Supply/value chain hot topics for today and tomorrow
Center-led principal and value-added services structures
Supply chain best practices
- Using strategic business processes to impact performance
- Inventory and working-capital management
- Governance and compliance
Industry trends and drivers
- Collaborations
Governing Innovation: The recipe for portfolio growth | Accentureaccenture
Accenture reports that with innovation investments increasing, it's critical to invest in growth with an innovation portfolio management strategy. Read more.
Engineering Services: con gli ingegneri per creare valore sostenibileaccenture
Collaboriamo con gli ingegneri di aziende capital intensive per combinare tecnologie innovative con un approccio pragmatico che aiuti a raggiungere risultati aziendali migliori.
Governing Innovation: The recipe for portfolio growth | Accentureaccenture
Accenture reports that with innovation investments increasing, it's critical to invest in growth with an innovation portfolio management strategy. Read more.
Engineering Services: con gli ingegneri per creare valore sostenibileaccenture
Collaboriamo con gli ingegneri di aziende capital intensive per combinare tecnologie innovative con un approccio pragmatico che aiuti a raggiungere risultati aziendali migliori.
The value of digitally influenced spending in emerging markets will approach $4 trillion by 2022, amounting to about 50% of all retail spending in Asia, Latin America, and Africa. But the dynamics will vary widely between markets, requiring B2C companies to “de-average” their offerings in order to succeed.
18th Annual Global CEO Survey - Technology industry key findingsPwC
Tech CEOs are optimistic about the global economy and both near term and future revenue growth. They view strategic alliances, including partnering with competitors, as a primary means to grow their businesses. We invite you to explore the analysis and contact us to discuss how we can help your business capitalise on the new - but challenging - opportunities for growth. Learn more http://pwc.to/1DaolqY
Website: http://www.pwc.com/gx/en/ceo-survey/2015/industry/technology.jhtml
The Fourth Annual Global Mobility Study [hyperlink] by L.E.K. Consulting, Vision Mobility and CuriosityCX highlights that there is a much greater uptake of ride-hailing and other new mobility options in India and China than in mature western economies. With relatively low levels of car ownership and less developed public transport systems in these Asian countries, new mobility use is now comparable with and set to overtake traditional transport for a segment of the population.
The enterprise software industry is being transformed by substantial investor capital, Cloud 2.0, artificial intelligence, data protection, preferred platforms, and a talent shortage, leading stakeholders of all kinds to make big changes, and big choices.
Local Dynamos – emerging-market companies focused largely on their home markets - are beating both local state-owned companies and multinational corporations, thanks to savvy digital strategies and an ability to meet rising consumer expectations. MNCs need to understand how the Dynamos are rewriting the rules in emerging markets.
Intelligent Operations for Future-Ready Businesses | Accentureaccenture
Accenture reveals that the relationship between intelligent operations and business value creation is key to becoming a future-ready organization. Read More.
Big Data and advanced analytics are critical topics for executives today. But many still aren't sure how to turn that promise into value. This presentation provides an overview of 16 examples and use cases that lay out the different ways companies have approached the issue and found value: everything from pricing flexibility to customer preference management to credit risk analysis to fraud protection and discount targeting. For the latest on Big Data & Advanced Analytics: http://mckinseyonmarketingandsales.com/topics/big-data
New trends have moved marketing the cusp of a new golden age. To deliver on the promise, marketing needs to execute on the 5S approach: science, simplicity, substance, speed, and story. This presentation walks through what marketers and business leaders need to get right to execute all of them. This presentation is based on a public webinar given by McKinsey partners Jonathan Gordon and Jesko Perrey.
Find out more from our Marketing and Sales practice: http://www.mckinsey.com/client_service/marketing_and_sales
EY's European Banking Barometer – 2015 identifies the views of 226 senior European bankers across 11 markets regarding their views of the macro-economic outlook and the impact they think it will have on the banking industry in 2015.
For further information visit: www.ey.com/ebb
This update on Mergers & Acquisitions, covering the full year of 2016, is based on publicly available information.
For more information: http://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/m-and-a-2016-deal-makers-catch-their-breath
Business Pulse - Dual perspectives on the top 10 risks and opportunities 2013...EY
Business Pulse explores the top 10 risks and opportunities faced by global organizations over the next few years.
Ernst & Young’s Business Pulse report is based on a large sample survey of companies in 21 countries and across various industry sectors.
The report takes the pulse of:
• Current thinking on risks and opportunities and emerging challenges
• Dual perspective on the themes arising from the top 10 lists
• Expectations from industry executives and Ernst & Young specialists
Read this presentation to conduct a self-assessment for your business and download the report at: http://goo.gl/CSKGQ
The new revenue recognition standard for life sciences companiesEY
Summary: These slides were presented at our EY Thought Center webcast on 15 June 2015 and explore how the revenue recognition standard will affect pharma, biotech and medtech companies. They look at practical application issues specific for life sciences companies and the implementation challenges, such as project set up, contract selection and use of tools. The webcast was hosted by Scott Bruns, EY Global Life Sciences Assurance Leader and included Tim Gordon, EY Global Life Sciences Financial Accounting Advisory Services Leader, Frederik Schmachtenberg, EY Global Life Sciences Assurance Resident and special guest, Derek Kosti, Senior Director of Finance and Worldwide Controller at Pfizer Inc. To hear a replay of the one hour webcast, copy this url into your browser: www.ey.com/GL/en/Issues/webcast_2015-06-18-1600_revenue-recognition-standard-for-life-sciences.
The value of digitally influenced spending in emerging markets will approach $4 trillion by 2022, amounting to about 50% of all retail spending in Asia, Latin America, and Africa. But the dynamics will vary widely between markets, requiring B2C companies to “de-average” their offerings in order to succeed.
18th Annual Global CEO Survey - Technology industry key findingsPwC
Tech CEOs are optimistic about the global economy and both near term and future revenue growth. They view strategic alliances, including partnering with competitors, as a primary means to grow their businesses. We invite you to explore the analysis and contact us to discuss how we can help your business capitalise on the new - but challenging - opportunities for growth. Learn more http://pwc.to/1DaolqY
Website: http://www.pwc.com/gx/en/ceo-survey/2015/industry/technology.jhtml
The Fourth Annual Global Mobility Study [hyperlink] by L.E.K. Consulting, Vision Mobility and CuriosityCX highlights that there is a much greater uptake of ride-hailing and other new mobility options in India and China than in mature western economies. With relatively low levels of car ownership and less developed public transport systems in these Asian countries, new mobility use is now comparable with and set to overtake traditional transport for a segment of the population.
The enterprise software industry is being transformed by substantial investor capital, Cloud 2.0, artificial intelligence, data protection, preferred platforms, and a talent shortage, leading stakeholders of all kinds to make big changes, and big choices.
Local Dynamos – emerging-market companies focused largely on their home markets - are beating both local state-owned companies and multinational corporations, thanks to savvy digital strategies and an ability to meet rising consumer expectations. MNCs need to understand how the Dynamos are rewriting the rules in emerging markets.
Intelligent Operations for Future-Ready Businesses | Accentureaccenture
Accenture reveals that the relationship between intelligent operations and business value creation is key to becoming a future-ready organization. Read More.
Big Data and advanced analytics are critical topics for executives today. But many still aren't sure how to turn that promise into value. This presentation provides an overview of 16 examples and use cases that lay out the different ways companies have approached the issue and found value: everything from pricing flexibility to customer preference management to credit risk analysis to fraud protection and discount targeting. For the latest on Big Data & Advanced Analytics: http://mckinseyonmarketingandsales.com/topics/big-data
New trends have moved marketing the cusp of a new golden age. To deliver on the promise, marketing needs to execute on the 5S approach: science, simplicity, substance, speed, and story. This presentation walks through what marketers and business leaders need to get right to execute all of them. This presentation is based on a public webinar given by McKinsey partners Jonathan Gordon and Jesko Perrey.
