Future Challenges of Clinical Development; a View from the CRO - Hani Zaki
For Cancer Center and Ins Co consideration v4 2
1. THE CHALLENGE OF
ACHIEVING WORLD
CLASS CANCER CARE
AND GROWING LONG
DISTANCE CANCER
ADVISORY AND GENOMIC
TESTING IN EMERGING
MARKETS
GLOBAL CARE, EVERYWHERE”
2. EXECUTIVE SUMMARY
This presentation explores these needs and details the potential opportunity to be developed and a
way to serve this need by developing service networks linking US Genomic Labs and Cancer Centers
with international patients in Emerging Markets; TestAnalytika as a Value Added Integrator enables
this relationship
Confidential and for discussion only 2
Talks:
3 dozen top oncologists
Survey:
50+ oncologists
Problems affecting patients:
1) Ordering and Follow up
2) Certified translations
3) Payments & Logistics
4) US advisory and know how
5) Insurance Co. buy in
Solutions- access to:
- Advanced genomic tests & results
- Referential Treatment Protocols & Diagnostic
Decision Support
- Cancer Management techniques and US
Cancer Center Long Distance Advisory
- Insurance Coverage & Prepay payment aids
Not available in Emerging Markets
- Support in locating, ordering and
interpreting US based molecular diagnostic
Genomic Tests
- Easy access to US based Cancer Center
Support
3. THE CHALLENGE OF MAKING A HIGHER LEVEL OF
CANCER CARE ACCESSIBLE FOR EXPATS
8/28/2015Confidential and for discussion only 3
Top level cancer
diagnosis &
Genomic Testing
The Gap
• Affordability / Lack of insurance
Coverage
• Lack of access and follow up
• Language barriers
• Logistics issues
• Interpretation of results
Expat Families
4. THE CHALLENGE OF MAKING A HIGHER LEVEL OF
CANCER CARE ACCESSIBLE FOR EXPATS
8/28/2015Confidential and for discussion only 4
Expat Families
• Insurance Coverage
• IT Platform for tracking and
follow up + EMR transmission
• Translation of results
• Coordination with Fedex
• Links with US Cancer Centers for
Remote Advisory and Diagnostic
Decision Support
Our Proposal
Top level cancer
diagnosis &
Genomic Testing
5. THE CHALLENGE OF MAKING A HIGHER LEVEL OF
CANCER CARE ACCESSIBLE FOR EXPATS
Confidential and for discussion only
The Gap is Closed
IMPROVING ACCESS TO
MEDICINES AND ONGOING
THERAPEUTIC SUPPORT WOULD
COME IN PHASE II
6. 8/28/2015Confidential and for discussion only 6
The
Challenge
The Target
Market
Our
Proposal
Go to
Market
Business
Plan Team
7. The Challenge
What the Problem is in Emerging Markets for Expats and Others
8/28/2015Confidential and for discussion only 7
8. CANCER INCIDENCE IN LATIN AMERICA AND CARIBBEAN (LATAM-C) IS
AROUND ONE MILLION CASES PER YEAR, CONCENTRATED IN FIVE MAJOR
CANCER TYPES AND WITH STRONG LONGTERM GROWTH
8/28/2015 8
The Challenge
9. CANCER INCIDENCE IN LATIN AMERICA AND CARIBBEAN (LATAM-C) IS AROUND 70% OF THE USA’S,
YET FIVE YEAR CANCER SURVIVAL RATES IN LATAM-C ARE ONLY 50% OF THE USA’S
8/28/2015Confidential and for discussion only 9
While Latin Americans contract cancer at
lower rates than residents of the United
States, they are nearly twice as likely to
die from it, the (Lancet) study said …
"If corrective action is not taken this
problem will become magnitudes of order
bigger than it is today, it will create
massive human suffering and it will
threaten the economies of the region," Paul
Goss, a professor at Harvard Medical School
who led the study, said at an event in Sao
Paulo on Friday. 04/26/2013
http://www.huffingtonpost.com/2013/04/2
6/latin-america-cancer-
epidemic_n_3165463.html
http://globocan.iarc.fr/ 2012
US vs LatAm-C Incidence and Mortality
50%
70%
The Challenge
Equal
10. TWO SOLUTIONS HAVE STOOD OUT FOR US TO ADDRESS:
1) ACCESSING US BASED CANCER CARE AND
2) ACCESSING US BASED CANCER LABORATORIES
US BASED CANCER CARE
Alliances between US
medical institutions via
