Organizacin Sanitas Internacional (OSI)

Presentation to Asian Development Bank. February 18 2016

Development of outcome-driven feasible healthcare projects

01
02
03
04
05

About OSI
Operational Highlights
Financial Highlights
OSI Business Model
OSI Public Health
Management Background

06
07
08

OSI Target Sectors

OSI in South East Asia
OSI and ADB

Disclaimer: The views expressed in this paper/presentation are the views

of the author and do not necessarily reflect the views or policies of the
Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of
the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be
consistent with ADB official terms.

01 OSI
Organizacin Sanitas Internacional
(OSI) is a group of companies specialized in
managing, assuring and providing healthcare
through its own network of hospitals, health
centers and accredited suppliers. OSI also
consists of educational institutions and
societal-oriented companies that complement
its ability to offer wide-ranging health services.

Sanitas oversees the care of its members

and patients by maintaining their health as
well as identifying and managing risk and
disease. We are leaders in comprehensive
health services in the countries where we
operate, and are widely recognized for our
scientific, technical, ethical and human
approach.

Created in Spain over 50 years ago and moved to Latin

America in 1980. Today, while growing in Latin and North
America, we continue to move forward with ongoing
development plans in Europe and Asia, where we work to
fulfill our mission.

02

Operational Highlights

Colombia

Venezuela

Cities

198

Brazil

Cities

55

Cities

2015 Development

Peru
Cities

570

28

USA
Cities

Members (thousands)

Members (thousands)

Members (thousands)
259.3

1,888.7

Affiliated Doctors (thousands)

Affiliated Doctors (thousands)

2.7

9.0

Hospitals
Primary Care Centers

51

Dental Centers

29

Ophthalmology Centers

Laboratories

48

Optical Centers

28

Affiliated Healthcare
Institutions:
2,634

0.3

OSI Health delivery network

2016 2017 Expansion Plan

OSI Health delivery network

Hospitals
Primary Care Centers

Dental Centers

Ophthalmology Centers

Optical Centers

Hospitals

Laboratories

Primary Care Centers

Primary Care Centers

Laboratories

Affiliated Healthcare
Institutions:

Affiliated Healthcare
Institutions:
219

4,047
Pharmacies

Laboratories

Employees (thousands)

Employees (thousands)
1.0

OSI Health delivery

network

OSI Health delivery network

1 Location

1.2

Employees (thousands)

Employees (thousands)

Primary Care Clinics

Affiliated Doctors

Affiliated Doctors (thousands)

1 Location

252.5

399.6

Guatemala

Members (thousands)

4.4

8.3

Mxico

Affiliated Healthcare
Institutions:
917

December 2015

East Europe

Asia

03

Financial Highlights
2012 Income Statement

Balance Sheet

2014

2013

Total Assets

1,010

967

755 Revenue

Equity

331

324

226 COGS

Gross Debt

155

166

143 Gross Income

53

80

Net Debt

78 OPEX
Other Non-Operating

Equity / Total Assets (%)

Net Debt / EBITDA ( x )

33%

34%

0.6

1.3

30% Net Income

1.8 EBITDA

2014

2013

2012

1,901

1,671

1,509

(1,484) (1,323) (1,216)

417

348

293

(430)

(333)

(299)

18.1

(5.0)

6.0

5.3

8.9

(0.3)

86.3

62.2

42.3

04

OSI Business model

1. The 5 Ps of Health Management

Personalized, because
it takes into consideration
the particular
characteristics of the
individual as a unique
and unrepeatable human
being.

At Sanitas we have developed an

inclusive health management model
that responds to the local needs
with:

Comprehensive health care

A health care network
Local health teams and staff
Risk-oriented health care approach
Integrated health information systems
Health outcome oriented
Standardized protocols and guidelines
Applied technology
Continuous training done by experts from OSIs
university

Predictive,
identifies the
potential occurrence
of a disease and
takes appropriate
action to prevent or
mitigate it.

Participative,
because it empowers
the informed
individual or active
patient to make
decisions affecting
his/her health.

Preventive, because it
designs actions aimed
at maintaining health.

Permanent is the fifth P

included in the model.
Health care should not be
intermittent or
conditioned; thus we rely
on a continuous
monitoring process.

