Salud, casos de éxito global

Healthcare redefined: from evidence to outcomesHealthcare redefined: from evidence to outcomes
Mega healthcare trends impacting
healthcare delivery in medium
development country - PERU
Presentation V1
Prepared for: CADE
Date: Nov, 2018

Healthcare redefined: from evidence to outcomes
Emerging growth markets are an increasing
focus for healthcare investment
2
0.00
1.00
2.00
3.00
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India China ASEAN World Australasia MENA US EU Russia Japan SS Africa Latin
America
2017 2018 2019
Real GDP growth; % change, year on year.
As of January 2018. Source: The Economist Intelligence Unit.

4 key drivers of rapid healthcare changes
3
Economic & commercial dynamicsSocial & demographic
Political & regulations Technological

Expanding middle income in Latin America
4
Wealth
Longevity
Health
1
2
3
2005 … 2015
LATAM: Household income distribution
(in millions of households)
Over US$45,000
US$10,000 - 45,000
Below US$10,000
Fastest growing segment:
Middle income households represents a 30% of the
population size

Aging is a global phenomena, with quicken pace
in emerging markets
5
Population is aging rapidly in less developed countries
2050
20132013
2050
A. Less developed regions B. More developed regions
1880 1890 1900 1940 1960 2000 20201980 20401920
7%
14%
%ofpopaged65+
France Sweden US Japan Brazil
Wealth
Longevity
Health
1
2
3
Sources: National Institute of Aging, US Census Bureau
Peru

Rising NCDs with continued burden from
infectious diseases
6
Source: GHD Database
• NCDs account for 65% of global deaths and 54% of DALYs
Wealth
Longevity
Health
1
2
3
85%
9%
6%
Developed country
Developed markets:
Disease profile
(% of total DALY)
67%
56%
64% 64%
72%
78% 80%
19%
15%
25%
14%
16%
14% 9%
14%
29%
11%
22%
12% 8% 11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Brazil Columbia Peru Venezuela Mexico Argentina Chile
LATAM: Household income distribution
(in millions of households)
NCD
Infectious
disease
Others
(injuries)

NCD disease state progression vs. Cost over time
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Healthy low
risk
At risk High risk Early clinical
symptoms
Active
disease
Time
Health status
Health spending
20% of people
generate 80% of
costs
Awareness Prevention Early detection Primary care Acute care
Management &
Monitoring
Bubble
represents size
of population

Escalating healthcare costs – a strain to payors
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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Brazil
Mexico
Colombia
Chile
Argentina
Peru
Uruguay
Public vs. Private Healthcare Expenditure Key LATAM Markets
Public
OOP
Private
insurance
Lack of regulation in the private
sector contributes to higher OOP
spending and greater inefficiencies
Publicly funded healthcare
sometimes fails to provide
adequate services
Healthcare reforms
placed emphasis on subsidising
health services for the poor
1
2
3

Acute care dependant, high inequalities in
resources across Latam
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Wellness Primary care Acute care Specialised
care
Community
care
Home care
UsageofCare
Continuum of Care
Healthcare Delivery Across Care Facility
Current delivery
(NOW)
• Acute care heavy reliant care model still prevalent across
Latam
• Large inequalities in the availability of spending and resource in
the region

Key
Changes
Universal
healthcare
Cost
control
Reshape
hospitals
Increase &
enhance
medical
manpower
It is no surprise that many emerging countries are
now launching key changes in healthcare delivery
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Protectionism
Privatization
of healthcare
Preference for local brands
Flexible policies for practicing in
multiple locations – at public and
private hospitals
Reimbursement changes that
promote adoption of regional
brands
Digital health solutions, such as
telemedicine to improve
efficiency
Upgraded public hospitals
Growth of private hospitals
Hospital consolidation
Increased pricing transparency
Diagnosis-related groups for
reimbursement
Increased government control on
purchasing costs at hospitals
Shift to private health insurance
Rise of public-private partnerships
Making progress but still more to do
Argentina, Brazil, Colombia & Mexico
Source: EIU Healthcare analysis

There are immense opportunities but also significant
challenges in Latam
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Disparity in care
Lack of adequate
funding
Cost pressures
from government
Lack of adequate
care in remote
areas
Insufficient number
of trained physicians
& technicians
Health insurance
coverage
Emphasis on
enhancing primary
care
Expansion of
healthcare providers
Savvier middle
income patients
with higher health
awareness
Source: EIU Healthcare analysis

Shifts in care models – Transforming healthcare delivery
12
12
Sick care
Health & well-being
Physician centric
Patient centric
Transactional
Integrated care team
Isolated individual
Socially connected
Passive patient
Highly empowered
Volume based care
Value based care

