Rhon Klinikum CFO and CTO presenting at mHealth Israel meetup event in Tel Aviv, Oct, 2015. Peter Neumann, CFO and Board Members, Martin Scherer, Head of IT Operations, as well as the Head of Rhon Klinikum's €50 million venture capital fund
Levi ShapiroFounder, mHealth Israel at mHealth Israel
2. 2
Disclaimer
• This document has been prepared by RHÖN-KLINIKUM AG (“RHÖN-KLINIKUM” or “the Company”) for information purposes only, solely for use during this presentation. It must be treated
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forward-looking statements set forth herein or to adjust them to future events or developments. Further, this presentation contains market, price and performance data which have been
obtained from Company and public sources. The Company believes that such information is accurate as of the date of this presentation. The information contained in this document has
not been independently verified, and no representation or warranty, express or implied, is made as to, and no reliance should be placed on, the fairness, accuracy, completeness or
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as defined in the Financial Services Markets Act 2000, or FSMA, and the Code of Market Conduct, made pursuant to the FSMA, which would amount to market abuse for the purposes of
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• This document is given in conjunction with an oral presentation and should not be taken out of context.
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RHÖN-KLINIKUM AG - October 2015
3. Content
1 Business Model and Investment Strategy for Digital Health
2 Network Medicine and IT Strategy
3
- Appendix
RHÖN-KLINIKUM AG - October 2015
4. 4
RHÖN-KLINIKUM at a Glance
Group revenues € 1,080m to 1,120m
EBITDA € 145m to 155m
Total number of beds in the market: 500,671 3)
GUIDANCE
FY2015
Ownership in German
hospital market
Germany’s first listed hospital operator
The only publicly listed pure-play on the German acute-care
hospital sector
Focus on specialized and high end-medicine
5 locations with 5.300 beds
>15,000 employees
~ 1.5% of the total German hospital market 1)
~ 8% of the German private hospital sector 1)
1) Based on number of beds of RHÖN-KLINIKUM/total beds and ø-CMI of ~1,5 per bed
2) Based on statutory and private insured patient revenues
3) latest available total number of beds in the market as of 2013
(Source: Federal Bureau of Statistics Germany ‚Grunddaten d. Krankenhäuser‘, Sept 2014)
German hospital market 2)
Total hospital expenditure ~ €80bn
10Y CAGR +3,5% p.a.
public
tax-
exempt
charity
investor
owned
34%
18%
48%
RHÖN-KLINIKUM AG - 1 - Business Model and Investment Strategy for Digital Health
5. 5
Next Big Market Catalyzer:
Digital Health & Network Medicine
RHÖN-KLINIKUM AG, as of May 2012
Digitalization Disruptive transformation of health systems towards better medical supplies along
the chain of medical care and IT driven efficiency gains from coordinated care
Network
Medicine &
Big Data
intelligence
Innovative, more patient friendly treatment approaches
Next level of transparency, health consciousness and patient orientation from
better access to health information and increasing use of wearables (e.g. Dr.
Google, electronic health file, healthcare apps)
Further shift from inpatient to outpatient treatment and set up of network
solutions between doctors and patients as well as among doctors and other
healthcare providers (eg tele monitoring of stroke/heart patients, virtual
medical advise)
Personalized medicine with less side effects from increasing amount of available
health data collected via wearables, biobanks, next generation sequencing and
better big data analysis tools (bioinformatics, cognitive diagnosis tools, cloud
computing, text data mining)
Saving potential from less redundancy in diagnostics and therapies
6. 6
Digital Health in Germany is lagging far behind
Huge growth
opportunities
for innovative
health
providers
„Medicine 1.0 versus Internet 4.0“:
Germany traditionally more reluctance at patients and doctors:
non-transparent, atomistic and
decentralized provider structure
traditionally rigid sector boarders
between outpatient and inpatient
and between acute, rehab and
nursing care, partially paid from
different insurance schemes
high data security fears
patient feels „at the mercy“ of
an obscure system
But currently strong political will and dynamic to force digitalization into the
German Health system (E-health law, digital agenda of Health Ministry)
set up of legal preconditions for secure and barrier free data transfers
(e.g. for electronic patient file and open telematic infrastructure)
First trials to develop new reimbursement solutions by health insurance
providers
RHÖN-KLINIKUM AG - 1 - Business Model and Investment Strategy for Digital Health
7. Mid- and Long-Term Growth Prospects
Strategic growth and business development at RHÖN-KLINIKUM
7
GENERAL
GROWTH
STRATEGY
I
Gain
additional
market share with
clear business
profile +3% to
+4% p.a.
