Sanitas Presentation: Development of outcome-driven feasible healthcare projects
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Transcript of Sanitas Presentation: Development of outcome-driven feasible healthcare projects
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Organizacin Sanitas Internacional (OSI) Presentation to Asian Development Bank. February 18 2016
Development of outcome-driven feasible healthcare projects
About OSI 01
Operational Highlights 02
Financial Highlights 03
OSI Business Model 04
OSI Public Health Management Background
05
OSI Target Sectors 06
OSI in South East Asia 07
OSI and ADB
08
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
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OSI 01
Organizacin Sanitas Internacional (OSI) is a group of companies specialized in managing, assuring and providing healthcare through its own network of hospitals, health centers and accredited suppliers. OSI also consists of educational institutions and societal-oriented companies that complement its ability to offer wide-ranging health services.
Sanitas oversees the care of its members and patients by maintaining their health as well as identifying and managing risk and disease. We are leaders in comprehensive health services in the countries where we operate, and are widely recognized for our scientific, technical, ethical and human approach.
Created in Spain over 50 years ago and moved to Latin
America in 1980. Today, while growing in Latin and North
America, we continue to move forward with ongoing
development plans in Europe and Asia, where we work to
fulfill our mission.
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2015 Development Colombia Venezuela Brazil Peru
December 2015
USA
2016 2017 Expansion Plan
East Europe
Asia
Mxico Guatemala
1 Location 1 Location 1,888.7
8.3
9.0
198
5
Members (thousands) Members (thousands) Members (thousands)
Affiliated Doctors (thousands)
Cities
Employees (thousands)
Cities Cities Cities
Members (thousands)
OSI Health delivery network OSI Health delivery
network OSI Health delivery network
Affiliated Doctors (thousands) Affiliated Doctors (thousands)
Employees (thousands) Employees (thousands)
Employees (thousands)
Affiliated Doctors
259.3
55 570 28
4.4 1.2
8
OSI Health delivery network
51
29
3
48
28
399.6 252.5
2.7 1.0
0.3
Hospitals
Primary Care Centers
Dental Centers
Ophthalmology Centers
Laboratories
Optical Centers
Affiliated Healthcare
Institutions:
2,634
Affiliated Healthcare
Institutions:
917
Cities 3
3 Primary Care Clinics
Laboratories
Pharmacies
Ophthalmology Centers
Dental Centers
Primary Care Centers
Hospitals
Optical Centers
Hospitals
Primary Care Centers
Laboratories
Laboratories
Primary Care Centers
1
4
3
1
1
2
5
1 2
2
2
Affiliated Healthcare
Institutions:
4,047
6
Affiliated Healthcare
Institutions:
219
Operational Highlights 02
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Balance Sheet 2014 2013 2012 Income Statement 2014 2013 2012
Total Assets 1,010 967 755 Revenue 1,901 1,671 1,509
Equity 331 324 226 COGS (1,484) (1,323) (1,216)
Gross Debt 155 166 143 Gross Income 417 348 293
Net Debt 53 80 78 OPEX (430) (333) (299)
Other Non-Operating 18.1 (5.0) 6.0
Equity / Total Assets (%) 33% 34% 30% Net Income 5.3 8.9 (0.3)
Net Debt / EBITDA ( x ) 0.6 1.3 1.8 EBITDA 86.3 62.2 42.3
Financial Highlights 03
-
04
At Sanitas we have developed an inclusive health management model that responds to the local needs with:
Comprehensive health care
A health care network
Local health teams and staff
Risk-oriented health care approach
Integrated health information systems
Health outcome oriented
Standardized protocols and guidelines
Applied technology
Continuous training done by experts from OSIs university
Participative, because it empowers
the informed individual or active
patient to make decisions affecting
his/her health.
Personalized, because it takes into consideration the particular characteristics of the individual as a unique and unrepeatable human being.
Preventive, because it designs actions aimed at maintaining health.
Permanent is the fifth P included in the model. Health care should not be intermittent or conditioned; thus we rely on a continuous monitoring process.
Predictive, identifies the
potential occurrence of a disease and
takes appropriate action to prevent or
mitigate it.
OSI Business model 1. The 5 Ps of Health Management
-
04
Sanitass business model consists on providing a patient-centered, comprehensive, high quality and cost effective health care delivery model through the establishment of a
primary care center network that serves an assigned population
Specialized Medical Center
Basic Medical Center
Outpatient services
Primary Care oriented
One-stop clinic
80% of healthcare needs attended
Resource planning and allocation based on our know-how in
business performance metrics.
