NETCARE PRESENTATION TO HEALTHCARE MARKET INQUIRY. MELANIE DA COSTA DIRECTOR STRATEGY AND HEALTH POLICY

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1 NETCARE PRESENTATION TO HEALTHCARE MARKET INQUIRY. MELANIE DA COSTA DIRECTOR STRATEGY AND HEALTH POLICY 1

2 PRESENTATION FORMAT Introduction to Netcare How Netcare interacts with other stakeholders Netcare s initiatives to improve access Examples of cooperation with public sectors Netcare s initiatives to improve quality of care Netcare s initiatives to increase affordability of healthcare CARE DIGNITY PARTICIPATION TRUTH PASSION 2

3 NETCARE HOSPITAL ASSETS Southern Africa 57 hospitals beds Including 5 Private Public Partnerships (PPPs) United Kingdom 53.7% ownership of BMI Healthcare since hospitals beds 40% of patients are NHS funded public patients CARE DIGNITY PARTICIPATION TRUTH PASSION 3

4 HOW NETCARE INTERACTS WITH OTHER STAKEHOLDERS 4

5 HOW NETCARE INTERACTS WITH STAKEHOLDERS 1/2 Medical schemes Doctors (Drs) Before a Dr can admit a patient, a scheme must authorise authorisation is not a guarantee of payment Annual hospital reimbursement negotiation Daily interaction on complicated patients Significant level of transparency on bill from line data on ward, theatre, equipment, drug and surgical items and disease and procedure codes. Unusually high information in terms of our international experience Quarterly liaison meetings at senior level By law private hospitals don't employ Drs Emergency Departments are run by independent practitioners Hospitals do not engage in choice of patient treatment or referrals to or between Drs Practitioner tariff negotiations are independent of hospitals Dr s do not participate in hospital revenue The hospital bill excludes services rendered by independent practitioners including Drs, pathologists, radiologists, physiotherapists and anaesthetists and other service providers. CARE DIGNITY PARTICIPATION TRUTH PASSION 5

6 HOW NETCARE INTERACTS WITH STAKEHOLDERS 2/2 Patient relationships Netcare provides information on the admission and discharge process; services provided; what to expect with procedures and what to look out for when patients go home Patients can access the following information on the Netcare website: Emergency Departments: Netcare s policy on the pricing of treatment provided to patients: Private Patient (self-pay) : Pricing Guidelines; Service covered and specialist information Information on: admission and discharge; Netcare complaints process Pamphlets on admissions on top 50 procedures or general information for medical; surgical or maternity admissions. Detailed information on wound care; pain management; medication etc. Multimodal system to assess patient experience including in-hospital surveys; post discharge surveys. Netcare measures patients satisfaction based on USA HCAHPS 1 : 21 patient perspectives on care encompassing 9 topics*. Patient feedback daily reports are ed to the relevant people at hospital and Head-Office level. Patient feedback is then assessed and appropriately responded to. 1 HCAHPS:Hospital Consumer Assessment of Healthcare Providers and Services * communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care CARE DIGNITY PARTICIPATION TRUTH PASSION 6

7 NETCARE INITIATIVES TO IMPROVE ACCESS 7

8 INVESTMENTS Over R8bn invested in capital expenditure over the last 8 years Opened 200 bed Netcare Waterfall Hospital in Midrand, with empowerment partners Part of consortium that opened 425- bed Queen Mamahato Memorial Hospital in Lesotho Opened new 200 bed hospital in Polokwane 2015 with empowerment partners Opened new 100 bed hospital in Pinehaven (West Rand) in 2015 ± nurses trained in SA since 1999 across 5 training academies Registrar & Fellow sponsorships. Cooperative agreements and MOU with 6 universities Hamilton Naki Foundation CARE DIGNITY PARTICIPATION TRUTH PASSION 8

