This document summarizes a presentation on identifying targets for acquisition within emerging markets. It discusses questions companies should consider around where to focus internationally and whether they have the right approach for BRICS countries. Due diligence is important and requires understanding a country's healthcare system, regulations, and intellectual property protections. When investing, companies should evaluate a market's potential for scale, growth and influence against its viability. India and China are presented as top opportunities due to their potential and viability, but within-country variability exists. Timing of acquisitions is also critical. A case study of Narayana Hrudyalya, a low-cost hospital chain in India, demonstrates an assembly line approach to reducing healthcare costs.
“Engaging with health markets is going to be critical for governments in the future, especially given the recent UN resolution,” notes Sara Bennett, referring to a UN resolution urging countries to work towards affordable Universal Health Coverage (UHC).
Many country governments will need to purchase services from both public and private providers to achieve UHC. At the same time governments need to guard against arrangements that enable powerful stakeholders to consolidate their position in a health system that provides ineffective services at an unnecessarily high cost.
Policy-makers, entrepreneurs, academics and funders convened in Bellagio, Italy, in December 2012 to explore this tension. The result was the Bellagio Statement on the Future of Health Markets (http://bit.ly/XFrN4X).
To broaden the conversation, participants in the Bellagio meeting are holding a roundtable webinar. The webinar will be chaired by Dr Sara Bennett from Johns Hopkins School of Public Health, who convened the session in Bellagio.
Discussants include: Kelechi Ohiri, Senior Special Adviser to the Honourable Minister of State for Health in Nigeria; Kwasi Boahene, Director Advocacy & Program Development at the Health Insurance Fund; and Sikder Zakir, Founder of the Telemedicine Reference Center Ltd. (TRCL); Guy Stallworthy, Senior Program Officer at the Bill & Melinda Gates Foundation; & Dr Allan Pamba, Director Public Engagement & Access Initiatives at GSK.
An initial presentation will help set the scene, outlining the background to the meeting as well as highlighting key points from the resultant statement. Following the introduction, the discussants will offer their reactions to and commentary on the Bellagio Statement. The webinar will then shift to a ‘fishbowl’ format, where the speakers and other participants at the meeting will have an open discussion on some of the main topics from Bellagio. The webinar will wrap up with a question and answer session for all.
Requirements for reimbursement of new medical devicesMike Sanchez
Requirements for Reimbursement of New Device TechnologiesPresented at The MD&M Minneapolis Conference, Master class “Start-up Accelerator” on October 28, 2013.
Define Reimbursement
Coverage, Coding and Payment Systems
Reimbursement Assessment of New Technologies
Strategy Development and Planning
Wrap-up/ Q&A
Make or buy role of private sector in healthAlaa Hamed
The Role of Private Sector in Health, the economic argument on how to make decision to produce or to buy health services, Based on the book "Public Ends, Private Means", A chapter on the political economy of private sector participation in the health sector by Alex Preker and April Harding
Business development framework for gamechangersdianabe
Scale Business Group sponsored Executive Leadership session presented by Nathan Beckord of VentureArchetypes at GameChangers confernce. www.grow-california.com
Specific Detailed Changes to the New ISO 13485:2016Greenlight Guru
Today's medical device regulatory environment is changing faster than ever. Keeping up can be daunting. The new quality management standard ISO 13485:2016 was published in Q1 of 2016.
greenlight.guru has partnered with special guest and consultant, Mark Swanson, to keep you ahead of these changes.
Mark spent the last 4 years on the working group that revised the new ISO 13485.
Mark has all the exclusive insider knowledge on the changes you want. And he's going to be sharing it with you for free.