Oppor-
tunistic and
accretive acquisi-
tions fitting our
portfolio
Net-
work medicine,
medical research and
technology driven
innovations
ORGANIC INORGANIC NEW BUSINESS AREAS
II III
LONG-TERM
Innovation Management and Technology Leadership in the Medical Field
Operation of internal innovation management structures (e.g. development of IT Alliance Platform)
Actively structured market surveys for suitable innovations (regarding rules of the German market)
Evaluation of incoming offers of innovative products (both, requested and unsolicited offers)
Formal structuring of participations in separate investment holding
7RHÖN-KLINIKUM AG - 2 - Innovation and Investment Strategy
8. Investment Strategy of Venture Holding
Investment Focus Target start-up companies with strong, growth-oriented
business model that is strategically relevant
Geographic focus: Germany, Europe (incl. Israel), North
America
Requirements of Target
Company
Product/concept based on leading technology that stands out
from competitors and for which product/market readiness is
imminent.
Our Goals Focus on long-term, advantageous partnership
Strengthening of our competitive position through access to
innovative solutions and markets
Generation of investment income
Investment Volume Individual investments up to EUR 2.5 million
Minority investment of around 25-30% intended
8RHÖN-KLINIKUM AG - 1 - Business Model and Investment Strategy for Digital Health
9. 9
List of criteria for assessing whether a target company offers innovative IT/medtech
solutions and is therefore of interest
On-site meeting between target companies (first assessment of product, management,
financial resources, experience, competitions, etc.).
Review of data, products, publications, etc. by Investment Committee (IC) and other RKA
experts from clinics regarding possible interest for clinic operations
Invitation to start-up companies to give a presentation to experts at one of our locations
Decision by IC whether there should be a pilot at a location (3-4 months)
At the same time, start of due diligence
Recommendation to management of the investment holding for investment through IC
General Investment Process
Searching for, reviewing and selecting target companies through 7 steps
I.
II.
III.
IV.
V.
VI.
VII.
RHÖN-KLINIKUM AG - 1 - Business Model and Investment Strategy for Digital Health
10. 10
Main Criteria for Initial Investment Appraisal
Closing efficiency gaps between patient and medical supplier
as well as between different sectors and providers with focus on
high-end acute and specialized hospital
outpatient centres
network medicine
Inter-sectoral
NetworkMedicine
Outpatient Centres (MVZ),
GPs, Specialists, other
(General) Hospitals in the
Region
Rehab, Elderly
Care, Nursing
Services
Maximum Care
and Specialized Hospitals
with focus on Cardio,
Neuro, Oncology, Pneumology,
Orthopaedics, Psychiatrics
Patient-centred processes and care
IT-based comprehensive integration of all value chain elements
RHÖN-KLINIKUM AG - 1 - Business Model and Investment Strategy for Digital Health
11. Content
1 Business Model and Investment Strategy for Digital Health
2 Network Medicine and IT Strategy
11
- Appendix
RHÖN-KLINIKUM AG - October 2015
12. 12
Future healthcare strategy
Network medicine as the future healthcare strategy
Navigation of the patient through the jungle of service providers
Disease pattern focusses on the correct clinic
Best possible healthcare of patient at appropriate place
Close proximity and short waits as additional requirement
Network medicine as the future healthcare strategy!
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
14. 14
Global prerequisites for
network medicine
The heterogeneous landscape of service providers must be organized
in transparent and plannable service alliances (networks):
Navigation of the patient through the jungle of service providers
Institutionalization of the alliance (contractual obligation of network
partners)
Regulatory framework for participation must be specified (mainly quality
parameters of the houses and comfort standards)
Rules and authorities for patient navigation (“anchor physician”, etc.)