Find out more from our Marketing and Sales practice: http://www.mckinsey.com/client_service/marketing_and_sales
EY's European Banking Barometer – 2015 identifies the views of 226 senior European bankers across 11 markets regarding their views of the macro-economic outlook and the impact they think it will have on the banking industry in 2015.
For further information visit: www.ey.com/ebb
This update on Mergers & Acquisitions, covering the full year of 2016, is based on publicly available information.
For more information: http://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/m-and-a-2016-deal-makers-catch-their-breath
Business Pulse - Dual perspectives on the top 10 risks and opportunities 2013...EY
Business Pulse explores the top 10 risks and opportunities faced by global organizations over the next few years.
Ernst & Young’s Business Pulse report is based on a large sample survey of companies in 21 countries and across various industry sectors.
The report takes the pulse of:
• Current thinking on risks and opportunities and emerging challenges
• Dual perspective on the themes arising from the top 10 lists
• Expectations from industry executives and Ernst & Young specialists
Read this presentation to conduct a self-assessment for your business and download the report at: http://goo.gl/CSKGQ
The new revenue recognition standard for life sciences companiesEY
Summary: These slides were presented at our EY Thought Center webcast on 15 June 2015 and explore how the revenue recognition standard will affect pharma, biotech and medtech companies. They look at practical application issues specific for life sciences companies and the implementation challenges, such as project set up, contract selection and use of tools. The webcast was hosted by Scott Bruns, EY Global Life Sciences Assurance Leader and included Tim Gordon, EY Global Life Sciences Financial Accounting Advisory Services Leader, Frederik Schmachtenberg, EY Global Life Sciences Assurance Resident and special guest, Derek Kosti, Senior Director of Finance and Worldwide Controller at Pfizer Inc. To hear a replay of the one hour webcast, copy this url into your browser: www.ey.com/GL/en/Issues/webcast_2015-06-18-1600_revenue-recognition-standard-for-life-sciences.
Cultural Times - The first global map of cultural and creative industriesEY
EY released on the 3rd of December 2015 "Cultural Times", the first global map of Cultural and Creative Industries. This overview underlines the contribution of the creative economy to global growth and job creation.
Find out more on ey.com/CulturalTimes
Summary: Even in a time of high biopharma valuations, adopting an activist mentality adds rigor to capital allocation and strategic decision-making, improving not just returns to shareholders but long-term value creation. Therefore, biopharma management teams and boards of directors should proactively assess the “fitness” of their capital allocation strategies and their alignment with operational performance goals by taking an outsider’s view of the business even when times are good — and before a material stumble provides a compelling reason for an outsider to act. For more on this topic, go to http://www.ey.com/GL/en/Industries/Life-Sciences/EY-vital-signs-how-fit-is-your-capital-allocation-strategy.
Putting digital technology and data to work for Tech CMO'sPwC
Tech Company CMOs are uniquely positioned to successfully leverage digital technologies and data to significantly impact business performance. At PwC, we're helping to change the goal of digital marketing from clicks and views to customer experiences designed to generate business performance. Explore how.
PwC’s Trends in People Analytics report highlights our recently published 2015 PwC Saratoga US benchmark data, as well as the implications for people analytics functions and key trends for consideration.
Moving digital transformation forward: Findings from the 2016 digital busines...Deloitte United States
Are you ready for a digital future? Nearly 90 percent of managers and executives surveyed expect “great” or “moderate” digital disruption, but fewer than half say their organizations are adequately preparing. Companies can take steps toward digital maturity, though—without necessarily putting technologists in charge.
To read more and download the full report, visit: http://deloi.tt/2fnahoe
The Boston Consulting Group, MIT Sloan Management Review, and the United Nations Global Compact joined forces to provide an inside look at how companies are dealing with sustainability issues: http://on.bcg.com/1Ci1R8l.
Findings on health information technology and electronic health recordsDeloitte United States
The Deloitte Center for Health Solutions 2016 Survey of US Physicians set out to understand physician adoption and perception of key market trends around health information technology and electronic health record data. Explore key survey findings to discover where physicians find the most value, barriers to adoption, and what they want next. http://deloi.tt/2d3b4w6
TMT Outlook 2017: A new wave of advances offer opportunities and challengesDeloitte United States
Important trends continue to shape the technology, media, and telecommunications (TMT) industry. What developments should you anticipate in 2017? https://subscriptions.deloitte.com/default.aspx?eventid=1323075
McKinsey Global Institute Report - A labor market that works: Connecting tale...McKinsey & Company
This presentation offers highlights from a new report by the McKinsey Global Institute, "A labor market that works: Connecting talent with opportunity in the digital age".
From shopping to social media, online platforms have transformed major segments of the global economy. They now are about to do the same for labor markets around the world. MGI examines the stubborn disconnect between people and jobs and the potential for online talent platforms to unlock real economic value over the next decade by creating better, faster matching between workers and available work opportunities.
Read the report in full:
http://mckinsey.com/Insights/Employment_and_growth/Connecting_talent_with_opportunity_in_the_digital_age
From touchpoints to journeys: Seeing the world as customers doMcKinsey & Company
Airport complaints are an excellent lens through which to view the new emphasis we need to bring to the entire customer journey, rather than focusing on single – often disjointed – touchpoints.
For our full article on the customer journey, please visit: http://www.mckinsey.com/business-functions/marketing-and-sales/our-insights/from-touchpoints-to-journeys-seeing-the-world-as-customers-do
McKinsey Global Institute's latest report shows how soaring flows of data and information now generate more economic value than the global goods trade. Here are the key charts and graphs that tell the story. For the full report, visit http://bit.ly/digiflows.
EY Human Capital Conference 2012: Service delivery model transformationEY
Current trends and recent experience:
► Challenges affecting HR today
► Anticipated benefits from HR service delivery model
transformation
► HR transformation experience and lessons learned
Delivering Value Beyond Savings_Cubist PharmaceuticalsZycus
This presentation will address how Cubist Sourcing has integrated itself with its business partners, and how it measures, monitors and reports the value it delivers to the business.
Profitable growth is all about access to the right knowledge
Want to know more?
Competing for growth is a global survey by Ernst & Young
focusing on growth. Through extensive research and conversations with 1,400 senior executives from companies around the world, Ernst & Young has developed key insights into how the world’s leading businesses are returning to profitable growth. To access our insights and learn more about Competing for Growth, contact your local Ernst & Young office or visit
www.ey.com/competing-for-growth
The theme for this quarter is momentum meets uncertainty. The upward trend in crude oil, natural gas, LNG and refined product prices that began in Q1 continued into Q2. Crude oil markets began the quarter just below $100/bbl and have closed below that level on only two days since late April. As we begin Q3, there are increasing concerns about the health of the global economy and how that might affect oil and gas demand.
Quarterly analyst themes of oil and gas earnings, Q1 2022EY
Financial questions continued to attract the most attention of the analyst community, with major focus on how companies will respond to the war in Ukraine, elevated commodity prices and improved cash flows. Strategic questions focused on how the changing geopolitical environment will affect capital allocation in the short and long term. Operationally, all eyes were on the capacity of companies to step up asset utilization and bring new projects to market quickly. Explore the latest EY quarterly analysts themes.
EY Price Point: global oil and gas market outlook, Q2 | April 2022EY
The theme for this quarter is rearrangement. The loss, or potential loss, of Russian oil and gas supplies is forcing producers, refiners and traders to rethink the flow of crude oil and refined products from the wellhead to the gas pump in light of sanctions, potential sanctions and the risk of reputational damage. Countries, companies and consumers will all be searching for ways to adapt, and the outcome of the race to bring alternatives to market could alter the global energy landscape for years to come.