Electronic medical records
Referrals and counter-referrals from network
20% of healthcare needs attended
Integrated medical data with the network
General Hospital
OSI Business model 2. Distributed Network
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OSI Business Model 3. Role of Medical Centers in the healthcare network
04
HIGH QUALITY: Supported by Lab,
imaging and specialized diagnosis
ACCESIBILITY health teams, facilities location, comfort and appointments management
EFFICIENCY AND COST CONTROL
COMPREHENSIVE continuous and coordinated
attention among the different complexity levels,
PATIENTS SATISFACTION
-
Health facilities that bring a one stop
clinic solution, by delivering
outpatient health services in an
integrated, coordinated, timely and
efficient way, altogether aiming at the
patients health value and operational
efficiency.
ONE STOP CLINIC
OSI Business Model 4. Sanitas Health Centers 04
-
Reduce the number of low-complexity emergency consultations at hospital centers
Enable access to health services
Integrate care in order to optimize the use of
high-complexity resources
Develop healthcare programs for patients with chronic diseases
Solve the most frequent health problems
OSI Business Model 6. Sanitass Health Centers objectives 04
-
04
Efficiency - HIGH quality / LOW Cost.
Keeping our patient healthy and, preventing complications.
Promotes the systems efficiency.
Resoluteness Handles al least 80% of health needs.
Health maintenances, prevention and risk management, episodic events care, chronic illness management.
Adopts protocols and guidelines for prevailing diseases.
Coordination of the different levels of the health care system: reference and counter reference.
Standardized and repeatable model.
OSI Business Model 7. Characteristics
-
04
Use of expensive resources Curative Medicine Specialist /physicians Unintegrated medical records Disease Focus Emergencies mostly treated at hospitals.
Cost efficient Preventive medicine. Multidisciplinary health team. Integrated medical records in a network Patient Focus Emergencies treated at the appropriate level
Traditional model Sanitass model
OSI Business Model 8. A comparison vs Traditional model
-
04
Specialized Clinic Hospital I - II
Hospital III IV
Medical Centers
Level III 5% - 10% of the demand. High cost.
Level II 10% - 20% of the demand.
Level I 80% health demand of the demand.
OSI Business Model 9. How we handle health care complexity level
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Risk Based Model
04 OSI Business Model 10. Base on Risk Management
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Integrated Medical Centers
Network
Health Insurance, Accessibility
Broad Customer Approach
Adaptive Health Plans
Ample Service
Panel
Primary Care
Specialty Care
Vaccinations
Imaging & diagnostic
Laboratory
Walk-in urgent care
Prescriptions Wellness Programs
Dental Programs
Premium Products
Group Insurance
Individual Insurance
Family Insurance
Other Specific Products
Public Plan Management
Basic Health Insurance
Health Management
Drivers
Key Success
Factors
Alignment of goals between insurer and provider
Interdisciplinary Medical Team and competencies
Complexity and chronic disease management
Healthcare promotion and prevention activities
Risk Screening and Management
Disease Management
Health Maintenance
Community
Members
OSI Business Model 11. Summary of Business and Value Model 04 A vertically integrated approach Integrated Insurance / Healthcare Services Health Value management Multiple complexity approach, focus on primary care Adaptability to multiple health systems (public, private, mixed).
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In 1993, the sanctioning of Law 100 promoted healthcare under the following values:
Efficiency: best use of financial and social resources
Universality: protection for all.
Solidarity: mutual-help.
Fullness: sufficient coverage.
Unity: common goal.
Participation: community involvement.
Providers
Insurers
Government SGSSS
Public Health Market Structure
FOSYGA
EPS Private +80%
EPS Gov.
Contributions
Capitations
Network Private
Network Integrated EPS Network
Network Gov.
Third Party Network
Budget
Contributions
Subsidized
OSI Public Health Management Background 1. The Colombian Experience (1) 05
-
Providers
Insurers
Government
+ 1.5 million POS members
insured
51 dedicated Primary Care centers for POS members
Clnica Universitaria Colombia
Primary Care Network
Public Health Market Structure
Sanitas provides insurance, health
management and provides services to
Mandatory Health Plan (POS) members
through EPS Sanitas and Clnica
Universitaria Colsanitas respectively.