partnership or sister
institution agreements
with leading LatAm
Hospitals and Medical
Centers
US BASED LABORATORIES
US Labs have
established alliances
with LatAm medical
and pharmaceutical
reps to represent
them and develop
business in LatAm
8/28/2015Confidential and for discussion only 10
The Challenge
IMPROVING
ACCESS TO
MEDICINES
AND ONGOING
THERAPEUTIC
SUPPORT
WOULD COME
IN PHASE II
11. US HOSPITALS HAVE LONG BEEN ATTRACTIVE FOR THE
INTERNATIONAL MARKET SEEKING TOP LEVEL CARE – BUT
LIMITED TO HIGH INCOME INDIVIDUALS
Confidential and for discussion only 11
http://www.forbes.com/2008/05/25/health-hospitals-care-forbeslife-
cx_avd_outsourcing08_0529healthoutsourcing.html
The Challenge
McKinsey & Co.:
Medical Travelers to USA
60K to 80K per year
Medical Travelers:
32% want better care
15% quicker access
9% lower prices
4% low cost procedures
Latin America has been
mentioned as representing a
proportionally higher number
of patients for US medical
centers
In Depth: U.S. Hospitals Worth
The Trip, but affordable only
by the top 1-3%
12. GENOMIC CANCER TUMOR PROFILING AND OTHER US BASED GENOMIC LAB
SUPPORT HAVE NOT GAINED MUCH TRACTION IN LATIN AMERICA VS.
INHERENT POTENTIAL
8/28/2015
FIRST WORLD GROWTH
12
The Challenge
LATIN AMERICAN CHALLENGES
“ We frequently encounter delays of up to three
our four months in receiving our biopsy results
because we have no direct contact with the
laboratory doing the genetic testing.”
- Argentine physician
“ We do not send many samples to the US
because for us the process is difficult and
complicated. Many of my colleagues do not
speak English.”
- Peruvian physician
“the process is slow, expensive and
complicated… it would be interesting to have an
easier method.. .Through our agreement with
Johns Hopkins, we have access to their
treatment protocols and opinions, but it is a
very slow and complicated process.”
- Chilean physician
13. BOTH SOLUTIONS HAVE UNDERPERFORMED vs
THEIR POTENTIAL (1)
Conflict between feeder model of bringing patients to the US and extension model of leveraging intellectual
capital overseas
Lack of a clear business strategy, low priority and subordination to US based growth or international exposure
in more important regions
Lack of clarity and alignment in relationship with foreign medical institutions
Informal definition of support relationship – frequently only dependent upon periodic teleconference case
discussions
No clear business model as to how to generate revenues and create mutual value from the relationship –
‘sister institution’ not linked to goals - ‘Ad hoc’ model of support only when called upon
Low level of accountability for growth or development of the relationship and no P&L responsibility
Not tied in to other global initiatives done by institutions such as development of Fellows, Post Doctorate
internships and use of international Alumni as a point of contact and growth
US institution may invest in the relationship and not develop channels to harvest many potential benefits
Separation between the Academic and the Clinical sides are failing to exploit synergies and economies of
scale, relationships and branding among the different areas – ‘feudal castles’
8/28/2015Confidential and for discussion only
EXPANSION OF US BASED CANCER CARE
The Challenge
14. BOTH SOLUTIONS HAVE UNDERPERFORMED vs
THEIR POTENTIAL (2)
1. Logistics issues and enrollment problems due to a limited non-US focus of these labs
and lack of flexibility for non-US patients in term of sign up (web pages focused on US
market only, US dollar payment only, English language results only).
2. Follow up on test progress and lack of “Concierge Service” - difficulty in following up
progress of clinical analyses through the laboratory and Annotation processes.