Shift from hospital centric to population-led model
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Discharge
Prevention Pre-Surgery Surgery Post-Op Care Rehab
Management
& Monitoring
Discharge
Hospital
Hospital/Ambulatory
Surgical Centre
Physician led
Patient led
Shift from
hospital-led to
population-led
model of care
Community or home careAcute/Specialized Care
Integrated care model

Integrated care – an increasingly important
model globally
14
Propensity of integrated care & value based healthcare
HighLow
France
Netherlands
Germany
UK
Healthcare in transition:
• Continued reforms to strengthen primary care
• Huge disparity and fragmentation remains
across care delivery
• Pilot programs implemented
• Still lacking in data on quality, outcomes and
costs for wider roll out
Advanced decentralized care model rolled out
nationally
• Highly developed primary care
• Established home-based care
• Community care services offering by hospital
• Capabilities for coordinated care with clear
measurements
Belgium
SwedenPoland
Spain

Shift in integrated care – The role of industry player
15
Pharma companies – ahead of the curve
Wellness programs
Education programs,
enhance patient
literacy
Early detection,
diagnosis & intervention
with primary care
Integrated drug
dosing with
monitoring devices
Enable remote
monitoring via digital
platform
Work with primary
care to improve
adherence
Awareness Prevention Early detection Primary care Acute care
Management &
Monitoring
Government
Industry
Disease
management
Level of
involvement
Impact to
population
Broader population focus Narrower focus at later stage

Payer models are shifting, with increasing participation
of private insurers
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Payer Model
Single state
payer
Multiple state
payers
State payer with
supplementary
private payers
State payers
competing with
private payers
Multiple
private payers
only
Pros
Cons
•No duplications •Allows choice •Combines a core
one with choice
•Potential for PPP
•Lower burden on
public expenditure
•Innovative
business models
•Balance in welfare
and market driven
approach
•Competition
benefits
patients
•Lack of choice
•High burden on
government
•Cross
subsidization
•High burden on
government
•Selection risks
•Duplication
•Complex
Patient View
•Duplication
•Complex
•Duplication
•Potential gaps
in coverage
Private insurersPublic insurers
Payer models are
shifting towards

Regulatory approval
process
• High quality manufacturing standards,
clinical safety and clinical effectiveness
need to proven, against a placebo
• Clinical effectiveness against comparative
therapies need to be demonstrated for best
outcomes over cost
Reimbursement &
success metric
• Fee-for-service
• Rewards volume services/ products
• Single payment for bundled services
• Rewards better patient outcomes
• Shared financial risks
Value based healthcare
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Care delivery
pathway
• Referral system for care delivery across
separate facilities, resulting in a
fragmented patient experience
• Integrated care delivery across separate
facilities, with patient-centric approach for a
seamless care experience
Health systems
organization
• Hospital organized around specialties
and departments, often with full line
of services
• Integrated practice units (IPUs) or local health
clusters comprising providers for various levels
of care i.e. primary, ambulatory, acute and
long-term care
Traditional health system
- Volume-based
Outcomes-based system
- Value-based
Moving
towards

The empowered and engaged “Dr. Patient”
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Informed
Decision Maker
More
Demanding
DIY
Interactive
Activities Done Through Social Media
(% of Social Media Users)
28%
27%
24%
20%
18%
16%
Support health-related cause
Comment about health experiences
Post about health experiences
Join health-related cause
Trace and share health symptoms or
behavior
Post reviews of medications,
treatments, doctors or health insurers

Placing patient at the heart of healthcare
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PHARMA &MEDTECH GOVERNMENT
Leverage technology to communicate, educate, engage & empower
Growing patient empowerment and engagement through technology, where patient
advocacy groups can provide a wealth of online resources to patients including
enhancing awareness and providing education
Across life cycle industry collaborations
Patient representations via patient groups to help medtech companies
incorporate patient insights across the life cycle of their product development
will increase
Support VBH
Patient groups will play
a key role in helping to
shape, develop and
define outcomes that
make the most
difference to patients,
Community health
partnerships
Patient groups to work
with hospitals,
physicians and
community groups to
forge community health
partnerships

4 technology changing the healthcare landscape
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• Impact all of
healthcare, across
stakeholders and
delivery pathways
• Combines
decentralization of
healthcare + patient
empowerment
• Key technology
applied in various
ways to bridge gap in
resource constraints
• Application of powerful
analytics to benefit all
aspects of healthcare
delivery – from
operational efficiencies,
costs controls and
optimizing care
Digital Health Mobile Health AI Big Data

Healthcare companies need to build strengths across
4 pillars to successful address industry future needs
21
I.
Build an
ecosystem to
deliver
solutions
II.
Shift towards
patient-centric
mindset
III.
Leverage
technology
IV.
Data analytics
form the
backbone

Thank you
Contact EIU Healthcare
22

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