OSI Public Health Management Background 1. The Colombian Experience (2) 05
498 hospital beds for POS members
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High blood pressure
International studies establish a coverage of 60 70 % and a control level of 70 80 %. Notes:
In-program patients: Patients diagnosed with HBP that have had their blood pressure controlled over the last 6 months.
Diagnosed patients: Patients currently diagnosed with HBP.
Controlled patients: Patients with SBP
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Diabetes Mellitus
International studies establish a optimal coverage between 60 70 % and a optimal control level of 40 50 %.
Notes:
In-program patients: Patients diagnosed with Diabetes and control consultations over the last 6 months.
Diagnosed patients: Patients currently diagnosed with Diabetes.
Controlled patients: POS-only high-risk final users controlled (stage 5 with HB1C
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126 114
54 64
10
INDONESIA PHILIPINES VIETNAM COLOMBIA OSI COLOMBIA
Maternal Mortality Rate (per 100,000 live births)
23 22
17
14 12
INDONESIA PHILIPINES VIETNAM COLOMBIA OSI COLOMBIA
Infant Mortality Rate (per 1000 live births)
5.400 infants are dying every year in SEA 3.000 mothers die every year giving birth
Most of them are preventable
OSI Public Health Management Background 2. Challenging Health Indicators (Maternal and children mortality) 05
Source: World Bank 2015 and OSI
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OSI Public Health Management Background 2. Challenging Health Indicators (Performance Indicators) 05
0
1
2
3
4
5
6
04/1
3
07/1
3
10/1
3
01/1
4
04/1
4
07/1
4
10/1
4
01/1
5
04/1
5
07/1
5
Waiting Times (General Consultations) days
Oportunidad Mximo
Performance Indicators
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Sanitas as an ideal partner in the public health sector
Relevant background in Public Health Management.
Vertically integrated to seek efficiency and improve patients health and user experience
Capacity to work with proprietary country-wide healthcare network and third party providers
Capacity to manage proprietary broader health products and public coverages
Strategically focused on providing access to healthcare in high-volume, low-income, high-footprint countries with Basic Health Coverage health plans.
Multi-country experiences to gain better understanding of local needs and best practices.
Health indicator oriented.
Sustainable long term growth model, paced with the populations health goals.
Capacity to collaborate in health regulation and coverage system definitions and improvement with governments, based on Colombian experience.
OSI Public Health Management Background 3. Summary 05
-
We focus on partnering and involving both public and private sectors, generating developmental opportunities with cross-participation
Public
Sector
Private
Sector
ADB
Healthcare network operators aiming at efficiently balancing healthcare services and facilitating access to their network with an appropriate health plan.
Health Insurance Companies willing to reduce medical cost and access to broader insured base with a lower income product or public insurance compatible
Multilateral Institutions: as entities acting as financial sponsors and stewardess of the implementation a viable country-scale inclusive healthcare solution, not as mere financiers of health infrastructure.
Central, regional or local governments, public health and social security agencies willing to resolve the populations health needs, efficiently manage budget / health expenditure and transfer financial and economic risks to private sector while accomplishing the health mandate
OSI Target sectors 06
-
Development of Primary Care Network with local partners.
Involvement in improvement and management of regional government facilities.
Indonesia
Philippines
Vietnam
Developments Goals and outcomes
Acquisition and capitalization of an existing medical center as an expansion platform
Negotiations to take on operation of a provincial network of hospitals and cross-municipal healthcare facilities through a PPP scheme.
Development of a no-balance billing oriented maternity clinic network.
Increase service delivery efficiency and overall network outcome
Improve network health outcome through 5P model implementation
MDG as a central element
Development to paediatric services and family primary care
Provide quality services under BPJS rate schemes
Increase management efficiency and accountability of financial and health indicators
Increase low participation of private sector in healthcare industry and implement primary care priority
OSI in South East Asia Current Relevant Developments 07
-
We acknowledge ADB is willing to grow its healthcare lending portfolio while increasing the
externalities with a stronger involvement in the value chain, leading to Projects
Comprehensive integrated
Viable and efficient
Health outcome-driven
with a broad scope (involving health access and services) and broad geographical footprint
defined, structured and managed professionally with positive economic and financial results.