04

OSI Business model

2. Distributed Network

Basic
Medical Center

Specialized
Medical Center

Outpatient services
Primary Care oriented
One-stop clinic
80% of healthcare needs attended
Resource planning and allocation
based on our know-how in
business performance metrics.
Electronic medical records

Referrals and counter-referrals from

network
20% of healthcare needs attended
Integrated medical data with the
network
General Hospital

Sanitass business model consists on providing a patient-centered, comprehensive, high

quality and cost effective health care delivery model through the establishment of a
primary care center network that serves an assigned population

04

OSI Business Model

3. Role of Medical Centers
in the healthcare network

ACCESIBILITY health teams,

facilities location, comfort and
appointments management

COMPREHENSIVE
continuous and coordinated
attention among the different
complexity levels,

HIGH QUALITY:
Supported by Lab,
imaging and specialized
diagnosis

PATIENTS
SATISFACTION
EFFICIENCY AND COST
CONTROL

04

OSI Business Model

4. Sanitas Health Centers

Health facilities that bring a one stop

clinic
solution,
by
delivering
outpatient health services in an
integrated, coordinated, timely and
efficient way, altogether aiming at the
patients health value and operational
efficiency.

ONE STOP CLINIC

04

OSI Business Model

6. Sanitass Health Centers objectives

Enable access to health services

Solve the most frequent health problems

Reduce the number of low-complexity

emergency consultations at hospital centers

Develop healthcare programs

for patients with chronic diseases

Integrate care in order

to optimize the use of
high-complexity resources

04

OSI Business Model

7. Characteristics

Efficiency - HIGH quality / LOW Cost.

Resoluteness Handles al least 80%

of health needs.
Coordination of the different
levels of the health care system:
reference and counter reference.
Adopts protocols and guidelines
for prevailing diseases.
Health maintenances, prevention
and risk management, episodic
events care, chronic illness
management.
Keeping our patient healthy
and, preventing complications.
Standardized and repeatable model.

Promotes the systems efficiency.

04

OSI Business Model

8. A comparison vs Traditional model

Sanitass model

Traditional model

Use of expensive resources

Curative Medicine
Specialist /physicians
Unintegrated medical records
Disease Focus
Emergencies mostly treated at hospitals.

Cost efficient
Preventive medicine.
Multidisciplinary health team.
Integrated medical records in a network
Patient Focus
Emergencies treated at the appropriate level

04

OSI Business Model

9. How we handle health care complexity level

Level III
5% - 10% of the demand.
High cost.
Hospital
III IV

Level II
10% - 20% of the demand.

Specialized Clinic
Hospital I - II

Level I
80% health demand
of the demand.

Medical Centers

04

OSI Business Model

10. Base on Risk Management

04

OSI Business Model

11. Summary of Business and Value Model

A vertically integrated approach

Integrated Insurance / Healthcare Services
Health Value management
Multiple complexity approach, focus on primary care
Adaptability to multiple health systems (public, private, mixed).

Health Insurance, Accessibility

Broad Customer
Approach

Group
Insurance

Individual
Insurance

Family
Insurance

Adaptive Health
Plans
Public Plan
Management

Health Management
Drivers
Risk Screening and
Management

Dental
Programs
Other Specific
Products

Ample Service
Panel

Primary
Care

Premium
Products
Basic Health
Insurance

Integrated Medical Centers

Network

Imaging &
diagnostic

Specialty Laboratory
Care

Community
Members
Health
Maintenance

Disease
Management

Walk-in
urgent care

Key Success
Factors
Alignment of goals
between insurer
and provider
Interdisciplinary
Medical Team and
competencies

Complexity and
chronic disease
management
Vaccinations

Prescriptions Wellness
Programs

Healthcare
promotion and
prevention activities

05

OSI Public Health Management Background

1. The Colombian Experience (1)

In 1993, the sanctioning of Law 100 promoted healthcare under the following values:
Efficiency: best use of financial and social resources
Universality: protection for all.
Solidarity: mutual-help.
Fullness: sufficient coverage.
Unity: common goal.
Participation: community involvement.
Public Health Market Structure

Providers

Third Party Network

Insurers

Network
Private

Contributions
Contributions

EPS
Private
+80%

Network
Integrated EPS Network

Capitations

Government
SGSSS
Budget

Subsidized

FOSYGA
EPS
Gov.

Network
Gov.

05

OSI Public Health Management Background

1. The Colombian Experience (2)

Public Health Market Structure

Providers

Sanitas provides insurance, health

management and provides services to
Mandatory Health Plan (POS) members
through EPS Sanitas and Clnica
Universitaria Colsanitas respectively.

Clnica Universitaria
Colombia

498 hospital beds for POS members

Insurers
+ 1.5 million POS members
insured
51 dedicated Primary Care
centers for POS members

Government

Primary Care
Network

05

OSI Public Health Management Background

2. Challenging Health Indicators (Chronic disease)

High blood pressure

Coverage on Diagnosed Patients

Controlled Patients

75.0%

85.0%

70.0%

80.0%
69.9% 69.9%

65.0%

66.0%

60.0%
55.0%

67.5%

63.0%
58.1%

50.0%

57.9%
53.2% 52.7% 53.6%

54.9% 55.6%

Coverage on

75.0%

81.7% 81.9% 81.9%

80.1% 80.2% 80.2% 80.5% 80.5% 80.7% 80.8%
79.2% 79.4%

70.0%
65.0%
60.0%

Optimal areas

Controlled patients

Optimal areas

International studies establish a coverage of 60 70 % and a control level of 70 80 %.