(You can view the full webinar here: http://www.greenlight.guru/webinar/iso-13485-2016-changes)
In this webinar you'll learn specifically:
-How to prepare for the coming regulatory changes with ISO 13485:2016
-How to apply risk based thinking to your quality processes to ensure compliance
-What you need to know about the design control updates
-How to incorporate ISO 9001:2015 and 13485:2016 to your supplier controls
-A general overview of the standard and its most significant changes (before anyone else)
“Engaging with health markets is going to be critical for governments in the future, especially given the recent UN resolution,” notes Sara Bennett, referring to a UN resolution urging countries to work towards affordable Universal Health Coverage (UHC).
Many country governments will need to purchase services from both public and private providers to achieve UHC. At the same time governments need to guard against arrangements that enable powerful stakeholders to consolidate their position in a health system that provides ineffective services at an unnecessarily high cost.
Policy-makers, entrepreneurs, academics and funders convened in Bellagio, Italy, in December 2012 to explore this tension. The result was the Bellagio Statement on the Future of Health Markets (http://bit.ly/XFrN4X).
To broaden the conversation, participants in the Bellagio meeting are holding a roundtable webinar. The webinar will be chaired by Dr Sara Bennett from Johns Hopkins School of Public Health, who convened the session in Bellagio.
Discussants include: Kelechi Ohiri, Senior Special Adviser to the Honourable Minister of State for Health in Nigeria; Kwasi Boahene, Director Advocacy & Program Development at the Health Insurance Fund; and Sikder Zakir, Founder of the Telemedicine Reference Center Ltd. (TRCL); Guy Stallworthy, Senior Program Officer at the Bill & Melinda Gates Foundation; & Dr Allan Pamba, Director Public Engagement & Access Initiatives at GSK.
An initial presentation will help set the scene, outlining the background to the meeting as well as highlighting key points from the resultant statement. Following the introduction, the discussants will offer their reactions to and commentary on the Bellagio Statement. The webinar will then shift to a ‘fishbowl’ format, where the speakers and other participants at the meeting will have an open discussion on some of the main topics from Bellagio. The webinar will wrap up with a question and answer session for all.
Requirements for reimbursement of new medical devicesMike Sanchez
Requirements for Reimbursement of New Device TechnologiesPresented at The MD&M Minneapolis Conference, Master class “Start-up Accelerator” on October 28, 2013.
Define Reimbursement
Coverage, Coding and Payment Systems
Reimbursement Assessment of New Technologies
Strategy Development and Planning
Wrap-up/ Q&A
Make or buy role of private sector in healthAlaa Hamed
The Role of Private Sector in Health, the economic argument on how to make decision to produce or to buy health services, Based on the book "Public Ends, Private Means", A chapter on the political economy of private sector participation in the health sector by Alex Preker and April Harding
Business development framework for gamechangersdianabe
Scale Business Group sponsored Executive Leadership session presented by Nathan Beckord of VentureArchetypes at GameChangers confernce. www.grow-california.com
Specific Detailed Changes to the New ISO 13485:2016Greenlight Guru
Today's medical device regulatory environment is changing faster than ever. Keeping up can be daunting. The new quality management standard ISO 13485:2016 was published in Q1 of 2016.
greenlight.guru has partnered with special guest and consultant, Mark Swanson, to keep you ahead of these changes.
Mark spent the last 4 years on the working group that revised the new ISO 13485.
Mark has all the exclusive insider knowledge on the changes you want. And he's going to be sharing it with you for free.
(You can view the full webinar here: http://www.greenlight.guru/webinar/iso-13485-2016-changes)
In this webinar you'll learn specifically:
-How to prepare for the coming regulatory changes with ISO 13485:2016
-How to apply risk based thinking to your quality processes to ensure compliance
-What you need to know about the design control updates
-How to incorporate ISO 9001:2015 and 13485:2016 to your supplier controls
-A general overview of the standard and its most significant changes (before anyone else)
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How to Make Postmarket Surveillance More Cost EffectiveApril Bright
When it comes to postmarket surveillance (PMS), it’s common for the costs to outweigh the value. But, by working with the right team, you’ll be able to execute a study that maximizes return on investment and minimizes the financial impact of conducting further observational research. Postmarket study challenges that must be addressed include enrollment delays, patient attrition, long-term follow-up, resourcing demands and global payor requirements. This session will provide a case study of one orthopaedic company’s seamless transition between postmarket approval and post-approval studies.