9 R260M INVESTED IN ACCESS THROUGH CORPORATE SOCIAL INVESTMENT Netcare Corporate Social Investment Indigent Emergency Medical Services Accessibility initiatives Community sponsorships Netcare CSI discretionary other Bursaries Public sector strike PMR.africa Diamond Arrow Award for Corporate Social Responsibility Initiatives Netcare won the national Diamond Arrow Award in the category for private hospital. This is the fourth consecutive year that Netcare has had the highest recognition by PMR.africa. Source: Company data CARE DIGNITY PARTICIPATION TRUTH PASSION 9

10 PARTNERING IN EXTENDING FREE ACCESS TO HEALTHCARE > patients treated since inception in following initiatives: Daily emergency assistance to indigent patients through Netcare 911 ED patients without medical cover are seen and admitted if necessary 37 Netcare Sexual Assault Centres Hear for Life programme (cochlear implant) Walter Sisulu Paediatric Cardiac Foundation, is the largest paediatric cardiac unit on the continent Johannesburg Craniofacial programme Netcare Sight for You programme (cataracts) Netcare Cleft Lip and Palate programme 600 adults and 217 babies treated during national public sector strike in 2010 * Emergency Department CARE DIGNITY PARTICIPATION TRUTH PASSION 10

11 EXAMPLES OF CO-OPERATION WITH PUBLIC SECTORS 11

12 PATHFINDER PROJECTS - LESOTHO Background One of the poorest areas of southern Africa Life expectancy years Incidence of TB of 632/ ¹ Prevalence of HIV/AIDS 26%² Maternal mortality 1115/ births² A population drainage area of 1.8 million people, half a million living in close proximity to hospital New 425 bed hospital and three primary care referral clinics managed by private sector Independent monitor: >1,000 KPI s each quarter. Failure triggers a penalty Independent study undertaken by Boston State University USA for the World Bank Sources: ¹ WHO 2012 Global TB Report; ² Lesotho Ministry of Health Joint Review Report 2012/2013 CARE DIGNITY PARTICIPATION TRUTH PASSION 12

AN EXAMPLE THAT IS WORKING IN THE PUBLIC SECTOR - LESOTHO Managing design, development and commissioning to ensure delivery on time and within budget Training & mentorship of nurses in special units

13 AN EXAMPLE THAT IS WORKING IN THE PUBLIC SECTOR - LESOTHO Managing design, development and commissioning to ensure delivery on time and within budget Training & mentorship of nurses in special units Provide the information management platform to ensure effective, efficient administration Manage the hospital and clinics on 18 year contract Excellent clinical being achieved CARE DIGNITY PARTICIPATION TRUTH PASSION 13

14 LESOTHO: COMPARATIVE DATA OF NEW PPP VERSUS OLD PUBLIC HOSPITAL Old Hospital (QEII-IN) New Hospital (QMMH-IN) % Hospital beds Inpatient admissions Inpatient days Outpatient visits* Deliveries* Average length of stay Hospital occupancy 61% 82% -34 Death rate* 12.00% 7.10% - 41 Maternity death rate* 0.24% 0.21% -13 Paediatric pneumonia death rate 34.40% 11.90% -65 Still birth rate 4.00% 3.10% -23 Survival of low birth weight infants (<1.5kg) n/a 69.8% >100 * Including primary care filter clinics Source: Endline Study for Queen Mamohato Hospital Public Private Partnership (PPP) September 2013 Center for Global Health and Development, Boston University, Department of Family Medicine, Boston University and Lesotho Boston Health Alliance, Maseru CARE DIGNITY PARTICIPATION TRUTH PASSION 14

15 ACCESS TO NEW TECHNOLOGY AND SERVICES First MRI scanner and bone densitometer First ICU and Neonatal ICU First Laparoscopic surgery and endoscopy procedures First Laminar flow theatres Introduction of emergency Neurosurgical interventions First electronic medical record and distribution of digital radiology images First primary healthcare filter clinics and Hospitals in Lesotho to have been accredited by Cohsasa Comprehensive audiology service including screening of new born babies Reduced waiting time for elective surgery from 6 months to 6 weeks Eradicated the hip and knee replacement waiting list for Basotho patients Improved access to dental services CARE DIGNITY PARTICIPATION TRUTH PASSION 15