Notes:
In-program patients: Patients diagnosed with HBP that have had their blood pressure controlled over the last 6 months.
Diagnosed patients: Patients currently diagnosed with HBP.
Controlled patients: Patients with SBP<140 and DBP<90 over the last 6 months.

05

OSI Public Health Management Background

2. Challenging Health Indicators (Chronic disease)

Diabetes Mellitus
Coverage on Diagnosed Patients
80.0%
60.0%
60.9%62.7%61.1%61.3%60.8%
40.0% 53.3%58.2%

67.2%69.8%70.2%71.7%71.8%

20.0%
0.0%

Coverage on diagnosed

Optimal areas

Controlled Patients
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

37.3%

49.6% 49.6% 49.4% 50.1%

45.7% 47.0% 48.0% 48.6%
42.6% 42.7% 44.1%

Controlled

Optimal areas

International studies establish a optimal coverage between 60 70 % and a optimal control level of 40 50 %.

Notes:
In-program patients: Patients diagnosed with Diabetes and control consultations over the last 6 months.
Diagnosed patients: Patients currently diagnosed with Diabetes.
Controlled patients: POS-only high-risk final users controlled (stage 5 with HB1C<7.5) and POS-only low-risk final patients (any stage of ERC with
HB1C<7).

05

OSI Public Health Management Background

2. Challenging Health Indicators (Maternal and children mortality)

5.400 infants are dying every year in SEA

3.000 mothers die every year giving birth

Most of them are preventable

Maternal Mortality Rate
(per 100,000 live births)

Infant Mortality Rate

(per 1000 live births)
23

126
114

22
17

14
54

12

64

10
INDONESIA

PHILIPINES

VIETNAM

COLOMBIA

OSI COLOMBIA

INDONESIA

PHILIPINES

VIETNAM

COLOMBIA

OSI COLOMBIA

Source: World Bank 2015 and OSI

2. Challenging Health Indicators (Performance Indicators)

Performance Indicators

Waiting Times (General Consultations)

days
Oportunidad

Mximo

07/15

04/15

01/15

10/14

07/14

04/14

01/14

10/13

07/13

0
04/13

05

OSI Public Health Management Background

05

OSI Public Health Management Background

3. Summary

Sanitas as an ideal partner in the public health sector

Relevant background in Public Health Management.

Vertically integrated to seek efficiency and improve patients health and user experience
Capacity to work with proprietary country-wide healthcare network and third party
providers

Capacity to manage proprietary broader health products and public coverages

Strategically focused on providing access to healthcare in high-volume, low-income, highfootprint countries with Basic Health Coverage health plans.

Multi-country experiences to gain better understanding of local needs and best practices.

Health indicator oriented.

Sustainable long term growth model, paced with the populations health goals.
Capacity to collaborate in health regulation and coverage system definitions and improvement
with governments, based on Colombian experience.

06

OSI

Target sectors
We focus on partnering and involving both public and private sectors,
generating developmental opportunities with cross-participation

Public
Sector

Private
Sector

Central, regional or local governments, public health and social security

agencies willing to resolve the populations health needs, efficiently
manage budget / health expenditure and transfer financial and economic
risks to private sector while accomplishing the health mandate
Health Insurance Companies willing to reduce medical cost and access to
broader insured base with a lower income product or public insurance
compatible
Healthcare network operators aiming at efficiently balancing healthcare
services and facilitating access to their network with an appropriate
health plan.

ADB

Multilateral Institutions: as entities acting as financial sponsors and

stewardess of the implementation a viable country-scale inclusive
healthcare solution, not as mere financiers of health infrastructure.

07

OSI in South East Asia

Current Relevant Developments

Developments

Philippines

Negotiations to take on operation of

a provincial network of hospitals and
cross-municipal healthcare facilities
through a PPP scheme.
Development of a no-balance billing
oriented maternity clinic network.
Development of Primary Care
Network with local partners.

Indonesia

Vietnam

Involvement in improvement and

management of regional government
facilities.
Acquisition and capitalization of an
existing medical center as an
expansion platform

Goals and outcomes

Increase service delivery efficiency and overall

network outcome
Improve network health outcome through 5P
model implementation
MDG as a central element

Development to paediatric services and family

primary care
Provide quality services under BPJS rate
schemes
Increase management efficiency and
accountability of financial and health
indicators

Increase low participation of private sector

in healthcare industry and implement
primary care priority

08

OSI and ADB

Our understanding of ADBs Health Strategies and Goals

We acknowledge ADB is willing to grow its healthcare lending portfolio while increasing the
externalities with a stronger involvement in the value chain, leading to Projects

Comprehensive integrated

with a broad scope (involving health

access and services) and broad
geographical footprint

Viable and efficient

defined, structured and managed

professionally with positive economic
and financial results.