with clear and measurable health indicators
focused on the least privileged and with the involvement of the main stakeholders
in which ADB has a creating and steering role and is identified together with other sponsors
OSI and ADB Our understanding of ADBs Health Strategies and Goals 08
Inclusive Healthcare
Beyond Financing: ADB added value and Brand recognition
-
Joint objective and efforts lead to successful development
Project Debt Funding (infrastructure and equipment)
Guidance
Branding
Institutional Support
Opportunity generation, project definition and development
Primary care product definition and commercialization
Efficient healthcare network operation
Join tablework:
o Project feasibility
evaluation
o Due Diligence
o Internal Approvals
PPP definition
Equity funding
Project steering
Asia Development Bank
Sanitas
OSI and ADB Collaboration Proposal 08
-
Example Collaboration Structures for Public Health Sector
Public Ownership with ADB Funding
Government PPP Vehicle
ADB
New Medical
Center
Network
Insured
Members
Existing
Network
Capitation
or other
Transfer
Sanitas Management
Funding
Coverage
Steering & Stewardship
Improvement
Appropriations
Ad-hoc Public Private Partnerships Existing framework enabled private
sector participation in public health
New regulatory enabling framework
OSI and ADB Collaboration Proposal 08
-
Example Collaboration Structures for Public Health Sector
Private Ownership with ADB Sanitas Co-Funding
Government Sanitas
ADB
New Medical
Center
Network
Insured
Members
Existing
Network
Co-Funding
Coverage
Capitation or other
Management
Improvement
Appropriations
Ad-hoc Public Private Partnerships Existing framework enabled private
sector participation in public health
New regulatory enabling framework
OSI and ADB Collaboration Proposal 08
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Contact Jaime Escallon Vice President Sales International Division +57 315 344 9857 [email protected] Pablo Ochoa de Zabalegui Country Director Philippines +63 917 323 62 89 [email protected]
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Annexes
A1 Relevant Sanitas Medical
Centers
18.02.16 Health centers 30
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Hospitals
Clnica Reina Sofa (Bogot - Colombia) Clnica Universitaria Colombia (Bogot - Colombia)
Unit # Beds
Pediatrics 24
Adults 91
Labor & Recovery 6
Maternity 5
Maternity 11
Intensive 4
Basic 8
Minimum 3
Neonatal NICU 15
Intermediate Care 3
Intensive Care 6
Cardiovascular ICU 0
ICU 9
Pediatric NICU 0
Total Beds 150
ORs Surgery Rooms 8
Unit # Beds
Pediatrics 44
Adults 198
Labor & Recovery 12
Maternity 0
Maternity 12
Intensive 6
Basic 13
Minimum 6
Neonatal NICU 25
Intermediate Care 6
Intensive Care 13
Cardiovascular ICU 15
ICU 34
Pediatric NICU 6
Total Beds 319
ORs Surgery Rooms 10
January 21, 2016 CONFIDENTIAL 31
Relevant Sanitas Medical Centers A2
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Clnica Iberoamrica (Barraquilla - Colombia)
Unit # Beds
Pediatrics 8
Adults 62
Labor & Recovery 5
Maternity 0
Maternity 5
Intensive 7
Basic 4
Minimum 3
Neonatal NICU 14
Intermediate Care 0
Intensive Care 8
Cardiovascular ICU 2
ICU 10
Pediatric NICU 0
Total Beds 99
ORs Surgery Rooms 7
Clnica Sebastin Belalczar (Cali - Colombia)
Unit # Beds
Pediatrics 14
Adults 43
Labor & Recovery 0
Maternity 0
Maternity 0
Intensive 4
Basic 4
Minimum 0
Neonatal NICU 8
Intermediate Care 0
Intensive Care 5
Cardiovascular ICU 0
ICU 5
Pediatric NICU 0
Total Beds 70
ORs Surgery Rooms 6
January 21, 2016 CONFIDENTIAL 32
Hospitals
Relevant Sanitas Medical Centers A2
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Clnica Santa Paula
(Caracas - Venezuela)
Clinisanitas Bucaramanga
(Colombia)
Clinisanitas Doral
(Florida - USA)
Clinisanitas #96
(Bogot - Colombia)
EPS Sanitas UAP
(Bogot - Colombia)
Clinisanitas Colina Campestre
(Colombia)
January 21, 2016 CONFIDENTIAL 33
Other hospitals and ambulatory centers
Relevant Sanitas Medical Centers A2