3. Difficulty in interpreting lab results due to language difficulties and limited MD
experience base in evaluating impact of genomic tests on therapies, lack of
Diagnostic Decision Support integrating Clinical History with test results and
Annotations
4. High out of pocket costs – USD 7,000 – 10,000 per case w/o insurance coverage in
practically all cases and problems with access to US Dollars in certain countries
5. Translation of results into local language; certification of EMR translations into English
6. Overall, a fragmented value chain and no one to integrate multiple players8/28/2015Confidential and for discussion only
US BASED GENOMIC LABORATORIES
The Challenge
15. LINKING US GENOMIC TESTING PLUS LONG DISTANCE CANCER
ADVISORY SERVICES COULD BE A POWERFUL ONE-TWO PUNCH
LONG
DISTANCE
CANCER
ADVISORY
SERVICES
US
GENOMIC
TESTING
Confidential and for discussion only
15
8/28/2015
• US based Cancer
Institutions are sine qua
non the leaders in Cancer
Care
• Expanding this intellectual
capital overseas is a
challenge, but one that, if
resolved, would support
both their Hippocratic and
institutional development
goals
• Genomic Testing is a
growing frontier and one
that US Cancer Centers are
developing aggressively
• US Genomic Testing labs
are focused on the US
Market, but their
capabilities and expertise
could jumpstart an
improvement in global
cancer care
• Limitations in outreach,
operations, fulfillment and
payment (insurance)
mechanisms limit their
ability to grow overseas
• The support of US Cancer
Centers would make their
services more accessible
and useable
The Challenge
Expandable to Neuro and
Cardio from Onco
16. WE BELIEVE THE CHALLENGE IS TO GET THE MOST OUT OF ADVANCED GENOMIC
TESTING BY BRACKETING WITH A SERIES OF SERVICES THAT MAKE IT MORE
ACCESSIBLE AND USEFUL TO INTERNATIONAL MDS AND PATIENTS
Financial,
Marketing and
Logistics
Support
Cancer Center
Advisory
Support
DDS
Genomic Test
8/28/2015Confidential and for discussion only 16
The Challenge
17. The Target Market
Who the Consumers are in Lat Am
8/28/2015Confidential and for discussion only 17
18. LATIN AMERICA PRESENTS MANY CONDITIONS THAT
MAKE IT APPROPRIATE TO LAUNCH A PROGRAM LIKE
TAK’S
MD’s have expressed a demand for the Service due to lower level of
familiarity with Genomic Testing
High economic growth centered around an emerging middle class
Tight links with the US and brand recognition of its medical centers
Private medical care is available for Medium and Higher income individuals
Age pyramid trending towards the peak Cancer years – 40+
Growing private insurance sector
Fairly open in foreign exchange conversion, although with roadblocks and
hurdles
8/28/2015Confidential and for discussion only 18
The Target Market
19. LATIN AMERICA PRESENTS A CONSOLIDATING AND
RAPIDLY AGEING MIDDLE CLASS WHICH IS OUR
TARGET MARKET
8/28/2015Confidential and for discussion only 19
The Target Market
20. OUR TARGET MARKETS IN LATAM START WITH PREPAY
AND THOSE COVERED BY INSURANCE AND WILL
EVENTUALLY GROW TO THE PUBLIC SECTOR
Current Sector-
Prepay/Selfpay
Clients
Target Sector-
those with
Insurance
Coverage
Final Sector –
Public Sector
Clients
8/28/2015Confidential and for discussion only 20
Around 3-5% or
18-30MM people
Around 15-18%
or 100MM people
Around 80% or
500MM people
Have the financial
wherewithal, but
lack the value
chain support
needed to utilize
these services
Could access these
services with
insurance coverage
and value chain
support
Could access these
services with Public
Sector help and
value chain support
The Target Market
21. LATIN AMERICA HAS A CLASS OF HIGHER NET WORTH INDIVIDUALS THAT WOULD