Economical questions for cost and proceeds distribution must be resolved
IT working surroundings for network medicine must be established
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
15. 15
WE for healthcare
RKA and partners in network medicine
WE for Healthcare as umbrella organization
Helios, Asklepios and other as partners
Supplementary insurance model „Pluscard“
We for healthcare: RKA and Partners in network medicine
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
16. 16
The goals of network medicine
Patient and required expertise matching in the alliance
Reasonable allocation of resources based on disease pattern
Processing and usage of knowledge/data from alliance for optimal care of
patients (Big Data and healthcare research)
Establishment of IT platform for network medicine
Concrete goals of network medicine
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
17. 17
IT-strategy for network medicine
NEEDS (hospitals and medical practitioners):
routinely exchanging all information electronically (all participating
organizations)
data/information of care/treatment across the entire care continuum
(over all sectors)
a longitudinal patient record must combine documents like images,
encounters, labs …
extensive communication and collaboration capabilities have to be available
secure messaging, notifications, subscriptions and query access
(and of course) right IT-platform for network medicine
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
18. 18
MPI: Base element of the “IT-Alliance Platform”
HIS HIS
MPI
HIE
ID Request ID Request
Provide and
register
documents and
data
Search and query
documents and
data
Patient
Identity
Feed
MPI: Master Patient Index
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
20. IT Infrastructure for network medicine
We use the „ICW Solution Portfolio“:
Care Coordination
Care Management
Patient Engagement
Health Information Exchange
Master Patient Index
• Activities at a glance
• Overview of most recent documents
• Medications (issued and which dose)
• Vital signs (f.e. blood pressure, weigth)
• Personalized notifications
• Exiting allergies
• …..
Quick access to entire care
continuum
Open Standards instead of
proprietary Interfaces (IHE,
HL7…)
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
21. 21
Summary
Conclusio:
The Alliance Platform is just arising
Practitioners, specialists and hospitals are integrated
But:
Mobile devices are always be with us
Mobile Technologies enable new culture of treatement
Big Source of Data for “Medical Analytics”
Virtual-Reality doctors are booming
We need a strategy for including
the „mobile devices and the outcoming results“
Consequence:
RHÖN-KLINIKUM AG - 2 - Network Medicine and IT Strategy
22. Content
1 Business Model and Investment Strategy for Digital Health
2 Network Medicine and IT Strategy
22
- Appendix
RHÖN-KLINIKUM AG - October 2015
23. Bad Berka
Our Portfolio in Detail
Revenue > €165m*
Beds > 660
~ 43,000 patients
23
Bad Neustadt (Saale)
Revenue > €200m*
Beds > 1,440
~ 46,000 patients
Frankfurt (Oder)
Revenue > €135m*
Beds > 830
~ 78,000 patients
More than 2/3 of revenue line from growth segments:
cardiovascular, oncology, pneumology, neurology, special orthopedics and psychiatrics
* Revenues based on FY 2014 figures
UKGM Giessen-Marburg
Revenue > €570m*
2 locations in Giessen and
Marburg with > 2,200 beds
~ 420,000 patients
3rd largest university clinic
in Germany with
~ 80 divisions/institutes
RHÖN-KLINIKUM AG - Appendix
24. 61
82
34
46
0
10
20
30
40
50
60
70
80
90
04 05 06 07 08 09 10 11 12 13
billion€
Hospital revenues (core market segment for RHÖN-KLINIKUM)
Outpatient acute care (additional growth opportunities)
24
Sustainable Growth: The German Hospital Market
Healthcare expenditure in Europe in % of GDP
Healthcare expenditure in Germany in % of GDP
Source: OECD health statistics, current expenditure on health care (July 7, 2015)
Source: Federal Bureau of Statistics Germany, “Gesundheitsausgabenrechnung” (2014)
Acute care healthcare expenditure in Germany
CAGR +3.5%
CAGR +3.4%
Germany is among the top healthcare spenders in Europe
The healthcare sector on average grows faster than GDP
Patient and payment structure in German hospitals:
- patients insured in the statutory health insurance: ~90%
- privately insured patients ~10%
Resilient growth market with average rate ~3.5% p.a.