It is likely crude oil and LNG prices will remain elevated for some time. The process of diverting Russian oil through countries unwilling to sanction it will take time and there is little indication OPEC members are willing (or able) to increase production to make up for the loss of Russian crude. Spare capacity sat at 3.7 mbpd at the end of 2021, just above where it was in January 2020. Currently, sanctioned Venezuelan and Iranian production (about 3 mbpd below their peak) could fill the gap, but political and commercial obstacles remain. At today’s prices, US shale production is attractive, but the fastest the industry has been able to grow is between 1mbpd and 2mbpd per year. The LNG infrastructure was already stretched before the war in Ukraine and there is little prosect of finding new supplies soon.
As the largest buyer of Russian energy, Europe will be the epicenter. There is a deeply embedded bias there in favor for renewable energy, and the current crisis is certain to result in an all-out effort to accelerate the build-out of wind and solar power. The capacity to add new green energy is limited though by the project pipeline and supply chains for solar panels and wind turbines, and it is likely that much of the shortfall will be made up with the new LNG infrastructure.
EY Price Point: global oil and gas market outlookEY
As the last quarter of the second pandemic year draws to a close, we continue to see heightened contrast
between the medical and economic points of view. While COVID-19 cases are close to their all-time highs, so
are equity prices, and a leading investment bank declared (on 2 December, 2021 after the Omicron outbreak in South Africa) that it was “optimistic about the possibility of a vibrant 2022.” When news of the variant hit in
late November, the markets were rocked by the prospect of yet another round of local mobility restrictions and
an interrupted return to normal international travel patterns, on top of the Biden Administration’s announced
release of 50 million barrels of crude from the US Strategic Petroleum Reserve. So far though, with OPEC
standing by its planned gradual return to normal production, oil prices have stabilized, albeit below where they
were in mid-November. Henry Hub prices, always at the mercy of the weather, responded predictably to a
warmer-than-normal early winter in the US, falling from US$6.60/MMBtu in early October to below
US$4.00/MMBtu by mid-December. In Europe and Asia, following a short reprieve at the start of the quarter,
piped natural gas prices have spiked again on concerns triggered by Russian troop buildups on the Ukraine
border and uncertainties surrounding the Nordstream 2 pipeline. Looking forward, OPEC and the U.S. Energy
Information Administration (EIA) in their last forecasts of the year both projected that 2022 oil demand would
be above what we saw in 2019. Although time will tell if those forecasts are realized and other events could
intervene, the response to new virus outbreaks is well-practiced and the trade-off between public health and
economic reality has tipped toward a cautiously optimistic view.
EY Price Point: global oil and gas market outlook, Q2 April 2021EY
The theme for this quarter is governed. Apparent market balance at prices that could be sustainable is the product of calculated choices by market leaders and the cooperation of those who follow them. Economics played their customary role as well, with capital scarcity in North America taking about 2 million barrels per day out of the market, about half of the remaining gap in demand. While inventories are close to their pre-COVID-19 levels, there is still uncertainty. The resolution of the pandemic is in sight, but timing is unclear. Vaccine distribution in the US is having an impact but Europe is struggling to contain a third wave of infections. The taps have opened on economic stimulus, but it remains to be seen if policymakers have done enough or if they have overshot the mark.
The shape of the crude oil forward curve has fundamentally changed since the end of the last quarter. In late December of last year, the Brent forward curve was gradually increasing while today, the curve is backwardated. This is a clear sign that the market sees a short-term dynamic that is disconnected from the medium-to-long-term fundamentals. The lasting impact of the COVID-19 pandemic remains to be seen. While many have opined that COVID-19 marks a turning point in energy transition, the IEA recently released a five-year forecast of oil demand that shows steady growth, albeit at rates that are below historical expectations.
Gas markets are a paradox. At the Henry Hub and at LNG destinations, demand grows, investment lags and prices will occasionally attract attention. Traders, so far though, are unconvinced and futures prices don’t indicate imminent scarcity at any link in the value chain.
EY Price Point: global oil and gas market outlookEY
We enter 2021 on a note of cautious optimism for global health, the world economy, and the oil and gas markets. The first weeks of December brought approval in the US and the UK of the first of several COVID-19 vaccines. The speed with which vaccine development occurred is unprecedented, but certainly welcome. In the weeks following the early November announcement of 90+% effectiveness by the manufacturer of the first approved vaccine, the price of WTI crude oil increased by US$10/bbl to US$48/bbl, the highest level since early March. Sustainability hasn’t returned yet, and whatever time it takes to get the world to normal, it will take even longer for normalization within the oil and gas markets. Inventories remain at historically high levels and, optimistically, it will take until April before inventory returns to levels observed in the preceding five years. That’s an estimate, and there has obviously been some difficulty properly calibrating the expectations of how balance will return and how long it will take. In late November, OPEC met to adjust its output plans because of the anemic rebound in demand. In mid-December, the IEA lowered its demand forecast for 2021 due mostly to continued sluggishness in aviation fuel demand.
A mild winter has interrupted a recovery in North American natural gas prices after a run-up motivated by curtailed capital expenditures, upstream activity and production. After an initial meltdown, with cargo cancellations and dramatic price reversal, LNG markets have made a remarkable comeback, and the spread between Asia and Henry Hub has reached a level we haven’t seen in almost three years. It may be the case that interruption in FIDs has brought us to the cusp of a balance that can support reliable returns.
EY Price Point: global oil and gas market outlook (Q4, October 2020)EY
Oil and gas prices have recovered steadily from their lows and are relatively stable, but that stability is supported by the combination of purposeful withholding of production by oil-producing countries and economic stress on upstream independents. Oil prices closed the quarter roughly where they started it, while refining spreads were down slightly. LNG spreads were substantially higher at the end of Q3 than they were at the beginning of the quarter but are still roughly half of what is generally thought of as sustainable.
Going forward, the market will be looking closely at how the economy and demand respond to new developments with respect to a potential COVID-19 vaccine and the US election.
EY Price Point: global oil and gas market outlookEY
As we close the second quarter of 2020, in most of Europe and Asia, the first (and hopefully last) wave of the COVID-19 crisis appears to be abating. In the parts of the US where the virus hit early, the profile has largely matched Europe’s, while in other parts, the urge to reopen businesses has trumped the desire to contain the virus and uncertainty looms. In the developing world, the crisis has just begun, but without the economic headroom and resources necessary to contain it. As the crisis unfolded, the effect on oil and gas demand has been predictable but difficult to gauge precisely and therefore difficult to manage.
Oil prices have crept up steadily as production has been curtailed through coordinated action (OPEC+) and because of economic reality (unconventional oil in North America). That trend has been subject to momentary spasms when bad news hit the market. It would be understandable if traders were nervous, and it seems that they are. Although nowhere near where it was at the peak of the crisis, option implied volatility is still at historically high levels. Gas markets, without the benefit of coordination on the supply side, continue to deal with the market implications of storage at or near capacity. Interfuel competition in power generation has always provided something of a floor, but those lows have been, and will continue to be, tested.
Zahl der Gewinnwarnungen steigt auf RekordniveauEY
Immer mehr deutsche börsennotierte Unternehmen müssen ihre eigenen Umsatz- oder Gewinnprognosen nach unten korrigieren. Im ersten Quartal stieg die Zahl der Prognosekorrekturen auf ein neues Rekordniveau: Insgesamt 77 Gewinn- oder Umsatzwarnungen wurden registriert.
Die Corona-Krise trifft auch die Versicherungsbranche mit voller Wucht. Die Versicherer rechnen mit weniger Neugeschäft. Jeder Fünfte mit Personalabbau und Prämienerhöhungen.
