The document provides an overview of the Brazilian healthcare market, highlighting the dual public and private systems, the role of the National Health Agency (ANS) in regulating healthcare, and the rising demand for private health coverage. It discusses the shift towards population health management (PHM) aiming to promote health and prevent disease, and outlines the goals and plans for the ASAP organization, which seeks to consolidate best practices in health management. Additionally, it points to significant opportunities for growth within the healthcare sector, particularly concerning chronic disease management.

1. Brazil Healthcare Market &
ASAP Launching
17th. October 2012
Andre Gibrail
ASAP member of Board of Directors
AxisMed COO - Chief Operating Officer
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2. Brazil in Brief - Overview
Estereotype
Soccer
Pele
Caipirinha
Rio de Janeiro
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Samba
Amazon
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3. Brazil in Brief - Overview
São Paulo City
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11 million people
19.8 million pets
6.5 million vehicles
148 Universities
110 museums
160 theaters
Unique town w/ 4 Tiffany’s stores
Largest fleet of helicopters, jet
aircrafts and cabs
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4. Brazil in Brief - Overview
São Paulo City
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1st. “Japanese city” out of Japan
1st. “Portuguese city” out of Portugal
1st. “Spanish city” out of Spain
3rd. “Lebanese city” out of Lebanon
3rd. “Italian city” out of Italy
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5. Brazil in Brief - Overview
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6. Brazil in Brief - Overview
Area:8.5 million km2 – 5th largest
Inhabitants:193 million (2009)
Government: Presidential federal republic
President: Dilma Rousseff
Official language: Portuguese
Currency: Brazilian Real (BRL)
Urban Rate: 84%
Nativity Rate: 15,77 / 1.000 inhabitants
Child Mortality Rate: 22,5 / 1.000 inhabitants
Life Expectancy: 73.4 years
HDI – Human Development Index: 0,699 (high human development)
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7. Brazil in Brief - Overview
Economically Active Population: 62%
GDP : US$ 2.4 tri 7th largest
GDP per capita: 12,144 USD
Inflation 2011: 6.5%
Interest rate: 7.4%
Exports: US$ 256 bi 2011 – Commodities, airplanes, vehicles
Imports: US$ 226 bi 2011
S&P/Moody´s rating: Investment Grade
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8. Brazil in Brief - Overview
Economic Momentum
Economy: Stable with significant growth
Population: Annual Income Increase
Broadening of the “middle class”
39 million people became middle class in the last 10 years
High growth of total outstanding credit in financial market
Government social programs decreased extreme poverty
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9. Brazil in Brief - Overview
Demographic Analysis
Proportion of Elderly Population
From 1980 to 2000:
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Fecundity: 4.4 to 2.3
children per woman
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Elderly population
growth 107%.
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1980
2000
2025
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Meanwhile growth rate
for group under 14 yrs
of age only 14%
Source: Secretaria de Vigilancia Sanitaria - Brazil
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10. Brazil in Brief - Overview
Chronic Diseases
80.5%
69.4%
31.7%
Source:
IBGE/PNAD 2003
Source: IBGE/PNAD
2003
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11. Brazil in Brief - Overview
Demographic Analysis
Chronic Diseases
Source: IBGE, 2008
(1) Include: Tendinitis or tenosynovitis (5.0%), chronic kidney disease (3,3%) and cancer (2,5%)
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12. Brazil in Brief - Overview
Brazilian Health Care Model – Public x Private Sector
• Public sector – SUS (Unified Health System)
– Government-run public healthcare system
– Around 150 million people
– Universal and comprehensive care (From basic
prevention to organ transplants)
– Family Health Program: multidisciplinary teams responsible for
attendance families at circumscribed regions.
