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The future of the healthcare sector is not what it used to be!From an Ego- to an Eco-system

Michel van Schaik, Director Healthcare

LifeKIC Update 1

Partnering in Life Sciences & Health 2014

Artis Amsterdam, November 27th 2014

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Diagnosis 2025: about the future of Dutch Healthcare

Interest Rabobank:

•Business (providing funding) •Coöperative mission

2010

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3 Scenario’s

Important ‘drivers’:

•Dutch economy (GNP)•Politics

Conclusion: the Dutch healthcare system is not sustainable!

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Diagnosis Health InnovationHow to improve quality, accessability and affordability of care?

“Innovation and entrepreneurship need to be improved in order to make the healthcare system sustainable”

Great need for disruptive innovations.

2013:Including a health innovation agenda supported by a strong coalition

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And: > 350 patiënts, professionals and experts

involved

“Coalition of the willing” (Public-Private-Partnership)

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Elderly related health issues (multimorbidity, loneliness, frailty,

etc.)

COPD en AstmaCancer

Chronic Heart disease

Focus

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405.000 chronische aandoeningen (+16%):•171.000 1 chronische aandoening (+9%)•234.000 > 1 chronische aandoening (+20%)

19 jaar en ouder

16.100 chronische klachten/aandoeningen (+8%):•10.400 1 chronische klacht/aandoening (+8%)•5.700 > 1 chronische klacht/aandoening (+8%)

56.000 risico op psychische aandoeningen (+27%)

70.000 functioneringsproblemen (+60%)

Projection of HC needs in Amsterdam 2030Estimate based on demographic developments

Functioneringsproblemen 65 jaar en ouder:• 3.500 lichte/matige dementie•35.000 mobiliteit -/+ lichte/matige dementie•21.000 mobiliteit en zelfzorg -/+ lichte/matige dementie• 7.100 ernstig fysiek -/+ lichte/matige dementie• 3.600 ernstige dementie

Chronische aandoeningen 19 jaar en ouder:•202.000 bewegingsapparaat• 62.000 Astma/COPD • 56.000 Incontinentie • 56.000 Diabetes Mellitus• 41.000 Kanker• 22.000 Hartinfarct• 19.000 CVA• 12.000 Dementie

Chronische klachten/aandoeningen 13-17 jaar:•6.300 Hoofdpijn•4.900 Astma/bronchitis•4.000 Eczeem•3.800 Chronische vermoeidheid•2.400 buikklachten•1.800 ADHD•450 Hartaandoening•300 diabetes mellitus• 300 Anorexia/Boulimia• 50 Kanker

Psychische aandoeningen (alle leeftijden):•15.000 Stemmingsstoornissen (bij huisarts)• 6.200 Angststoornissen (bij huisarts)• 1.700 Schizofrenie (bij huisarts)

78.000 (+54%) 65-74 jaar

61.000 (+56%) >75 jaar

170.000 (+5%) 0-19 jaar

560.000 (+4%)20-64 jaar

81.000 risico op eenzaamheid (+29%)

65 jaar en ouder

50.000 mobiliteitsproblemen (+ 19%) 19 -64 jaar

13-17 jaar

6.800 risico op psychosociale problematiek (+10%):•3.700 matig risico (+10%)•3.100 hoog risico (+10%)

13-17 jaar

870.000 (+10%)Amsterdam:

383.000 Nederland (-2%)164.000 ov Westers (33%)122.000 ov NWesters (+47%) 83.000 Marokko (+15%) 60.000 Suriname (-13%) 46.000 Turkije (+10%) 12.000 Nld Antillen (-2%)

Source: TNO

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Central government

Central government

InsurersProviders

Healthcare consumers

InsurersProviders

Healthcare consumers

Eco-networkEco-network

Personal Pre-emptive

PredictiveParticipatory

Regulation of central supply

•Input financing: budget and permits•Focus: institution and healthcare professional•Disease & Care

Managed Competition•Output financing: Pay for performance•Focus: Healthcare consumer (pathogenesis)•Health and behaviour

Sustainable health-value systems

•Outcome financing: Individually and socially•Focus: Functioning & Participation•Focus: Citizen and Health (Vitality & Well-being, Salutogenesis)

Healthcaresystems

Innovation / technology development

Medical technology

Pharma

Information & Communication technology

GeneticsRobotics

Nanotechnology

Bio-techNutri-tech

Pater-systemWelfare state

Central governanceTop-down and instructivePatronizing

Ego-systemMarket mechanism

Governmental frameworkMaintenance and remote monitoring

Eco-systemValue creation

Connecting governmentReciprocityStyle flexibility

Role government

Besides a main focus on the patientwe need to change management philosophy

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Transition of the Dutch healthcare system:

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• Sharing vision and knowledge;

• Help setting stage for “Healthy & Vital” Amsterdam;

• Facilitate HC entrepreneurship (incubator?);

• Provide hands on support for SME’s (businesscase);

• Connection with other HC innovation platforms;

• Share local, national and international networks;

Rabobank’s role in LifeKIC?

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Investment strategy

1. Other includes for example: Clean processing and Sustainable agriculture 2. % are an indication of the investments per theme over the lifetime of the platform, the actual year on year allocation will vary. The platform has the flexibility to invest up to 15% in

innovations outside the themes, e.g. clean processing (which is considered a theme across the themes). 3. Average investment size based on a € 60M fund size

I mpact investing based on themes

Geographic scope

I nvestment phase

Venture capital investments

Phased investment in national frontrunners3

4 current DGF portfolio companies

16 entry tickets (seed/series A): € 0.75M

14 follow-on (series A/B): € 2M

6 growth: € 3M

Total portfolio of 20 companies targeted

Maximum of 12.5% of committed capital invested in one venture

Clear focus and strategy to achieve financial and strategic return by accelerating innovation

Other1 Nutrients

Food & Health

B io-refinery

Revalue waste

25%

25% 25%

25%

Allocation of investments2

Bio-refinery

Revalue waste

Nutrients

Food & Health

National base and focus with global outreach

The platform looks to invest from a strong Dutch base with an international reach through its network

Investment predominantly in Dutch companies with possibility to invest up to 20% outside of the NL

Current platform has an established network throughout the world in over 100 countries across 6 continent

€10M

€ 1M

Regional support /

seed capital

National frontrunners

Industry network / knowledge

Venture Capital

Own global network with

partners

Global player

Local MKB

International VC Corporate VC

National VC with global reach

Local banks Regional funds

I mpact investing

Environmental and social impact are key conditions for investments. The impact will be assessed and monitored on venture and fund level.

I nvestment themes

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• Excellent HC professionals and providers;

• Highly ranked research institutes;

• Innovative corporations (HC technology & nutrition);

• (Sense of) urgency;

• We need entrepreneurs with great ideas and execution power;

My ambition:Help develop, implement and export Dutch HC solutions

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www.managementboek.nl