Liquidity for advanced manufacturing and automotive sectors in the face of Co...EY
With a global economy in crisis due to Covid-19 our liquidity and cash management deck for advanced manufacturing and
mobility companies looks at how these companies should best respond.
IBOR transition: Opportunities and challenges for the asset management industryEY
EY Wealth & Asset Management explores the practical implications and the way forward for the transition to the new risk-free rates. This presentation aims to help asset managers and asset owners explore IBOR transition strategies that are compliant and future-focused.
Fusionen und Übernahmen dürften nach der Krise zunehmenEY
Folgt auf die Corona-Krise ein M&A-Boom? Laut Capital Confidence Barometer von #EY hoffen 40 Prozent der deutschen Unternehmen auf sinkende Bewertungen von Übernahmekandidaten.
EY Price Point: global oil and gas market outlook, Q2, April 2020EY
The first quarter of this year has seen some extraordinary events. As if chronic oversupply, prices stuck below sustainable levels, the looming energy transition, and investor pressure to decarbonize weren’t enough, our industry now faces a dramatic, but hopefully temporary, downturn in demand as a result of the ongoing COVID-19 outbreak.
Our Global Chemical Industry Leader Frank Jenner explores the trends and drivers that will shape the chemical industry of tomorrow in our latest Chemical Market Outlook.
Die Geschäftslage im Mittelstand hat sich leicht verschlechtert, ist in den meisten Branchen aber weiter überwiegend gut - die Einstellungsbereitschaft sinkt.
The European Unemployment Puzzle: implications from population agingGRAPE
We study the link between the evolving age structure of the working population and unemployment. We build a large new Keynesian OLG model with a realistic age structure, labor market frictions, sticky prices, and aggregate shocks. Once calibrated to the European economy, we quantify the extent to which demographic changes over the last three decades have contributed to the decline of the unemployment rate. Our findings yield important implications for the future evolution of unemployment given the anticipated further aging of the working population in Europe. We also quantify the implications for optimal monetary policy: lowering inflation volatility becomes less costly in terms of GDP and unemployment volatility, which hints that optimal monetary policy may be more hawkish in an aging society. Finally, our results also propose a partial reversal of the European-US unemployment puzzle due to the fact that the share of young workers is expected to remain robust in the US.
where can I find a legit pi merchant onlineDOT TECH
Yes. This is very easy what you need is a recommendation from someone who has successfully traded pi coins before with a merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi network coins and resell them to Investors looking forward to hold thousands of pi coins before the open mainnet.
I will leave the telegram contact of my personal pi merchant to trade with
@Pi_vendor_247
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
Seminar: Gender Board Diversity through Ownership NetworksGRAPE
Seminar on gender diversity spillovers through ownership networks at FAME|GRAPE. Presenting novel research. Studies in economics and management using econometrics methods.
The Evolution of Non-Banking Financial Companies (NBFCs) in India: Challenges...beulahfernandes8
Role in Financial System
NBFCs are critical in bridging the financial inclusion gap.
They provide specialized financial services that cater to segments often neglected by traditional banks.
Economic Impact
NBFCs contribute significantly to India's GDP.
They support sectors like micro, small, and medium enterprises (MSMEs), housing finance, and personal loans.
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
Abhay Bhutada Leads Poonawalla Fincorp To Record Low NPA And Unprecedented Gr...Vighnesh Shashtri
Under the leadership of Abhay Bhutada, Poonawalla Fincorp has achieved record-low Non-Performing Assets (NPA) and witnessed unprecedented growth. Bhutada's strategic vision and effective management have significantly enhanced the company's financial health, showcasing a robust performance in the financial sector. This achievement underscores the company's resilience and ability to thrive in a competitive market, setting a new benchmark for operational excellence in the industry.
when will pi network coin be available on crypto exchange.DOT TECH
There is no set date for when Pi coins will enter the market.
However, the developers are working hard to get them released as soon as possible.
Once they are available, users will be able to exchange other cryptocurrencies for Pi coins on designated exchanges.
But for now the only way to sell your pi coins is through verified pi vendor.
Here is the telegram contact of my personal pi vendor
@Pi_vendor_247
Yes of course, you can easily start mining pi network coin today and sell to legit pi vendors in the United States.
Here the telegram contact of my personal vendor.
@Pi_vendor_247
#pi network #pi coins #legit #passive income
#US
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
1. 22nd Annual Health Sciences
Tax Conference
The evolving value chain in life sciences
December 4, 2012
2. Disclaimer
► Any US tax advice contained herein was not intended or
written to be used, and cannot be used, for the purpose of
avoiding penalties that may be imposed under the Internal
Revenue Code or applicable state or local tax law
provisions.
Page 2 The evolving value chain in life sciences
4. Presenters
► Jeff Holtz ► Peter Anderson
Johnson & Johnson Ernst & Young LLP
New Brunswick, NJ New York, NY
+1 212 773 3720
► Karen Holden peter.anderson@ey.com
Ernst & Young LLP
New York, NY ► Sanjeev Wadhwa
+1 212 773 5421 Ernst & Young LLP
karen.holden@ey.com Iselin, NJ
+1 732 516 4183
sanjeev.wadhwa@ey.com
Page 4 The evolving value chain in life sciences
5. Agenda
► Supply/value chain hot topics for today and
tomorrow
► Center-led principal and value-added services
structures
► Supply chain best practices
► Using strategic business processes to impact performance
► Inventory and working-capital management
► Governance and compliance
► Industry trends and drivers
► Collaborations
Page 5 The evolving value chain in life sciences
6. Key challenges for the pharmaceutical
(pharma) and life sciences industry
Demand side challenges Supply side challenges
Challenges to meet
for investments
across the supply and
value chain
► Adapting business strategy ► Competition and price
to the new mix of: pressures (open markets)
► Generic competition
► Cultures and tastes Demand side Supply side
► Cost reduction essential to
Marketing; compete and be profitable
Supply chain
► Ensuring business research and
manufacturing
development
processes and assets match (R&D)
operations
► Supply side rationalization a
market needs
critical success factor
► Emerging market focus
► Procurement, e.g., rationalize
► Brands across markets suppliers
Sales activities Sourcing activities
► Intellectual property (IP)
management strategy across
► Meeting changing patterns multiple brands
of consumer demand in line Direct Wholesale
Suppliers Logistics
► Regulatory environment
with new key markets sales Retail
Page 6 The evolving value chain in life sciences
7. Meeting the challenges — examples of supply
and demand side rationalization strategies
Active pharmaceutical Opportunities across the supply chain
Inactive
Suppliers ingredient (API)
ingredients
Other materials
Reduce spend
Centralization of services and risk management
Leveraging purchasing skills,
Procurement rationalizing suppliers
Operations:
Internal
► Manufacturing/services provision Supply chain rationalization
supply
► R&D and IP management
chain Lean manufacturing processes
processes ► Clinical trial processes and management Logistics management
Inventory/capacity management
Sales
Protect and develop brands
Coordinated IP management and
brand development strategy
Finished
End users goods
Management of issues re generics
Adapting business models to the new outcomes-based, patient-centric world
Page 7 The evolving value chain in life sciences
9. Centralized business models implemented for pharma
and life sciences companies
Centralization can be achieved in: Key decision variables:
► Key functions ► What degree of change can be implemented?
► Transaction flows (hub) ► Where do the key opportunities exist?
► Product groups ► What are the potential benefits?
► Assets such as IP ► Are the benefits realistically achievable?
