A”, on-campus facility
• Increase inpatient capacity at main hospital
• Align physician and hospital interests by programmatic affiliation or employment
Results:
• Complete alignment and relocation of all hospital neuro/orthopaedic programs and services
• Transition of key physicians to employed status
• Recruitment of physicians to replace non-participants
Jackson, Michigan
Neuro Musculoskeletal & Orthopaedic Center
Developed 2010
58,000 Square Feet
Allegiance Specialty Center
Includes:
Diagnostic Imaging Center Physical Therapy
Home Medical Equipment Retail Store Rheumatology
Neurology Spine Therapy
Orthopaedics Sports Medicine
Osteoporosis
19
Castle Rock, Colorado
On-Campus Specialty Care Center
Developed 2013
60,000 Square FeetScope of Programs:
• Cardiology
• Dermatology
• Gastroenterology
• General Surgery
• OB/GYN
• Oncology
• Outpatient Lab
• Physical Therapy
• Pediatrics
• Primary Care
• Oral & Maxillofacial
Surgery
Castle Rock Adventist Health Campus
20
Castle Rock, Colorado
On-Campus Medical Office Building II
Under Development, Opening June 2016
60,000 Square Feet
Scope of Programs:
• Internal Medicine
• Dermatology
• Spine Therapy
• Dental
• Orthopaedics
21
Castle Rock Adventist Health Campus
Howell, Michigan
Ambulatory Facility
Under Development, Opening July 2016
50,000 Square Feet
Scope of Programs:
• Cardiology
• Imaging
• Urgent Care
• Physical Therapy
• Pharmacy
• Primary Care
• Ob-Gyn
22
St. John Providence Health Center
Bettendorf, Iowa
Free Standing Ambulatory Care Center
Developed 2014
40,000 Square Feet
23
Scope of Programs:
• Primary Care
• Convenient Care
• Diagnostic Imaging
including CT and MRI
Genesis Health System
Moline, Illinois
Off-Campus Ambulatory Care Center/First Phase of Wellness Medical Campus
Developed 2013
50,000 Square Feet
Co-Owned with Physician TenantsScope of Programs:
• Convenient Care
• Dialysis Center
• ENT
• Plastics
• Primary Care
Genesis Health System
24
Lenexa, Kansas
Two Free Standing Ambulatory Care Centers
Phase I Developed 2008
Phase II Developed 2013
158,000 Square Feet
Co-Owned with Physician Tenants
Scope of Programs:
• Ambulatory Surgery
• Bariatric Surgery
• Diagnostic Imaging
• Emergency Department
• Urology Care
• Bariatric Care
• Wound Care
• Multi-Specialty Suite
• Pharmacy
• Physical Therapy
• Primary Care
• Pain Management
Shawnee Mission Health – Prairie Star I & II
25
Pendleton, Oregon
On-Campus Medical Office Building
Developed 2013
50,000 Square Feet
Co-Owned with Physician TenantsScope of Programs:
• Cardiology
• Dentistry
• Hospital Administration
• Infusion Therapy
• Pediatrics
• Retail Gift Shop
• Sleep Lab
St. Anthony Hospital
26