PAY TO USE THESE GENOMIC TESTS AND US CANCER ADVISORY SERVICES; THEY
COMPRISE 3-5% OF THE TOTAL OR 18-30MM OF THE 600 MM POPULATION
8/28/2015Confidential and for discussion only 21
Analisis Lambda International Consultants, Data base from respective sources in each country
Using 0.15% cancer
incidence rate, this
represents 30-50,000
cancer cases per year
PrePay individuals have
been hampered by the
logistics, fulfillment and
integration of multiple
players required to
access services,
irrespective of payment
capabilities
The Target Market
22. LATIN AMERICAN PRIVATE HEALTH INSURANCE COVERS 100MM PEOPLE – 4X
TO 6X MORE
Confidential and for discussion only 22
Latin American
Private Health
Insurance is a
USD 38BN
Industry
covering 100 MM
people
Reaching 1% of
insured would
be 1MM people
Country
% covered
Private
insurance
Population
MM
Number
Covered MM 1% of Insured
Argentina 10% 40 4.00 40,000
Brasil 30% 190 57.00 570,000
Chile 16% 17 2.70 27,000
Colombia 35% 45 15.53 155,250
Mexico (1) 8% 110 8.80 88,000
Peru 4% 30 1.05 10,500
Venezuela 9% 30 2.78 27,778
Total 20% 462 91.85 918,528
Other areas 10% 150 15.00 150,000
Total Latam-C 17% 612 106.85 1,068,528
Source: Mapfre Insurance, Latin American Health Systems, 2009;
(1) http://www.facmed.unam.mx/sms/temas/2010/03_mar_2k10.pdf
Analysis by Lambda International Consultants
8/28/2015
Insurance companies have
not had an external partner
to support them in
integrating the logistics,
fulfillment and integration
of multiple players
required to access services,
irrespective of payment
capabilities, in addition to
the outreach and other
support functions required
for international programs
The Target Market
23. WE ESTIMATE THAT 6MM IS THE ADDRESSABLE AND CAPTURABLE MARKET
FOR AN INSURANCE PROGRAM OFFERING GENOMIC TESTING AND US
CANCER SUPPORT= 1% OF THE POPULATION
8/28/2015Confidential and for discussion only 23
30
70
3 3
27
67
0
10
20
30
40
50
60
70
80
High Net Worth Insured Middle Class Insured
Capturable Market
Total MM Genomic Insurance Buyers Non Buyers
24. ENGAGING THE PUBLIC SECTOR WOULD ULTIMATELY ACCESS
MOST OF LATIN AMERICA’S POPULATION IN THIS INITIATIVE
Percentage of the Population in LatAm
Self Pay Insurance Public Sector
8/28/2015Confidential and for discussion only 24
• Public Sector users have neither
insurance nor PrePay-SelfPay
capabilities
• Nevertheless, they are a huge
number and incorporating them
into a program would reduce
cost and absorb fixed costs
enormously
The Public Sector is a more
long term goal, but once
the value and feasibility of
these Programs are
demonstrated in Private
Sector Initiatives, it is
certain that a percentage
of the Public Sector will
move to adopt similar
offerings
The Target Market
25. Our Proposal
What we Propose to the Consumers in Lat Am
8/28/2015Confidential and for discussion only 25
26. OUR PROPOSAL IS TO DEVELOP AN INSURANCE BASED SYSTEM
OF COVERAGE WHICH WILL ALSO SUPPORT SELFPAY/PREPAY
AND ULTIMATELY LEAD TO PUBLIC SECTOR ADOPTION
Prepay
TAK SUPPORT
PLATFORM
MEDICAL ,
FINANCIAL
INSTITUTIONS
AND MDs
Insurance
TAK SUPPORT
PLATFORM
BROKERS,
INSURANCE
COMPANIES,
AFFILIATED MDs
Public TAK SUPPORT
PLATFORM
PUBLIC SECTOR
INSTITUTIONS
8/28/2015Confidential and for discussion only 26
Our Proposal
PAYMENT CHANNEL EXECUTION/FULFILLMENT OUTREACH
FIRST PHASE
LATER PHASE
27. OUR SUPPORT PLATFORM WOULD USE INFORMATION TECHNOLOGY TO
INTEGRATE THE DIFFERENT PLAYERS STARTING AT THE INSURANCE
COMPANIES PLUS PROVIDE A SECURE DATA EXCHANGE, TRACKING AND
PAYMENT PLATFORM
8/28/2015Confidential and for discussion only 27
Our Proposal
DATA EXCHANGED
• Patient information
• Payor information
• Logistics information
INS CO.