High
Full principal with
IP
Medium
Sales and
marketing
principal
Benefit
Supply chain
management
company
Import and
export company
Low
Sourcing
company
Service
company
Business impact
Page 9 The evolving value chain in life sciences
10. Full principal model for global pharma and
life science companies
Profit Profit
Ownership of products Ownership of products
Invoice Invoice
Contract manufacturer IP principal Limited risk distributor
Invoice Product
Ownership Deliver Warehousing
Invoice sales and
of material goods services
services
Deliver
goods
Suppliers Centralized warehouse (inventory of principal) Customers
Legal title Physical flow
Material rel. invoice Services
Page 10 The evolving value chain in life sciences
11. The center-led principal (CLP) alternative
Business issue Business drivers
No overall estimated ► CLP can mitigate
realization ERP issues
percentage (ERP)
Center-led
principal system
CLP provides: Bundled or unbundled Deductibility and ► Unbundled services
services, IP withholding tax and royalties may
► Routine
(WHT) mitigate these issues
services ► Value-based fees
for value-added
► Non-routine Indirect tax and ► No change in
services
services customs duty product flows/pricing
► Management fees
► IP ► Limited value-added
for routine
services tax/customs impact
► Royalties for IP
Local sales entities
Page 11 The evolving value chain in life sciences
12. The value-added services model within CLP
It is essential that the CLP has full control over the risks it assumes, substance behind the
functions it performs and the financial capacity to withstand the risks it contractually bears.
► Allocation of risks to the CLP must be substantive in nature.
► The substance follows control and financial capacity to bear the risks.
Control — capacity to make decisions to take ► Requires company to have employees with
on the risk (decision to put the capital at risk) authority to perform control functions
and decisions on whether and how to manage ► Not required to perform day-to-day activities
the risk, internally or using an external provider but must be able to assess outcomes
► Requires company to hold sufficient of
Financial capacity — capital and liquidity
capital and liquid assets to bear risks
position should be held as per that which an
► Can be arranged via financial guarantees
independent entity would require to be able to
and other means as long as arm’s-length
bear and withstand the risks allocated to it
principle is applied to transactions
Consequence: party controlling risk should be compensated by an increase in expected return.
Page 12 The evolving value chain in life sciences
13. Foreign base company services income
(Sec. 954(e))
► The foreign base company services income rules apply to
treat services income as Subpart F income when a
Controlled Foreign Corporation (CFC) performs services
for, or on behalf of, a related person and performs those
services outside its country of incorporation.
► When the CFC receives substantial assistance from
related US persons, service income will be Subpart F,
regardless of where earned.
► Under Notice 2007-13, this rule applies only when the cost to the
CFC of the assistance provided equals or exceeds 80% of the total
cost to the CFC of performing the services.
► The rule does not apply to assistance from other CFCs.
Page 13 The evolving value chain in life sciences
14. Foreign base company services income
(Sec. 954(e))
► Place of performance is a factual issue.
► Watch for foreign base company sales vs services
income.
► Service income related to the purchase and sale of property from
or to related parties may be characterized as foreign base
company sales income (see Treas. Reg. Sec. 1.954-1(e)(1)).
► Substantial contribution rules come into play.
► Certain transactions may be treated separately.
► For example, a CFC manufactures and sells property to a related party
and also provides installation and warranty services.
► In general, the CFC will be viewed as earning separate sales and services
income.
► Compare the predominate character rule (Rev. Rul. 86-155).
Page 14 The evolving value chain in life sciences
15. Foreign base company services income
(Sec. 954(e))
► There is no branch rule of foreign base company services
income.
► Thus, services provided between and among disregarded entities
will not be Subpart F.
Page 15 The evolving value chain in life sciences
16. Overall risks and benefits — incremental
value-added services vs CLP
The overall risks and benefits vary based on several factors.
CLP with value-added CLP with profit split CLP with full residual
service
Bundled or split return Split (per service) Bundled Bundled
Expected risk of challenge Medium risk Medium risk High risk
Implementation difficulty Low difficulty Medium difficulty Medium difficulty
Expected benefits Medium benefits Medium benefits High benefits
Substance shift to center Low to medium shift Medium shift High shift
Initial conclusions
► Various types of return structure are applicable for a CLP providing value-
added services.
► Payments may be bundled or split.
Page 16 The evolving value chain in life sciences
17. Bundled or separate payments? WHT
considerations in Asia
► Services fees do not always attract WHT in Asia-Pacific.
► For technical services fees, WHT generally applies if the services are sourced or performed in the local country.
► Payments may avoid WHT if:
► The payments are characterized as technical services fees and rules are based on the rule detailed above.
► The services are not deemed to be sourced in the local country.
► Note that this general rule does not always apply — full WHT applies on technical services regardless of source
in some cases.
► Under a single payment, many Asia-Pacific authorities deem such payments
to be royalties:
► Technical service fee characterization may be challenged in favour of a royalty if former does not attract WHT.
► If the payment is a single payment and IP or know-how is deemed included, then such challenges are frequent.
► Examples include India, Korea, Hong Kong, Indonesia, China, Japan, Thailand and others.
► Note: technical services fees are shown at non-treaty rates.
SG Treaty WHT rates CN IN JP KR AU NZ ID TH MY SA
Royalties 10% 10% 10% 15% 10% 5% 15% 15% 8% 5%
Dividends 10% 0% 15% 15% 15% 15% 10% 10% 0% 10%
Interest 10% 15% 10% 10% 10% 10% 10% 15% 10% 0%
Technical services 25% 10% 20% 20% 0% 15% 20% 15% 10% 0%
Source: Ernst & Young Worldwide corporate tax guide and the relevant tax treaties
Page 17 The evolving value chain in life sciences
18. Bundled or separate payments? WHT
considerations in Latin America
► Services fees do not always attract WHT in Latin America (Latam):
► WHT in Latam countries depends on the nature of the service. Each country has a definition for each type of service (i.e.,
royalties, technical assistance, management fees).
► Management fees and general services
► WHT generally applies if the services are sourced or performed in the local country.
► Payments may avoid WHT if the services are not deemed to be sourced in the local country.
► Technical services are typically subject to withholding taxes regardless of where they are performed.
► Under a single payment, many Latam authorities deem such payments to be subject to the higher
withholding taxes:
► Service fee characterization may be challenged in favor of a royalty or other category if the former does not
attract WHT.
► If IP or know-how is deemed included, then royalty classification is likely.
Brazil Mexico Argentina Colombia Venezuela Chile Peru Panama
Royalties 15% 30% 28% 33% 30.6% 30% 30% 12.5%
Dividends None None None or 35% None or 33% None or 34% 35% 4.10% 5%
Interest 15% 30% 35% 33% 32.30% 35% 30% 12.50%
Technical services 15% 25% 31.5% 33% 10.2% 20% 15% 12.50%
Source: EY Worldwide corporate tax guide. General rates under domestic law.
Page 18 The evolving value chain in life sciences
19. The value added services solution
► Potential solution: Expected
incremental
prof its Full residual prof its
► Divide the payment into several
component parts, including:
► Routine management
services fee
► Value-added services fee Intellectual property
► Royalties on IP in the event Value-added services
that any rights on valuable Routine services
IP are granted to the sales
companies Commercial risks and dif f iculty in implementation
► Deductibility and transfer
pricing challenges easier
to manage:
► Multiple payments linked to
specific services and IP ► Value added services are a newer
► Easier to defend using concept but are frequently applied.
benchmarks
Page 19 The evolving value chain in life sciences
20. Types of value-added services for life
sciences/pharma companies
1. Services to API manufacturer
Product testing services ► Comparable uncontrolled price (CUP) or controlled
price method (CPM) search for similar service
providers
Plant/production plan layout/design ► CUP or CPM search for design service providers
Centralized procurement services ► CUP or CPM search for procurement companies
Quality processes ► CUP or CPM search for quality service providers
2. Services to API local market life sciences/pharma sales
Request for proposal support services ► CUP or CPM search for marketing services
Warranty support services ► CUP or CPM search for warranty insurers
Database creation ► CUP or CPM search for IT service providers
Demand planning and inventory management ► CUP or CPM search for Supply Chain Management
(SCM) service providers
3. Services to drug R&D entities
Clinical trials project management/technical support ► CUP or CPM search for similar at-risk service prov.