Health device makers, to date, have primarily targeted consumers who are either fitness focused or chronically ill. But between these two extremes sits a large, fragmented and often overlooked population who seek better information to effectively manage their health. Our research suggests that successful solution providers will approach this market opportunity as an ecosystem of partners – with an integrated solution that extends beyond the device itself. By plugging the information gap for these consumers, solution providers can help fuel healthcare innovation.
Transforming Health Markets in Asia and AfricaJeff Knezovich
Gerry Bloom and David Peters introduce the key concepts from their new book, Transforming Health Markets in Asia and Africa, at a recent launch event hosted by the Results for Development Institute for the DC Health systems Board.
White Paper - Internet Marketing Strategies For The Medical Device Industryjerryme5
This is a White Paper that I wrote, while employed at Exemplum, that talks about various marketing strategies that medical device companies can use to leverage the Internet to market their products more effectivelty.
An outline of India's Medical Devices market, along with practical tips on Market Entry for Startups and SME's on navigating the complexities. For more details connect at https://ontogenix.com
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hitt services gives a multiple range of advising, projects and support that covers the main needs of knowledge of all actors in healthcare market.We design easier and more profitable ways for:
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The committee’s focus was on ensuring the safety and security of individuals, communities, and the nation as a whole. Throughout its deliberations, the committee aimed to uphold constitutional values such as justice, dignity, and the intrinsic value of each individual. Their goal was to recommend amendments to the criminal laws that align with these values and priorities.
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Medical Device Conference - Identifying Targets Within Emerging Markets
1. CASE STUDY: IDENTIFYING TARGETS WITHIN EMERGING
MARKETS
PRESENTED AT:
3RD ANNUAL MEDICAL DEVICE BUSINESS DEVELOPMENT:
MERGERS, ACQUISITIONS & CORPORATE STRATEGY
ATLANTA, GA JANUARY 30-31, 2017
GABRIELA I. COMAN
gcoman@rubinrudman.com
(240) 356-1508
1
2. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
MANY QUESTIONS, NO SIMPLE ANSWERS
• Where to focus on internationally, what specific market & why?
• Do you have the right approach to the BRICS countries?
2
3. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
MANY QUESTIONS, NO SIMPLE ANSWERS
• Do you have the infrastructure to manage integration
• What are the opportunities of success; synergies
• What are the challenges to be addressed early
• What are the legal structures, regulatory requirements
• IP protection globally
• Critical quality elements of the acquirer to maintain
• Acquisition alignment to your business needs
• Where do you see your company in the next 5, 10, 20 years?
3
4. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
New Technologies in 2019-2050
• Be the Chief Visionary Officer
4
5. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
ACQUIRER’S CONSIDERATIONS
• Why Invest
• Where and When
• Due Diligence
5
6. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
WHY INVEST
• Potential to improve market position and growing share for the company’s core business
over the long term
• Gaining an early-mover advantage
• Long term opportunities to export out of the BRICS country back into the developed
markets
• Create a sustainable leadership position and profitable growth in a local market
Why not
• Lack of financial transparency
• Difficult due diligence
• Valuation often inflated (shortage of available assets have created inflated valuations)
• High cost of assets
• Integration and execution after the deal are complicated
• Talent is scarce
• Deep cultural gaps
• High volatility from socio-political uncertainties and fast policy changes, fragmented
regional markets, local competition, concerns over quality and compliance
• Growing in these countries requires a broad distribution network and an ecosystem that
includes regulators and other public relationships; also local teams with deep market
knowledge
6
11. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
WHERE AND WHEN
• Typically, two dimensions govern the where-and-when decision
• First, acquirers should consider a country’s potential for scale, growth,
profitability and influence on external markets.