PAYORS DATA EXCHANGED
• Test information
• DDS/Medical opinion information
• Patient Progress information
TRANSLATION
SERVICES
PAYEES
28. WE PROPOSE TO OFFER AN INTEGRATED LEVEL OF SERVICE TO MD’S AND
PATIENTS IN LATAM-C TO FACILITATE ACCESS TO US CANCER CENTER
SUPPORT AND GENOMIC CANCER TESTING
Leading Cancer Center Long Distance Cancer
Advisory Services and Consultations
1. PreTest Long Distance Cancer
Advisory Services for Patients in
stages I-IV
1. Prior to the execution of Molecular
Diagnostic tests
2. Could include genetic test for
inherited risks
2. PostTest Long Distance Cancer
Advisory Services for Patients in
stage IV
1. Following the execution of
Molecular Diagnostic tests
Molecular Diagnostic Laboratory advisory
and support
1. Send biopsies and samples for laboratory work in US
at Molecular Health or other labs
1. Molecular Health would be the supplier of choice for
genomic analysis, but pursuant to local MD selection and
approval
2. Support in logistics and processing
3. Translation of laboratory results
4. Secure platform for data transmission
5. Oncological review of genomic test results,
1. TAK’s pool of top oncologists would supply a review of the
test results providing Diagnostic Decision Support and
orientation in terms of Cancer Management for the patient
linking test results with patient EMR
6. The program is also investigating different value
added financial options, apart from basic insurance
coverage; these include:
1. Support in FOREX conversions if needed
2. Financing options for those that want to self pay, not insure
8/28/2015
Confidential and for discussion only
28
Our Proposal
Later
phases
would
include
testing for
hereditary
cancers in
Stages I-III
29. BASIC SERVICE – GENOMIC TESTING, MOLECULAR DIAGNOSTIC
LABORATORY ADVISORY AND SUPPORT – MOSTLY FOR STAGE IV
PATIENTS AS REQUESTED BY THE LOCAL MD
US Lab would perform Genomic Testing at its leading edge facility – Molecular Health has
been contacted and has a signed LOI to perform this service- others would depend on MD
request
Support in logistics and processing ensuring timely delivery of results
Translation of laboratory results and management of EMR transmissions via HIPAA approved
channels; hardcopy transmissions via Fedex or other carriers
Diagnostic Decision Support, Referential Protocols and Cancer Management support based
on test results (provided by external oncologists)
A Portal to assist Patient/MD/Pathologist would agglomerate relevant recent research in
order to assist the patient’s treatment and knowledge
Email support for the physician would be maintained for 30 days from date of delivery of
test results
Patients prior to Stage IV would not be covered in the Basic Service
Confidential and for discussion only 29
Our Proposal
30. PREMIUM– COMPLETE LONG DISTANCE CANCER ADVISORY AT A US CANCER
CENTER INCLUDING GENOMIC TEST, ADVISORY AND SUPPORT IF APPROPRIATE AND
REQUESTED BY THE LOCAL MD – FOR PATIENTS FROM STAGE I-IV
Patients in Stages I-III would proceed to a Complete Long Distance Cancer Advisory Service focused on
advising the local MD with transmission to the USA of all relevant EMR’s and other clinical information for
the US MD to make an informed evaluation of the case and alternatives.
Genetic test for inherited predisposition in children of affected parent could be included
Were this case to evolve into Stage IV then the local MD would have the option to order a Genomic Test
from one of the labs affiliated with the program- Molecular Health as the preferred provider. Patients that
enter already at Stage IV could start at the Molecular Diagnostic testing stage or the Long Distance Cancer
Advisory Service
US Lab would perform Genomic Testing at its leading edge facility – Molecular Health has been contacted and has a
signed LOI to perform this service as our preferred provider
Support in logistics and processing ensuring timely delivery of results
Translation of laboratory results
Diagnostic Decision Support, Referential Protocols and Cancer Management support based on test results provided by
external oncologists
A Portal to assist Patient/MD/Pathologist would agglomerate relevant recent research in order to assist the patient’s
treatment and knowledge
Email support for the physician would be maintained for 30 days from date of delivery of test results
The Complete Long Distance Cancer Advisory could occur before or after the Genomic Tests were in, with
timing depending on the results; In some cases it could precede and evaluate the usefulness of genomic
tests depending on local MD input.