Drug R&D strategy and development services ► CUP or CPM search for similar at-risk service prov.
Page 20 The evolving value chain in life sciences
22. Using strategic business processes to
impact operating performance
► Sales and operations planning (S&OP)
► Principal governance
Page 22 The evolving value chain in life sciences
23. Using strategic business processes to
impact operating performance
► Sales and operations planning (S&OP):
► As part of supply chain redesign, many companies are looking at
this key business process to drive significant improvements in
planning and forecast accuracy and to sustain governance and
compliance structure.
► S&OP processes support substantial contribution.
► The governance and compliance process can be designed within
the S&OP framework.
► Process should monitor that the principal is “living the structure.”
► Process should create documentation for future tax authority review.
Page 23 The evolving value chain in life sciences
24. What is sales and operations planning
(S&OP)?
► S&OP has a vast array of definitions:
► “an integrated business management process developed in the 1980s by Oliver
Wight through which the executive/leadership team continually achieves focus,
alignment and synchronization among all functions of the organization”
Wikipedia, the free encyclopedia
► “a set of decision-making processes to balance demand and supply, to integrate
financial planning and operational planning, and to link high level strategic plans
with day-to-day operations”
Tom Wallace, S&OP 101
► the “function of setting the overall level of manufacturing output and other activities
to best satisfy the current planned levels of sales, while meeting general business
objectives of profitability, productivity, competitive customer lead times, etc., as
expressed in the overall business plan”
APICS The Association for Operations Management
Page 24 The evolving value chain in life sciences
25. Substantial contribution and S&OP
Indicia of manufacturing Potential activities carried out by principal
1 Oversight and direction of the activities or process ► Oversight of manufacturing processes
► S&OP process
under which the product is manufactured
► Formulate policy internal and external manufacturers
2 Activities that are considered in, but are ► Finish and fill
insufficient to satisfy, the substantial transformation ► Sterilization
► Ownership of inventory
3 Material selection, vendor selection or control of
► Manage supplier risk (capacity, obsolescence)
raw materials, work-in-process or finished goods ► Determine supplier capacity and continuity
► Identify and manage cost-improvement initiatives
4 Management manufacturing costs or capacities
► Cost reduction (e.g., inventory reduction, price reduction)
► Direct the planning and production schedules for internal and
5 Control of manufacturing-related logistics external manufacturing
► Monitor production orders, schedules and output to ensure
products are manufactured and scheduled delivery dates are met
► Evaluate quality systems and share best practices
6 Quality control ► Negotiate quality agreements
► Ultimate quality responsibility
7 Developing, or directing the use or development of, ► IP ownership
product design and design specifications, as well as trade ► Develop technology transfer process for new product introductions
secrets, technology or other intellectual property for the ► Transition design or process changes to external partners
purpose of manufacturing or producing the product ► Partner with partners on supply chain development initiatives
Page 25 The evolving value chain in life sciences
26. Effective S&OP aligns objectives
Product Make-vs-
availability buy
decisions
Promotional
plans Short- and long-
term capacity
Customer management
opportunities
Product lifecycle
Competitor management
actions
Inventory management
Portfolio
management Network optimization
Annual plan/budget
Revenue plan
Operating income/profit plan
Capital investment plan
Wall Street guidance
Finance
S&OP supports the organization by balancing goals across
markets, plant operations, supply chain and finance.
Page 26 The evolving value chain in life sciences
27. Why does S&OP fail?
► Companies are organized and typically work in silos, but planning
needs to be executed horizontally.
► S&OP is viewed as a supply chain process instead of a fully
integrated, enterprise-wide planning process.
► Financial, sales, marketing and operations plans rarely match.
► Organization structure does not support effective S&OP.
► Processes are not focused on the right elements; people are not
doing the right things the right way.
► Executive sponsorship is inadequate.
A lack of management support and leadership is the most
common reason for implementation failures.
Page 27 The evolving value chain in life sciences
28. S&OP process cadence
Weekly view
Activity Month 1 Month 2 Month 3
Demand
review and
exception
process
Supply
review
process
Integrated
reconciliation
meeting
MBR
meeting
EBR
meeting
Process Month 1 Month 2 Month 3
Meeting
Page 28 The evolving value chain in life sciences
29. Principal governance and compliance
► Use of a performance management framework to review
operational performance
► Establishes principal oversight of manufacturing and
markets
► Monitors that the principal is “living the structure”
► Creates documentation for future tax authority review
Page 29 The evolving value chain in life sciences
30. Supply chain governance
Operational metrics are used by principal companies to monitor the performance of manufacturing
sites and markets. Metrics should be reliable and action oriented.
Centrally reported metrics were collected Centrally reported
through various scorecards and dashboards. metrics
Operational
Metrics were reviewed and operational
focused metrics
focused metrics identified.
identified
Metrics reviewed
Operational focused metrics were reviewed
with stakeholders
with stakeholders to determine validity.
Critical operational metric was identified that Operational
measures key business process performance. metrics
Page 30 The evolving value chain in life sciences
31. Supply chain governance — example of
operational metrics
These 15 metrics provide visibility into manufacturing and markets’ operational performance.
Operational metrics scope Recommended operational metrics
Process Item
Operational metrics Existing
area no.
Strategic 1 Percent in stock
metrics 2 Forecast error
Planning 3 Forecast bias
4 Inventory value
5 Inventory turnover
Operational 6
Percent principal approved/endorsed
1
Procurement spend
metrics 1
7 Percent of spend in principal lead SRM
(in scope) 8 Distribution cost as percent of sales
Global logistics and 9 Distribution cost per unit shipped
supply 10 Shipments not delivered on time (%)
11 Shipments not delivered full (%)
12 Right first time
13 BOH commitments
Tactical metrics Manufacturing
14 Budget variance
15 Critical findings
Page 31 The evolving value chain in life sciences
32. Supply chain governance activities
Compliance guidelines and operating metrics are aligned to key activities that are critical for governance
and oversight.