• Second, acquirers should evaluate a country’s viability—everything from the
government’s openness to multinationals, to exposure to compliance risks,
to such infrastructure issues as the number of hospital beds per capita.
Balancing potential and viability, China and India surface as the clear
leaders among Asia-Pacific markets.
11
13. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
WHERE AND WHEN
• Within any given BRICS country, there is wide variability in potential across
categories (China’s pharma sector v. the orthopedics implant sector)
13
15. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
WHERE AND WHEN
• Theoretically, once you identified the area, start with the strategy from top
down
• Look at the demographic aspect of the region
• Where are the regulations more beneficial to you
• Balance between strategic and realistic v. opportunistic
• Finally, timing is critical.
15
18. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
1) Evaluate what medical products and devices would sell
• certain medical devices are more easily accepted and sold than others
• do any of the medical products and devices need to be modified
• what is the competitive landscape
• are there any new potential products/devices that could be identified
18
19. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
2) Consider targets through various channels
• Assess the analytics
• Look at competitors
• Access import data
• Reach out to trade conferences, professional associations
and trade shows
• Find a local partner (sourcing and closing the deal)
• If you are there for 1st time, consider minority investment with a partner
• Access lists of distributors, agents, third party intermediaries – relationships
are crucial
19
20. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
3) Understand the healthcare system of the BRICS country
- government, state and local legislation
re medical devices
- hospitals, clinics, related facilities (private v. public split of healthcare
expenditures; number of registered hospitals and manufacturing
companies; percentage GDP spent on healthcare; hospital beds
per capita; public physicians per 1000 population, etc.)
20
21. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
4) Understand the regulatory system of the BRICS country
• Understanding the country’s laws is very important
• Regulatory framework: most countries will follow CE Mark and FDA
requirements (to a degree)
• Understanding each country/region’s regulatory standards are critical to the
success of your transaction
• Analyze the local tariff requirements and comparable technology sales to
determine market potential for any given device
21
22. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
5) Go Global, Think Local
• Communication: partnerships fail not because of key areas, but due to poor
planning/execution
• Face to Face is critical to executing a meaningful international deal
• Communicate the value of a transaction in terms the target company
understands will benefit the target
• Trust
22
23. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
DUE DILIGENCE
6) Intellectual Property protection
• Determine how important your IP portfolio is to your company both
offensively and defensively
• Where and when to file
• What are you willing to invest over the years (maintenance fees; annuities)
• Must be willing to litigate with foreign courts in the event of infringement
• Trivia Patent Question
23
25. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
CASE STUDY
• Warby Parker Example (Innovative Approach)
• Narayana Hrudyalya
25
26. Healthcare – Key Challenges in Emerging Countries
Narayana Hrudyalya - CASE STUDY
The death rate has declined but birth rates continue to be high in most
of the emerging countries
Health care structure is over-burdened by increasing population
Family planning programs need to be (re)activated
India faces the twin epidemic of continuing/emerging infectious
diseases as well as chronic degenerative diseases
The former is related to poor implementation of the public health
programs, and the latter to demographic transition with increase in life
expectancy
26
27. Healthcare – Global Healthcare Trends
Cost is the biggest health care issue.
Pressure to contain costs from all sides —
governments, providers, health plans, life
sciences companies, and consumers.