16 CARE DIGNITY PARTICIPATION TRUTH PASSION 16

17 CARE DIGNITY PARTICIPATION TRUTH PASSION 17

SUMMARY OF NETCARE PPP/PPI EXPERIENCE Netcare South Africa

and Pelonomi) Port Alfred and Settlers PPP UCT Private Hospital

hospitals Primary care Commuter Walk-In Centre Free Patient Choice

centres and built a gateway clinic Manage a health system from

18 SUMMARY OF NETCARE PPP/PPI EXPERIENCE Netcare South Africa Bronkhorstspruit Hospital Bloemfontein co-location PPP (Universitas and Pelonomi) Port Alfred and Settlers PPP UCT Private Hospital Netcare United Kingdom Mobile cataract services Elective surgical hospitals Primary care Commuter Walk-In Centre Free Patient Choice Netcare Lesotho Replaced the Tertiary hospital and 3 primary care centres and built a gateway clinic Manage a health system from primary care to tertiary on a fixed budget CARE DIGNITY PARTICIPATION TRUTH PASSION 18

19 PATHFINDER PROJECTS: UNITED KINGDOM Providing clinical services to the NHS since 2011 An example of a pathfinder project: ophthalmology treatment centres Contracted to provide cataract operations over 5 years; provided 6 mobile units (2 theatres 2 wards and 2 outpatient units) Operate 6 days a week, 50 weeks a year operations per theatre per day six days a week 45 outpatient pre operative assessments per day 60 follow up post operative visits per day CARE DIGNITY PARTICIPATION TRUTH PASSION 19

20 Short video clip on UK Mobile Units CARE DIGNITY PARTICIPATION TRUTH PASSION 20

21 CARE DIGNITY PARTICIPATION TRUTH PASSION 21

22 THE UK PPP IN SUMMARY Demonstrated ability to deliver high volume surgery on a sustainable basis Introduced new operating and clinical pathways into NHS Clinical outcomes better than any other published in NHS or private sector Patient satisfaction extremely high Pathfinder project adaptable elsewhere and in different disciplines CARE DIGNITY PARTICIPATION TRUTH PASSION 22

23 SOUTH AFRICAN AREAS OF COLLABORATION WITH GOVERNMENT Participate in 4 PPP s but they exclude actual clinical delivery Tabled multiple elective waiting list proposals HASA presentation to Health Portfolio Committee 08 summarising possibilities Treasury s Technical Assist Unit benchmarked Netcare s processes (2009) Netcare s assistance in the 2010 public sector nurse strike Private-public Social Compact on healthcare Assistance with 2014 drug shortages Close cooperation with DoH, NICD and SA Military Health Services on Ebola mgt We believe there are many areas of potential collaboration between private and public CARE DIGNITY PARTICIPATION TRUTH PASSION 23

24 CARE DIGNITY PARTICIPATION TRUTH PASSION 24

25 NETCARE S INITIATIVES TO IMPROVE QUALITY OF CARE MELANIE DA COSTA DIRECTOR STRATEGY AND HEALTH POLICY 25

26 NETCARE HAS EMBEDDED THE TRIPLE AIM AS A FOUNDATIONAL PRINCIPLE AND PHILOSOPHY Best patient experience Achieving high value for patients must become the over-arching goal of healthcare delivery, with value defined as the health outcomes achieved per dollar spent. Michael Porter N Engl J Med 2010, 363:26 Best outcomes Triple Aim Most cost effective Improvement capability Science based improvement skills and processes Robust integrated technology CARE DIGNITY PARTICIPATION TRUTH PASSION 26