• Currently covers 95% of total (5.290) city councils
• Private sector
– 48.7 million people
– Business Models:
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Self-Managed Plans,
Health Maintenance Organizations,
Health Co-Operatives of Physicians, and
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13. Brazil in Brief - Overview
ANS – Healthcare National Agency
• Regulatory Agenda – 9 themes
– Financial Model of the sector – looking for best ways to finance the elderly
– Ensuring access and quality of care – quality and quantity of network providers
based on the number of members
– Payment model to suppliers – starting discussion on P4P
– Pharmaceutical assistance – bring PBMs initiatives for people with common
chronic diseases
– Incentive to competitiveness – standardizing and making public main KPIs
– Access to information – making ANS’s website and publications become a
reference for the stakeholders: members, health plans, providers and society
– Old contracts – Incentives to adapt the contracts signed before the regulation
– Care to the elderly – Incentives to provide a preventive and
holistic care
– Integration between private and public sector – Members ID
unification to reduce overlays
Source: ANS
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14. Brazil in Brief - Overview
ANS – Healthcare National Agency
• Disease Management and Wellness Promotion
August 2011 – ANS publish 2 “Regulatory rule making” to incentive the
implementation of disease management and wellness programs by
Health Plans.
Nowadays, there are 760 programs registered and approved by ANS
covering 1.2 million beneficiaries.
Programs focus on: physical activities, healthy eating, cancer prevention,
sexually transmitted diseases, osteoporosis, hypertension, diabetes,
smoking cessation and obesity.
Another focus is the health of the elderly
Source: ANS
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15. Brazil in Brief - Overview
ANS – Healthcare National Agency
• Disease Management and Wellness Promotion Results
– Reduced exposure to risk factors such as physical inactivity, inadequate nutrition
and smoke;
– Adoption of health habits;
– Increased functional ability;
– Increase use of preventive screenings and early treatment of cancer;
– Reducing rate of hospitalization for chronic diseases;
– Changes in habits and home environment to prevent falls in the elderly;
– Proven financial return on the investment made
by Health Plans in the Programs
Source: ANS
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16. Brazil in Brief - Overview
ANS – Healthcare National Agency
• Disease Management and Wellness Promotion – Examples of
Results
70.4% Reduction in the number of hospitalizations in the elderly
11.8% Reduction of fractures in people over 85 years old
18.8% Reduction in demand for care in emergency rooms
92.1% Patients with high BP controls BP
62.3% People who lost weight after 8 months
63.5% Diabetic patients controlled (glycated hemoglobin less than 6.5%)
83.3% Patients with controlled dyslipidemia (LDL <130)
Source: ANS
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17. Brazil in Brief - Overview
ANS – Healthcare National Agency
• Disease Management and Wellness Promotion
“It is a paradigm shift: the goal to the health system should be promote
health and, not only, to treat diseases. The ANS invites Brazilian society
to participate in this change”.
Mauricio Ceschin – President of ANS
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18. Brazil in Brief - Overview
Foundation of ASAP
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19. Identifying the problem
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Focus on disease and not on health
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Lack of coordinated and sound practical actions
and theoretical content on health promotion and
disease prevention.
3
Lack of a forum focused on the consolidation of
best practices on health management
4
Lack of standardized actions and predefined
metrics.
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20. Identifying the problem
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Need of health indicators for measuring even more reliable
and impartial.
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Carrying out actions by companies, in an isolated
way, with poor integration
Doubts about the return of the programs of health
promotion and disease prevention.
Communication failure with stakeholders regarding
the results and benefits of PHM.
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21. Challenges continue to face
Life expectancy of the population continuously increasing:
Technological advances in medicine;
Development of pharmacology;
Democratization of the access to information.
The challenges are magnified, bringing questions to health managers.
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22. Questions
How to transform a reactive model of health in a
proactive system?
How to define actions against the explosive growth
of chronic diseases?
How to disseminate and replicate best practices?
How to measure the quality of services and
outcomes?
How to manage the risks of health preventively?
How to optimize health costs without sacrificing
quality?
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23. Population Health Management-PHM
The Population Health Management
has all the virtues and strategies to address
these challenges.
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24. Population Health Management-PHM
Population
Determinants
of Health
Access to healthcare
Environment
Stratifying Risk
Genetics
Healthy or risk not Identified
Risk Identified
In treatment
High complexity
Intervening on health
Management of
Health Risks
Awareness and health
Promotion
Monitoring,
Orientation and
Support
Case Management
and coordination
Habits
Measuring Results
Operational Indicators
1
Economic,
Financial,
and
Actuarial
2
Analysis
Of
Use
3
Organizatio
nal
Productivity
Health Indicators
4
Adherence
and
satisfactions
with
programs
5
Clinical and
Health
Status
6
Prevention
Indicators
7
Behavioral
Change
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Quality of
life
and wellbeing
Source: Adapted from CCA outcome guidelines #5
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25. Foundation of ASAP
With a new vision of health,
ASAP is born with the clear purpose
to promote an alliance between all
stakeholders, working for the outcomes,
results and progress, as well as best
practices. This framework is clearly
understood and applied in health
promotion to different populations, with
results even more effective and viable.