Health outcome-driven

with clear and measurable health

indicators

Inclusive Healthcare

focused on the least privileged and

with the involvement of the main
stakeholders

Beyond Financing: ADB added value and Brand

recognition

in which ADB has a creating and

steering role and is identified
together with other sponsors

08

OSI and ADB

Collaboration Proposal

Joint objective and efforts lead to successful development

Asia Development Bank

Sanitas
Opportunity
generation, project
definition and
development
Primary care product
definition and
commercialization
Efficient healthcare
network operation

Join tablework:
o Project feasibility
evaluation

o Due Diligence
o Internal Approvals
PPP definition
Equity funding

Project steering

Project Debt Funding

(infrastructure and
equipment)
Guidance

Branding
Institutional Support

08

OSI and ADB

Collaboration Proposal
Example Collaboration Structures for Public Health Sector
Public Ownership with ADB Funding

Steering & Stewardship

Ad-hoc Public Private Partnerships

Existing framework enabled private
sector participation in public health
New regulatory enabling framework

ADB
Funding

Sanitas

PPP Vehicle

Management

Capitation
or other

Government

Improvement
Appropriations
Coverage

Insured
Members

New Medical
Center
Network

Existing
Network
Transfer

08

OSI and ADB

Collaboration Proposal
Example Collaboration Structures for Public Health Sector
Private Ownership with ADB Sanitas Co-Funding
Ad-hoc Public Private Partnerships
Existing framework enabled private
sector participation in public health
New regulatory enabling framework

ADB
Co-Funding

Sanitas

Capitation or other

Management

Coverage

Insured
Members

New Medical
Center
Network

Government

Improvement
Appropriations

Existing
Network

Contact

Jaime Escallon
Vice President Sales International Division
+57 315 344 9857
jdescallon@colsanitas.com
Pablo Ochoa de Zabalegui
Country Director Philippines
+63 917 323 62 89
pablo.ochoa@ph.sanitas.me

Annexes
A1 Relevant Sanitas Medical
Centers

18.02.16

Health centers

30

A2

Relevant Sanitas Medical Centers

Hospitals
Clnica Reina Sofa (Bogot - Colombia)
Unit

# Beds

Unit

# Beds

Pediatrics

24

Pediatrics

44

Adults

91

Adults

198

Labor & Recovery

Labor & Recovery

12

Maternity

Maternity

Maternity

11

Maternity

12

Intensive

Intensive

Basic

Basic

13

Minimum

Minimum

Neonatal NICU

15

Neonatal NICU

25

Intermediate Care

Intermediate Care

Intensive Care

Intensive Care

13

Cardiovascular ICU

Cardiovascular ICU

15

ICU

ICU

34

Pediatric NICU

Pediatric NICU

Total Beds
ORs Surgery Rooms

January 21, 2016

Clnica Universitaria Colombia (Bogot - Colombia)

150

CONFIDENTIAL

Total Beds

319

ORs Surgery Rooms

10

31

A2

Relevant Sanitas Medical Centers

Hospitals
Clnica Iberoamrica (Barraquilla - Colombia)
Unit

# Beds

Unit

# Beds

Pediatrics

Pediatrics

14

Adults

62

Adults

43

Labor & Recovery

Labor & Recovery

Maternity

Maternity

Maternity

Maternity

Intensive

Intensive

Basic

Basic

Minimum

Minimum

Neonatal NICU

January 21, 2016

Clnica Sebastin Belalczar (Cali - Colombia)

14

Neonatal NICU

Intermediate Care

Intermediate Care

Intensive Care

Intensive Care

Cardiovascular ICU

Cardiovascular ICU

ICU

10

ICU

Pediatric NICU

Pediatric NICU

Total Beds

99

Total Beds

70

ORs Surgery Rooms

ORs Surgery Rooms

CONFIDENTIAL

32

A2

Relevant Sanitas Medical Centers

Other hospitals and ambulatory centers

Clnica Santa Paula
(Caracas - Venezuela)

Clinisanitas Doral
(Florida - USA)

January 21, 2016

Clinisanitas Bucaramanga
(Colombia)

Clinisanitas #96
(Bogot - Colombia)

CONFIDENTIAL

Clinisanitas Colina Campestre

(Colombia)

EPS Sanitas UAP

(Bogot - Colombia)

33