27 QUALITY LEADERSHIP FRAMEWORK CARE DIGNITY PARTICIPATION TRUTH PASSION 27

28 INTEGRATED QUALITY BALANCE SCORECARD ACROSS ALL DIVISIONS CARE DIGNITY PARTICIPATION TRUTH PASSION 28

29 FOCUS AREAS Quality Assurance: Active participation in development of the National Core Standards(NCS). Netcare hospitals have achieved an overall compliance of over 85% in group audits against the NCS. Patient experience: Hospitals are focused on continuous improvement on HCAHPS definitely recommend and overall experience and meet targets. Comprehensive infection prevention and antibiotic stewardship programs across all facilities that meet and exceed global best practices. Outcomes measures have shown reduced antibiotic utilisation and consistent year on year improvement for focused infection risks such as ventilator associated pneumonia (VAP), central line associate blood stream infections (CLABSI), of surgical site infections (SSI) and catheterassociated urinary tract infections (CAUTI). CARE DIGNITY PARTICIPATION TRUTH PASSION 29

30 QUALITY: INTERNATIONAL BENCHMARKING OF PATIENT EXPERIENCE SA Patient-centric quality performance vs. US HCAHPS¹ benchmark Definitely recommend Medication information Discharge information Nursing score Pain management H US HCAHPS 1. HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Services CARE DIGNITY PARTICIPATION TRUTH PASSION 30

31 NETCARE S INITIATIVES TO INCREASE AFFORDABILITY OF HEALTHCARE MELANIE DA COSTA DIRECTOR STRATEGY AND HEALTH POLICY 31

32 KEY COST COMPONENTS IN HOSPITAL CARE Cost of sales and operating costs Universal cost of hospital delivery: building; nursing salaries; doctor salaries and drugs and surgicals SA legislation precludes private hospitals from employing doctors 37.6% Cost of drugs and medical consumables 43.1% Payroll 2.7% Catering 5.8% Administration 10.8% Other CARE DIGNITY PARTICIPATION TRUTH PASSION 32

33 GLOBAL COMPARISONS Nurse recruitment and training Netcare has sought to address shortage of nurses by: Training >3000 nurses p.a. and recruiting from India. Nursing salaries (per month) SA: ranges from R R per month UK: range from R to R per month India: from R1 800 to R9 000, while in certain states, a minimum wage of R2 350 Cost of hospital build (per bed) SA: R2.5-R3.5m UK: 1m (R23m) India: R1m-R1.8m Consumable costs (drugs and medical devices) SA : Drugs and surgicals charged at costs. Considered procurement strategy to lower cost UK: Netcare s analysis of various drugs vs. UK market indicates significantly higher prices in SA India: Medical devices - the reuse of single-use devices is a fairly prevalent practice¹ Source: Some hospitals routinely reuse medical devices sold as single-use products - such as $160 steel clamps employed during beating-heart surgeries, which CARE Hospitals and NH sterilize and reuse 50 to 80 times (Harvard Business Review) CARE DIGNITY PARTICIPATION TRUTH PASSION 33

34 SA PRIVATE HOSPITAL VS PUBLIC HOSPITAL BENCHMARKING Like-for-like comparison for the operating cost per admission for the public and private sectors 5.3% difference 4.7% difference Private hospital sector Public hospital sector Private hospital sector Public hospital sector Operating cost per admission (R)¹ Development cost per m² (including escalation)² 1. Source: Shivani Ramjee: Comparing the cost of hospitalisation across the public and private sectors in South Africa 2. Source: Walter xxxx IUSS Public Hospital Cost Model, a collaboration between the CSIR, the National Department of Health and the Southern Bank of Africa CARE DIGNITY PARTICIPATION TRUTH PASSION 34

35 SA PRIVATE HOSPITAL VS PUBLIC HOSPITAL BENCHMARKING Like-for-like comparison for the operating cost per admission for the public and private sectors 5.3% difference DOH introduced Folateng private wards in some public hospitals, using similar tariffs for medical schemes as those used by private hospitals. The Folateng private wards in four Gauteng public hospitals ran at a loss of around R40 million last year Private hospital sector Public hospital sector Operating cost per admission (R)¹ 1. Source: Shivani Ramjee: Comparing the cost of hospitalisation across the public and private sectors in South Africa 2. CARE DIGNITY PARTICIPATION TRUTH PASSION 35

36 THANK YOU! 36

Stakeholder engagement SA

72 Stakeholder engagement SA At Netcare, communication with our stakeholders is integral to the way we do business. The eight stakeholder groups below have been identified on the basis of the extent to