# Supply chain governance activity Compliance guidelines Operational metrics
► Demand plan submitted to principal monthly ► % in stock
► Master Production Schedule (MPS) submission ► Forecast error
1 Finished goods planning/manufacturing
guidelines ► Forecast bias
► MPS adherence guidelines
► MPS/Material Requirements Planning (MRP) ► Forecast error
submission guidelines ► Forecast bias
2 Intermediate goods planning/manufacturing
► MPS/MRP adherence guidelines
► Substantial direct material/drug product ► % principal approved/endorsed spend
contracts endorsed by principal ► % of spend in principal lead SRM
3 Direct materials sourcing ► Purchase price variance report submitted to
principal monthly
► Excess and obsolete inventory management ► Budget variance
costing performed at principal ► Inventory value
4 Manufacturing cost management
► Supply chain agreements adjustments ► Inventory turnover
approved by principal
► All inter-transfer approved by principal ► Distribution cost as % of sales
► Transportation plan submitted to principal ► Distribution cost per unit shipped
5 Logistics
monthly ► Shipments not delivered on time (%)
► Transportation plan adherence ► Shipments not delivered full (%)
► Quality parameters met ► Right first time
6 Quality ► Quality reports submitted ► Board of Health (BOH) commitments
► Critical findings
Page 32 The evolving value chain in life sciences
33. Supply chain governance — metrics,
agreements and S&OP
Key activities that help achieve business objectives and support the principal structure
Supply chain
► The principal to review the
agreements and
1 MSA planning
parameters
currently used planning
parameters for select
products
►
Compliance The implementation of
S&OP ► A key process for decision
2 guidelines and
operational
compliance guidelines to
support the principal structure
and operational metrics to
support the business
4 process
making and control of supply
chain activities and business
results
metrics processes
► Identification of thresholds
Escalation and setting of business
3 thresholds
scenarios that will need to be
escalated to the principal for
Operating ► The operating manual to be
review or approval
5 manual
the guiding document for all
processes, responsibilities
and controls
Page 33 The evolving value chain in life sciences
35. Industry trends and drivers
► The life sciences business environment
► Patents: wave of patent ► Commercial structure:
expiries on key products inefficiencies in traditional
and threat of follow-on Reduced growth (top-line) sales and marketing model
biologics ► Compliance commitments:
Margins squeezed
► Productivity: low R&D increased requirements,
productivity slide vs Reputation in complexity and enforcement
historical performance decline actions
and biotech sector ► Customer relationships:
Consolidation
► Pricing: cost containment (mid-market) increasingly informed and
placing pressure on prices active stakeholders
and market access — first demanding value and
Europe, now the US transparency over business
practices
Page 35 The evolving value chain in life sciences
36. Healthcare costs (HC) continue to outpace
economic growth
UK Germany Spain
300 300 400
€2.650 €2.250 €1.850
Index
Index
Index
200 200 250
100 100 100
1992 1997 2002 2007 1992 1997 2002 2007 1992 1997 2002 2007
France US Japan
300 300 400
€3.150 €5.351 €2.381
Index
Index
Index
200 200 250
100 100 100
1992 1997 2002 2007 1992 1997 2002 2007 1992 1997 2002 2007
HC costs GDP Wages
Source: OECD Health Data 2008; EIU. x HC cost per capita 2006 (€) Index: 1992 = 100
Page 36 The evolving value chain in life sciences
37. Higher spend doesn't necessarily lead to
better outcomes
Internationally, higher spend not Costs outpacing improved quality
correlated with increased health for past decade in US
6,000 250
5,000 United States
Expenditures ($) per capita
4,000 200
3,000
(%)
2,000 150
Japan
1,000
Singapore
0 100
68 69 70 71 72 73 74 75 76 1994 1996 1998 2000 2002 2004 2006
Healthy life years Year
Costs Quality
Source: OECD Health Data 2008; EIU.
Page 37 The evolving value chain in life sciences
38. Value-based interventions — how do we define
the value?
►
Health care
value
Health outcomes
Risk-adjusted
outcomes
Patient health experience for a
given medical condition
÷►
Cost of providing
value-based services
Self-management cost of
patient care
=
per dollar spent ► Health status achieved and retained ► Personnel
► Survival
providing ► Extent of recovery or disability ► Facilities
services ► Disease progression ► Supplies
► Recovery/disease management
► Technology
► Right diagnosis
► Value measured ► Treatment errors ► Administration
► Complications ► Net cost across cycle of
across full cycle ► Recovery time
of care ► Sustainability of health care (to minimize cost
► Recurrences shifting)
► ER visits
Focus on results — measured by
quality and efficiency
Source: Redefining Health Care: Creating Value-Based Competition on Results; Michael E. Porter.
Page 38 The evolving value chain in life sciences
39. The collaboration imperative
► Working together for mutual gain
► US health care is transforming from a provider- and payer-
dominated system to one in which patients are at the center of care.
► Forces at work require new levels of collaboration.
► Collaboration, the new competition
► Collaboration crossroads:
► When does collaboration make the most sense for your
organization?
► What strategic issues do you need to address to thrive in a
collaborative environment?
► How are your leaders serving as role models for a collaborative
culture?
► What are the tax impacts of collaboration?
Page 39 The evolving value chain in life sciences
40. In fact, several partnerships and pilots are
positioned to build collaborative care partnerships
I3G Johnson & Johnson
Merck — M2Gen AstraZeneca — Healthcore Fresenius — Aetna
(J&J) — AOK and Care4s
Nationwide network for Merck’s for-profit collaboration AstraZeneca and HealthCore A patient-centric care
integrated outpatient care for with H. Lee Moffitt Cancer Center (WellPoint’s health outcomes coordination program is
schizophrenia patients in Lower aims to improve cancer care with based subsidiary) are conducting improving clinical outcomes and
Saxony region of Germany: personalized treatments. retrospective and prospective reducing costs by slowing the
► Case managers and nurses studies to determine effective progression of chronic kidney
Moffit’s M2Gen database of
build the team on site. and economical treatments for disease in members and
genetic data derived from tumor
► Structured treatment path with chronic diseases. facilitating gentler, less costly
tissue samples and clinical
psycho-educational or drug transitions to dialysis or pre-
information from 85,000 patients
adherence and shared transplant care. The program is
allows researchers to match
decision-making initiatives are enhancing coordination of care
molecular signatures of patients’
in place. among specialists, primary care
cancers with treatments.
providers and nurses.
► Patients and relatives are
active in the decision process.
Sanofi-Aventis — Baltimore Lilly — Anthem BCBS and
Abbott — Anthem BCBS**,
Merck — Camden Coalition County Dept. of Aging, five other Indiana-based
UHC*, Humana, Cincinnati
of Healthcare Providers John A. Hartford Fdn and Health Care Provider
doctors
NCOA (HCPs)
Merck Foundation committed Cincinnati Patient-Centered Sanofi-Aventis, the Baltimore The alliance aims to achieve
$15 million in 2009–2013 to fund Medical Home (PCMH) Pilot and County Department of Aging, the better outcomes for diabetes
the Alliance to Reduce Co-Pilot Project is organized John A. Hartford Foundation and patients. Policyholders of
Disparities in Diabetes, a under the Aligning Forces for the National Council on Aging Anthem BCBS who have
public/private partnership Quality (AF4Q) initiative. (NCOA) launched a pilot diabetes, but have performed
encouraging evidence-based program to help physicians their testing, will receive
The project is sponsored by reminder phone calls.
collaborative approaches to connect older patients with
Health Improvement
improve care and reduce care diabetes to evidence-based
Collaborative of Greater
disparities in low-income, education and wellness support.
Cincinnati and funded by
underserved populations..
Anthem BCBS, Humana, Abbott,
UHC* and various physician
practices.
*UHC=United Healthcare; **BCBS=BlueCross BlueShield Association
Page 40 The evolving value chain in life sciences
41. Rather than research-focused initiatives, improving
patient health outcomes is the ultimate goal.
Inspiration Clinical transformation
Novo Nordisk in China* Aspiration ► Real-world data informing discovery and
Inspiration
Patient-focused, healthier development Merck/M2Gen
outcomes
► Increased focus on “pills+” that help prevention,
adherence and self-management
Aspiration
New therapies for druggable
compounds
Health care delivery
transformation
Aspiration
► Patient–physician Patient N Permanently funded, national
connectivity and multi- *CER Infrastructure
channel information
pipelines Patient
► Improved multi-sourced and
predictive data
► Behavioral economics levers
Aspiration
Aspiration: Collective care
Personalized Healthcare model
Inspiration
Inspiration (Nutrigenomics and Nutrigenetics) Commercial transformation
Sanofi and NCQA
Merck/CIGNA
► Providing product and services in non-traditional settings
► New business models creating lifelong relationships with
Inspiration customers and improving outcomes
Wellpoint/Watson ► Organizing around patient populations
► Customer segmentation Inspiration
Inspiration ► Behavioral economic levers Coalition Against
GSK and GAVI
in 48 Least Developed Major Diseases (CAMD)
Inspiration
Countries (LDCs)**
Merck/Camden Coalition
*Comparative effective research (CER)
Model will enable pharmaceutical companies to access larger markets (from a $200 billion to $2.5 trillion market).