Confidential and for discussion only
30
Our Proposal
31. OUR SUMMARY OF THE INSURANCE COVERAGE PROPOSED
8/28/2015Confidential and for discussion only 31
BASIC
SERVICE
Stage IV
only
Genomic Test
Diagnostic
Decision Support
PREMIUM
SERVICE
Stage I-IV
at
discovery
US CANCER CENTER
ADVISORY SERVICE
Our Proposal
Diagnostic
Decision Support
GENOMIC TEST
TIME LAPSE UNTIL STAGE IV *
* IF NO STAGE IV, GENOMIC TEST AND DDS REPLACED BY TWO FOLLOW ON US CANCER CENTER ADVISORY SERVICES; IN Stage IV TEST MAY PRECEDE ADVISORY SERVICE
US CANCER CENTER
ADVISORY SERVICE
OPTIONAL CASH PURCHASE
MH as preferred provider
MH as preferred provider of Genomic Test; Diagnostic Decision Support performed by one of the leading US Cancer Centers
32. STRUCTURED INSURANCE PRODUCT OFFERINGS – ESTIMATED
PRICE TO CLIENT IS AFFORDABLE TO THE MIDDLE CLASS
Latin America
Standard Pricing
(Family=4
people)
Insurance
Coverage USD
(Nominal Value)
Coverage
Starts at
Genomic
Test
Diagnostic
Decision Support
via US Oncologist
No of distance
consultations
With US Cancer
Center
Estimated annual
Premium
(actual figures
may vary)
Basic
Individual
USD 12,500 Metastasis
(Stage IV)
None USD 35
Basic Family USD 12,500 Metastasis
(Stage IV)
None USD 130
Premium
Individual
USD 17,500 Discovery
(Stage I,II or
III)
One Pre Test USD 70
Premium
Individual
USD 17,500 Discovery
(Stage IV)
One Post Test USD 70
Premium
Family
USD 17,500 Discovery
(Stage I,II or
III)
One Pre Test USD 200-225
Premium
Family
USD 17,500 Discovery
(Stage IV)
One Post Test USD 200-225
Our Proposal
Nominal Value is for Consumer evaluation only; Basic and Premium have costs defined on a per Company basis
33. THE USD 200 COST PER FAMILY IS LOW COMPARED
TO TOP LEVEL LOCAL AND GLOBAL/INTERNATIONAL
MEDICAL INSURANCE COSTS
8/28/2015Confidential and for discussion only 33
AVERAGES
BASED ON
INTERNATIONAL
AND LOCAL
COVERAGE FOR
FAMILY OF 4
34. OUR PROGRAM TO COMPLEMENT INSURANCE WAS
WELL RECEIVED IN LATAM-LAUNCH IS IMMINENT
TestAnalytika has launched its first policy into Latin America and the Middle
East via Redbridge
It expects to launch the second policy via a grey market broker in Ecuador in 35
days;
TestAnalytika has presented this program to insurance companies in LatAm
with strong response
TestAnalytika is also working with local financial institutions to establish a
payment plan for those who do not have insurance coverage
Part of this financing may be covered by credits in life insurance policies
Employee Benefit Plans have also emerged as a recent target of interest
Confidential and for discussion only 34
Our Proposal
35. WE HAVE CONTACTED MANY OF THE PREMIER US MEDICAL
CENTERS FOR SUPPORT
Leading Cancer Center Long Distance Cancer
Advisory Services and Consultations
1. Memorial Sloan Kettering (Oral
agreement in place with email
confirmation)
2. UM Sylvester Cancer Center (Oral
agreement- contract underway)
3. UC San Diego (In talks scheduled
for Sept 15)
4. Penn Medicine (Oral agreement)
5. Memorial Health System, FL (In
talks)
6. MD Anderson (Oral agreement)
7. UC San Francisco (Visit scheduled
for Sept)
Molecular Diagnostic Laboratory advisory
and support
1. Signed LOI with Molecular Health; Foundation
Medicine, others under review
2. Access if needed Genomic Labs at Memorial
Sloan Kettering, MD Anderson, UPenn, UMiami
8/28/2015
Confidential and for discussion only
35
Our Proposal
36. Go To Market
How to reach the Consumer
8/28/2015Confidential and for discussion only 36
37. INSURANCE COMPANIES IN LATAM ARE
CLEARLY IDENTIFIED AND TARGETED
8/28/2015Confidential and for discussion only 37
Go to Market
These companies could
be targets for taking on
risk themselves or
fronting underwritten
policy
38. OUR INSURANCE MARKET LOCAL PARTNERS
ARE SOLID FIRMS
COUNTRY GROUP OBSERVATIONS
Mexico MASA/others
pending
Third generation insurance executives
invoicing over USD 50MM in premiums with top
level access to all insurance companies
Brasil TBD In conversations with JLT, Marsh, other major
groups to complete alignment