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26. Objectives of ASAP
Main objectives of ASAP are:
Bring together companies and
institutions
that operate, manage, and interact,
either directly and indirectly to
Population Health Management.
Provide knowledge to stratify
and reduce risks
in a systematic manner,
within scientific methodologies
with proven results and gains.
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27. Partnership
The CCA is an institution
recognized internationally that,
in the last decade, led the
convergence of U.S. companies
and other parts of the world who
work within the value chain of
PHM, establishing standards and
metrics that become
reference for the Industry.
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28. Timetable
2012: ASAP “flight departure”
Launching of
ASAP on the
web
Launching of
ASAP
September/12
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29. Timetable
2012: ASAP “flight departure”
Pos CCA
Forum event
Launching of
ASAP on the
web
Launching of
ASAP
September/12
October/12
FORUM CCA
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Goal: Achieve
42 members to
ASAP
November/12
December/12
“Tropicalization
light” of CCA
material –
Outcomes
Guidelines”
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30. Timetable
2013 to ASAP
In 2013, we plan to :
Consolidate the importance of its creation;
Build the initial technical basis;
Attract new members.
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31. Timetable
1st. Semester of 2013
Hire a new
technical
manager /
coordinator
1st. ASAP
Workshop
January/13
March/13
Launching of
monthly
electronic
newsletter
with scientific
content
Visit to
CCA
1st.
ASAP Forum
April/13
May/13
Research to
demonstrate the
maturity of the
Brazilian market in
PHM
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June/13
Monthly visits to the
companies that run
PHM programs in
Brazil
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32. Timetable
2nd. Semester of 2013
Offering
package for
managers to
participate in the
CCA Forum13
July/13
2nd. ASAP
Workshop
August/13
Launching of
Good Practices
Guidelines
Visit to
CCA
September/13
October/13
Participation in
the Fórum of
CCA and road
show
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3rd. ASAP
Workshop
November/13
December/13
Goal: Achieve 100
members
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33. Foundation of ASAP
Members of the Board of ASAP
Fábio Abreu
Paulo Marcos Souza
Michel Daud Filho
Maurício da Silva Lopes
Luiz Carlos Monteiro
Paulo Hirai
Maria Cristina Nader
Claudio Tafla
Marilia Ehl Barbosa
José Antonio Diniz de Oliveira
Fernando Fernandes
Regina de Arruda Mello Blanco
Pedro Luis Gonçalves Ramos
Antonio Pedro de Oliveira
André Gibrail
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34. Foundation of ASAP
Summary of Brazilian HealthCare Market
Growth Opportunity
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35. Foundation of ASAP
Summary of Brazilian HealthCare Market Growth Opportunity
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36. Foundation of ASAP
Summary of Brazilian HealthCare Market Growth Opportunity
Rising demand for private coverage
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37. Foundation of ASAP
Summary of Brazilian HealthCare Market Growth Opportunity
Market Consolidation Opportunity
Top 15 plans cover 40.8% of the
private market while 1,163 cover the
other 59.2%: Consolidation
opportunities exist
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38. Foundation of ASAP
Is there a room for PHM in this Market?
Large market to explore
High growth potential
Can be applied to both private and public sector
Chronic diseases are responsible for more than 70% of deaths
WHO forecasts deep changes in Brazil´s epidemiological profile from
2005 to 2015:
More than 10 million people will die due to a chronic disease
Deaths caused by chronic disease will rise 22%, specially by diabetes
which will rise 82%
ANS is focused on promoting PHM
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39. “ It is not because things are difficult that we do not dare,
it is because we do not dare that things are difficult.”
Seneca
Roman Stoic philosopher
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40. Thank you.
www.asapsaude.org.br
Andre Gibrail
andre.gibrail@asapsaude.org.br
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