Page 41 The evolving value chain in life sciences
42. Initiatives that focus on collaborative care and quality- and
outcome-based payment are the most highly evolved.
Competitive advantage
established; drives expanding Aspiration:
base of covered lives served Coordinated integrated care
Patient focused
Advanced risk-sharing Holistic payment model
Expand collaborative care pilots to employer
arrangements produce Population context
contracts and 2–3 payers: Abbott and Cincinnati
recurring, predictable cost
PCMH collaboration, Camden Coalition of Standardized
and revenue streams
Healthcare Providers and Alliance to Reduce
Disparities in Diabetes, Maryland multi-payer Transformation rooted in
Confidence in capitation critical mass; clinical practices
PCMH funded by Merck, Pfizer and Sanofi-
and risk pool viewed as leading practice
Aventis
arrangements
Capabilities
Clinical councils expand to broader membership
Multiple payment bundling of PCPs and selected specialists; reduction in
Narrow network products based arrangements; material “at disparity of treatment practices among staff; J&J and
on Accountable Care risk” revenue — UHC and 5 VUMC collaborating in “systemic medical care”
Organization (ACO) panel; ACO oncology practices expanding EHR and decision support
products offered on exchanges
Payment neutral constructs to Maturing teams of primary care physicians (PCPs), case
Form and operate ACO and support experimentation and navigators and analysts; recurring comparison of outcomes to
PCMH pilots infrastructure development standardized evidence-based practices; e-health information and
education resources created and sponsored by multi-disciplinary
Market teams, including HCPs, payers, pharma and technology firms
engagement Payment models
Newly established clinical councils Installation of enterprise
of selected medical staff focus on tools complete; data
quick wins Population and governance and
Clinical outcomes reporting
Today: navigation
Stabilized process for data management produce
collection and reporting; matures; roadmap “single source of truth”
Fee for service Multiple desktop
implementation
applications roadmaps for mature
Episode-based care Automated enterprise tools and data underway
aggregating and
Clinician focused in silos reporting analyzing data management
Individual context
High variability
Evolutionary Revolutionary Disruptive
Page 42 The evolving value chain in life sciences
43. Supply chain and operations management is the
sourcing and delivery arm of collaborations
Pharma
1.0
Drivers of change:
Drugs ► Health care reform
Academia CROs ► Health IT
2.0
► Super consumer
Food cos.
Biotech Medtech
Retail cos. ► Value mining
Diversified
drug portfolios
Health insurance
Telecom cos.
cos.
3.0
Social media Health record
Delivering healthy outcomes:
cos. cos.
► Managing patient outcomes
Health
Information outcomes Health care ► Expanding access to health care
cos. providers
► Meeting unmet medical needs
Payers Physicians
Patients
Key consideration supply chain management:
► What manufacturing, operational and packaging assets are part of the collaborative operation?
► How will service-level, quality, compliance, risk and liability sharing agreements be handled?
► Who contributes the methods and tools that power the collaboration’s success?
Page 43 The evolving value chain in life sciences
44. Collective disease networks enhance physician Future state
example
decision making and improve patient outcomes.
Pharmaceutical — patients for life Payer — enroll and deliver intervention
► Funding Patient Centric Medical Home (PCMHs) National Committee for Quality
► Enroll patient (20,000 pilot members identified through claims analysis)
Assurance (NCQA certification) + procuring patient visit time
► Initial outreach conducted by both pharmacist and Primary Care Physician (PCP)
► Outcome dev./measurement (VBID)
► Initial baseline screenings (using biometrics)
► Longitudinal observational data — epidemiological patient stratification
► Create incentives to align P4O with 10 NCQA measures to ensure better health
► Metrics for Rx (medication possession ratio), patient and provider adherence
outcomes (4 PCP visits)
► New relationships with patients for life (patient care experience)
► Developing clinically nuanced VBID
Leveraging community networks
► KOLs and community physicians (branding and Continuing Medical Education (CME) ► Risk metrics (Harm per 100 patient days, readmissions
VBID
► Identifying patients with diabetes
within 30 days, adverse events per patient days, % of
► Patient literacy — paid pharmacist time
Big Pharma Payer patients with lab values outside therapeutic ranges, cost
► Behaviors (CSAT) — predictive patient profiling
(J&J/Merck/ NYS (BCBS Highmark) per inpatient case, delivery of evidence-based care
Health Foundation) 100% of the time)
► Predictive Key Opinion Leader (KOL) profiling — EY solution model
Pharmacy Benefit Manager (PBM )— manage Pharmacy — patient stratification of risk
risk/cost ► Health Effectiveness Data and Information Set (HEDIS)
measures
► Claim analysis retrospective, predictive,
► Condition specific (hyperlipidermia, Chronic Obstructive
avoidable
Pulmonary Disorder (COPD),
► Outcome development + measurement
►hypertension, asthma)
► Improving recruitment and removing barriers
PBM Pharmacy ► Quantitative:
Pharmacy and providers sharing EMRs
to care
(Medco) ► Consumer satisfaction,
► Patient stratification based on personalized
► Consumption profile (i.e., high utilizers, patients with
medicine
multiple co-morbidities)
Manage risk/cost
Patients and
► Claim analysis (retrospective, predictive, avoidable)
families
► Outcome development + measurement, diagnostics
self-manage
Honest broker — manage incentives/savings after discharge
PCPs — Deliver interventions
► Business model: sustainable prevention programs
► Physician interventions — based on severity
in community — self mgmt., support and counseling
Honest broker, Provider ► Rx adherence + metrics (e.g., pharmacist monitoring)
► TPA (third-party adjudication)/bank
PMO, network, (Northwestern ► Lifelong consent + baseline health risk profiling
► Bundled payment model/capitation on risk/savings
coordinator Memorial ► Incorporating community health workers into primary care
► Incentive management (benefit and quality credits)
(Ernst & Young LLP) Physicians Group) homes to liaison between physicians and communities
► Calculation of cost/savings and understanding of losses
► VBID layers on incentives to steer individuals to high-value practices and adopt
► Risk management (monitoring)/validate risks transferred
treatment and behavior change recommendations offered by physicians — continuous
► Observing customers, conducting surveys — adjusting for Hawthorne effect
FMEA (Failure Mode Effect Analysis) of high-risk areas
► Design of similar protocol/care across all settings (community by community)
► Ernst & Young LLP IP and solutions
Page 44 The evolving value chain in life sciences
45. Diabetes-related hospital admissions and interventional outcomes —
Chicago heat map
► Combine zip code boundary files from Census Bureau Hospital
with graphing capabilities of statistical software to create admission
heat maps of the Chicago area. rates Potential predictors
► Colors are based on hospital admission rates. Red zip
codes indicate high admission rates compared to yellow White
zip codes. ► In initial testing we found the following
potential predictors to be significant:
► Lower right section illustrates possible effects of ► Age, gender, income/poverty, race,
diabetes intervention approaches on admission rates. number of hospitals
This step can be fine tuned with patient level information Male
related to interventions. ► There appears to be a negative
correlation between education level
► Although the model does not show high incidence distribution and hospital admission (top
Education
of diabetes for the white population, EY’s deeper level — row last column). This means the more
analysis revealed that the areas dominated by high- graduate educated the population in a zip code,
earning professionals and white-dominating the lower the hospital admission rate.
communities have a higher number of people at risk
of developing diabetes.
Effect of lifestyle modification Effect of medication
Pre-intervention model of hospital admission rates
Based on
national
averages
Chicago Chicago
Chicago
Chicago diabetes — related hospital admissions
Chicago diabetes — related hospital admissions post-intervention heat map — lifestyle and
pre-intervention heat map medication adherence
Low High
Page 45 The evolving value chain in life sciences