Transformational change is taking place
across the globe. Several dynamic market
forces, in particular are requiring providers
and health plans to rethink traditional
business models to better address shifting
or emerging health care challenges
Adoption of new digital HIT advances such as
electronic health records, mHealth applications
and predictive analytics is transforming the
way physicians, payers, patients, and other HC
stakeholders interact
The global health care regulatory landscape
is complex and evolving. The primary driver
is patient health, safety, and privacy;. Key
factors including rapid clinical and
technology changes; increased scrutiny by
governments, the media, and consumers;
more sophisticated risk-monitoring 27
28. Case Study – Narayana Hrudyalya
A Snapshot of a Revolution
28
30. ATypical Day at NH
450Admissions 150 Major
Surgeries 42 Cardiac
Surgeries
4200Outpatients
250
417Dialysis
Procedures
Cardiac
Procedures
10 Surgeries
1Transplant
13200 Laboratory
Tests
30
31. Serving unmet needs
More than
50%of NH patients
are from economically
weaker sections
[32.7% of the total Indian population fall
below the international poverty line of
US$ 1.25 per day (PPP) while 68.7%
live on less than US$ 2 per day]
(As per World Bank, Year2010)
31
32. Assembly line approach to healthcare delivery
10% of all the heart surgeries
in India performed at NH
Unique Health City model
leveraging economies of
scale & scope for lowering
healthcare costs
32
33. Health City: Agglomeration of
Centers of Excellence
“Health City” - Acampus with 2000 to 5000 beds,
spread among 4-5 hospitals, dedicated to individual
specialties
Best way to reduce the cost of healthcare
through economies of scale & scope
Improves the quality of clinical outcomes by exposing
to multiple specialists collaborating on a single patient
Sharing of resources to reduce cost
Excellent set up for research activities
Increasing volumes
Thereby reducing costs
33
34. Reaching out to the Grassroots
Pioneered the concept of telemedicine in India
590 tele ECG network
150 connected Telemedicine centers
54,000 cardiac patients treated free
10,000 patients treated in various CCUs
53 locations in Africa
34
35. Low Cost Surgical Hospital Model
Typically modeled as 300 bedded surgical hospitals,
located primarily in Tier II and Tier III cities
Built as a pre-fabricated structure
with minimal RCC construction
Ground floor construction thereby
reducing construction costs
Maximum utilization of natural daylight
35
36. Superior Operating Strategy
Tight control on costs
Hybrid and dynamic pricing
Achieving best outcomes
Better inventory management
Pay-per-use Model
36
37. Leveraging Technology
Digital Radiology
Migrated to digital
radiology for better throughput and image
quality, while working in a film less
and paper light environment.
Automation
First in India to ideate an ICU automated system
Analyzes patient parameters to assist doctors
Reduces human error
37
38. Cloud ERPSystem
Integration of all NH units through an ERPSystem
deployed on a cloud
Allows real time access to data across the group
Dramatically impacts the bottom-line by taking advantage
of the pay per use concept, resulting in zero investment
and maintenance costs
First hospital group in India to have
an ERPsystem on a cloud38
39. CSR Initiatives – A promise to the society
NH is modeled as a Social Enterprise rather than a Corporate
Donations received from the philanthropic
organizations supported by NH - Used only
for the treatment of poor patients
NH created a chain of 16 primary health
centres across Amethi and Raibareilly
to offer free services including consultations &
medication to more than 30,000 patients in a
month
Udayer Pathe - Enabling poor children to
become future doctors by offering soft loans
for study
39
40. Yeshaswini Micro-Health
Insurance Scheme
World‟s largest self funded micro-health insurance
scheme catering to more than 3 million people
Conceptualized by NH and launched by
the Government of Karnataka in 2003
Covering over 1600 surgeries
at a Monthly premium of 18 Rupees
Success of the model ensured replication by
2 other States covering 30 million people
Studied by Harvard Business School
Unaffordability can be
tackled when united
40
41. If you have reached
NH, your worries are
over
An average of over 16 heart
operations on children every day
100 free or discounted pediatric
surgeries a month
India's largest and most advanced
Pediatric liver transplant program
41
43. Udayer Pathe – making dreams come true
Enabling poor children to study to become doctors by offering soft loans
Scholarships to selected children from deprived backgrounds
NH mentors these children right from the age of 14 years
43
45. IDENTIFYING TARGETS WITHIN EMERGING MARKETS
• Be the Chief Visionary Officer
• Be curios
• Start small
• Have trust
• Don’t get stuck on the escalator
THANK YOU
45