Source: OECD health statistics, current expenditure on health care (July 7, 2015)
11.1% 11.1% 11.0% 11.0% 10.9%
10.1%
8.9% 8.8%
8.5%
8.1%
7%
8%
9%
10%
11%
12%
in%ofGDP(2013ornearestyear)
9.7%
10.2%
10.7%
11.2%
11.7%
2001 2004 2007 2010 2013
trend
increase
11.7%
11.2%
10.7%
10.2%
9.7%
RHÖN-KLINIKUM AG - Appendix
25. 25
Source: Federal Bureau of Statistics Germany 2014
Rising life expectancy
Increase in proportion of elderly and multimorbid people
- Today, 28% of the total population is older than 60 years
- This share will increase to 32% in 2022 and to 37% in 2032
Increase in “lifestyle” diseases and chronically ill people
Structural rise in demand
Age structure in Germany
2014 2022
Men Women
I. Changing Demographic Patterns
New products and wider range of indications
- Access to new patient groups who were regarded untreatable in the past
(e.g., replacing heart valves at 80 year old patients)
Innovative, more patient-friendly treatment approaches
- Demand for minimal-invasive procedures or personalized medicine
Higher severity mix, additional patient groups, increasing efficiency
II. Progress of Medical Technology and New Treatment Methods
Organic Growth: Driven by Two Megatrends
RHÖN-KLINIKUM AG - Appendix
Editor's Notes
Very resilient market growth of roughly 3,5% p.a. over last 10Y for hospital expenditure from statutory and private health insurances in Germany
Outpatient market growth: ~ 3.3% (10Y CAGR)
Approx. 1.5% market share estimate based on beds/volume analysis with an average CMI - severity factor - of 1,5 per case
Innovative products at the intersection of IT and medical technology flood currently the healthcare market, with upward trend. Therefore, we have to map carefully the demand of RHÖN-KLINIKUM AG (aligned with the corporate strategy) to the available innovative products offered on the market.
We focus on three medical working environments: Hospital, Outpatient Centres, Network Medicince
Innovative products at the intersection of IT and medical technology flood currently the healthcare market, with upward trend. Therefore, we have to map carefully the demand of RHÖN-KLINIKUM AG (aligned with the corporate strategy) to the available innovative products offered on the market.
We focus on three medical working environments: Hospital, Outpatient Centres, Network Medicince
This multi-step process allows us to give our doctors and IT experts a deep insight into the product side of the start-ups, while at the same time achieving our own insight into the financial and legal capabilities and potential of the start-ups together with our external partner. Thus, by contrast to the established start-up industry, a large amount of the risk is already assessed in advance.
If the pilot is a success and we then roll out the product, we are ourselves effectively improving the valuation of the start-up, which is why we set out the valuation of the investment beforehand
Innovative products at the intersection of IT and medical technology flood currently the healthcare market, with upward trend. Therefore, we have to map carefully the demand of RHÖN-KLINIKUM AG (aligned with the corporate strategy) to the available innovative products offered on the market.
We focus on three medical working environments:
Hospital
Knowledge-based expert system
Innovative medical devices/ technology
Mobile devices/ apps
Resource logistics
Bio-signal sensor technology
Outpatient Centres
Delegation/substitution of practices care
Virtual consultation hour (amended with healthcare nurse)
Telemonitoring
Ambient Assisted Living (AAL)
Network Medicince
Web EPA+
Patient navigation,
Process monitoring
Big Data
Intelligent Practice-Systems
Innovative quality monitoring
Roughly 70% of our medical offer coming from deseases of civilisatzion major growth segments in inpatient services
traditionally cardio and neuro (heart and brain attacks and subsequences)
most complex and intensive care cases in high end medicine are linked with oncology and pneumology
Current trend in industrialised countries: psychiatrics and special orthopadics incl. neuro surgery