Colombia Vista Financial
and Consulting
Boutique financial advisory firm that includes
the ex COO of Liberty Mutual Europe; also ex
CEO of LM Venezuela
Peru F4SI/others Regional foundation focused on Healthcare
and Education initiatives; participating as a JV
partner focused on Public sector
Ecuador PROANO Multiple allies among the top firms
Venezuela MaKler Strong local company with top flight
clientbase 8/28/2015Confidential and for discussion only 38
Go to Market
39. OUR WORKING RELATIONSHIPS ARE AIMED AT
MAXIMIZING SALES AND MINIMIZING INVESTMENTS
TAK has proposed a joint profit sharing relationship with the local partners,
reducing our share of capital expense and increasing traction in the markets
They share with us the insurance company commissions, in exchange for
supervision of the day to day relationship and the sales and marketing efforts
The S&M efforts would be paid for out of the 5% S&M fee
The local partner would also get a commission on each test sale resulting from the
insurance company relationship
Local Partner would be lead broker, supervising other brokers and leading Sales and
Marketing and Medical Education activities
8/28/2015Confidential and for discussion only 39
Go to Market
40. A KEY SALES AND MARKETING WILL BE TO INCREASE LATAM
MD’S AWARENESS AS TO GENOMIC TESTING AND THE
ADVANTAGES OF US CLINICAL SUPPORT
8/28/2015Confidential and for discussion only 40
Go to Market
25%
57%
18%
What percentage of patients would you perform genomic tests
on?
n=160 US MD's
Over 90%
In between
Less than 10%
Even in the US
there is an
enormous gap in
awareness of
Genomic Testing
41. OUR MARKETING STRATEGY IS A MIX OF TRADITIONAL AND
SOCIAL MEDIA USING 5% OF INSURANCE PREMIUMS
COLLECTED
25%
25%25%
20%
5%
TAK's Proposed Marketing
Budget
Trad. Detailing
E-Detailing
B2C Social Media
Events &
Hospitals
Trad. Media
8/28/2015Confidential and for discussion only 41
Go to Market
$-
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
Cost per Medical Center Per
Year
42. Business Plan
What the business would look like
8/28/2015Confidential and for discussion only 42
43. FOUR CHANNELS ARE AVAILABLE FOR US
WITHIN INSURANCE AND RELATED FIELDS
Traditional
Onshore
Insurance
Channel
(via Straight
Risk or Fronting
+Reinsurance)
Traditional
Offshore Grey
Market
Companies
Employee
Benefit Plans
via Insurance
based packages
Direct to
Consumer via
Online Access (
onshore or
offshore policy)
8/28/2015Confidential and for discussion only 43
Business Plan
44. OUR BUSINESS PLAN FOR A LOCAL PARTNER
LIKE YOU REVOLVES AROUND THESE AREAS
8/28/2015Confidential and for discussion only 44
Business Plan
1. Sell within and to your existing client base
1. Link up with a local onshore company that wants to develop or just front the
product
2. If legally viable, sell an offshore product as “medical travel insurance” – note that
all payments to providers are made in the US, no conflict with local insurance
regulators
2. Develop international executive benefits plan business through distribution
partners and existing corporate clients
1. May be via a Captive Insurer for tax benefits
2. May be via an offshore “Mutual Insurance Company” to reduce costs
3. Sell directly into new areas by use of internet and other channels
45. OUR CONSERVATIVE ESTIMATE FOR ARGENTINA IS
AROUND 15-20,000 PEOPLE COVERED- REACHING 1%
OF THE POPULATION WOULD BE 400,000 PEOPLE
Covering 5,000 families at USD
225/family means over USD 1,100K
premiums
Local Partner take of 20% is over
USD 220K
Additionally, 5% commission on
services provided upon cancer
incidence should generate USD 20K
more in fees
8/28/2015Confidential and for discussion only 45
Business Plan
0
2000
4000
6000
8000
10000
12000
14000
16000
Year 1 Year 2 Year 3
People Covered
People
46. Team
Who would run the program
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47. LIN GIRALT
Lin Giralt is Managing Director of Lambda International Consultants, LLC, Houston, TX and
Adjunct Professor, Jones Graduate School of Business at Rice University.
Lin has over 30 years work experience of which 20 years are in consulting. He started his
consulting career with McKinsey & Company and Booz-Allen & Hamilton leading projects
throughout all of Latin America and founded Lambda in 1997. His main focus is corporate
strategy, processes, organization and market entry strategies. His focus is on startups,
medium sized businesses and how to help them become more competitive in a globalized
economy.
In the medical field, Lin designed all the business and commercial processes for a major
plastic surgery clinic, reviewed the commercial strategy and logistics for a major
pharmaceutical products manufacturer and helped a distributor of prosthetic products
segment the market and develop a more effective go to market strategy.
Prior to consulting he served as Operations and Sales Manager for a family owned
agribusiness and Construction Manager for a series of office and industrial projects in the US
and overseas.
Lin Giralt is Chairperson of the Rice Graduate Alumni Committee and is also former Vice-
president of Houston’s MBA Council. In addition to a Rice M. Architecture degree, he holds a
B.A. from Duke University and an M.B.A. in Finance and Real Estate from The Wharton
School. Married (32 years), two kids, four cats, one dog. He is a Golfer and Squash player, a
student of history and military and business strategy
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Team
48. ZEKE WIMERT
Zeke Wimert has been a senior leader at Fortune-500, multinational and start up
technology companies, Zeke has extensive experience as a thought leader and
builder of profitable, high profile operations in various industries and markets,
both in the United States and Internationally.
He has held senior roles as CEO, COO and Senior Vice President-level assignments
at global companies such as National Semiconductor, Motorola and Oracle, as well
at successful start up organizations such as Unitools, AboveNet Communications
and OptiConnect. His industry expertise spans semiconductors, enterprise
software, telecom infrastructure products, high-availability internet networks,
and carrier voice and data services.
Over the past seven years as a consultant, he has been actively involved in
management and acquisitions of a wide range of companies in the US and
internationally, including direct management roles in turnaround situations in
exceptionally complex, fast-moving markets.
Zeke Wimert graduated from the United States Military Academy and received a
degree in Applied Engineering, followed by a Masters degree in Economics, with
honors, at the State University of New York at Stony Brook as well as graduate
work in Operations Research and Systems Analysis at Georgia Tech.
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Team
49. Our Team is building up, we hope this presentation
clarifies doubts and your organization can join us
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Team
EXECUTIVE
TEAM
INSURANCE
COMPANIES
& BROKERS
US CANCER
CENTERS
US GENOMIC
LABS
INVESTORS
“ McKinsey & Co. narrowly defined medical travelers as only those whose primary and explicit purpose in traveling was to obtain in-patient medical treatment in a foreign country, putting the total number of travelers at 60,000 to 85,000 per year.
In Depth: U.S. Hospitals Worth The Trip
…. Additionally, it's estimated that 32% of all medical travelers simply want better care than is available in their home countries, mostly those in the developing world, and 15% want quicker access to medically necessary procedures. That's compared to only 9% of medical travelers seeking medically necessary procedures at lower prices and 4% seeking low-cost discretionary procedures. ”
Latin America has been mentioned as representing a proportionally higher number of patients for US medical centers