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NETCARE PRESENTATION TO HEALTHCARE MARKET INQUIRY .
MELANIE DA COSTA | DIRECTOR STRATEGY AND HEALTH POLICY
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 2
PRESENTATION FORMAT
Introduction to Netcare
How Netcare interacts with
other stakeholders
Netcare’s initiatives to
improve access
Netcare’s initiatives to
improve quality of care
Netcare’s initiatives to
increase affordability of
healthcare
Examples of co-operation with public sectors
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 3
NETCARE HOSPITAL ASSETS
Southern Africa 57 hospitals Including 5 Private Public Partnerships
(PPPs)
10 421 beds
United Kingdom 53.7%
ownership of BMI Healthcare
since 2005
56 hospitals
2 785 beds 40% of patients are NHS funded public patients
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HOW NETCARE INTERACTS WITH OTHER STAKEHOLDERS
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 5
HOW NETCARE INTERACTS WITH STAKEHOLDERS 1/2
Medical schemes
• 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
Doctors (Drs)
• 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 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 HCAHPS1 : 21 patient perspectives on care encompassing 9 topics*.
• Patient feedback daily reports are emailed 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
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NETCARE INITIATIVES TO IMPROVE ACCESS
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 8
INVESTMENTS
Over R8bn invested in capital expenditure over the last 8 years
Opened 200 bed Netcare Waterfall
Hospital in Midrand, with empowerment
partners
Opened new 200 bed hospital in
Polokwane 2015 with
empowerment partners
Part of consortium that opened 425-
bed Queen ‘Mamahato
Memorial Hospital in Lesotho
Opened new 100 bed hospital in
Pinehaven (West Rand) in 2015
±40 000 nurses trained in SA since 1999
across 5 training academies
Registrar & Fellow sponsorships. Co-
operative agreements and
MOU with 6 universities
Hamilton Naki Foundation
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 9
R260M INVESTED IN ACCESS THROUGH CORPORATE SOCIAL INVESTMENT
Indigent Emergency Medical Services
Accessibility initiatives
Community sponsorships
Netcare CSI discretionary other
Bursaries
Public sector strike
Netcare Corporate Social Investment 2010-2015
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 10
PARTNERING IN EXTENDING FREE ACCESS TO HEALTHCARE
>140 000 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
Hear for Life programme
(cochlear implant)
37 Netcare Sexual Assault
Centres
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
Walter Sisulu Paediatric Cardiac Foundation, is the largest paediatric cardiac unit on the
continent
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EXAMPLES OF CO-OPERATION WITH PUBLIC SECTORS
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 12
PATHFINDER PROJECTS - LESOTHO
Sources: ¹ WHO 2012 Global TB Report; ² Lesotho Ministry of Health Joint Review Report 2012/2013
New 425 bed hospital and three
primary care referral clinics managed by private sector
Independent study undertaken by Boston State
University USA for the World Bank
Independent monitor:
>1,000 KPI’s each quarter.
Failure triggers a penalty
Background • One of the poorest areas of southern Africa • Life expectancy 42-43 years • Incidence of TB of 632/100 000¹ • Prevalence of HIV/AIDS 26%² • Maternal mortality 1115/100 000 births² • A population drainage area of 1.8 million people,
half a million living in close proximity to hospital
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 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 14
LESOTHO: COMPARATIVE DATA OF NEW PPP VERSUS OLD PUBLIC HOSPITAL
* 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
Old Hospital (QEII-IN)
New Hospital (QMMH-IN) %
Hospital beds 409 390 -5
Inpatient admissions 15 465 23 341 51
Inpatient days 91 808 116 648 27
Outpatient visits* 165 584 374 669 126
Deliveries* 5 116 7 431 45
Average length of stay 5.94 5.00 -16
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
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 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 16
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 17
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 18
SUMMARY OF NETCARE PPP/PPI EXPERIENCE
Netcare United Kingdom
• Mobile cataract services • Elective surgical hospitals • Primary care Commuter
Walk-In Centre • Free Patient Choice
Netcare South Africa
• Bronkhorstspruit Hospital • Bloemfontein co-location
PPP (Universitas and Pelonomi)
• Port Alfred and Settlers PPP
• UCT Private Hospital
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 19
PATHFINDER PROJECTS: UNITED KINGDOM
Operate 6 days a week,
50 weeks a year
6 mobile units (2 theatres
2 wards and 2 outpatient units)
20 – 24 operations per theatre
per day six days a week
45 outpatient pre operative assessments
per day
60 follow up post operative
visits per day
Providing clinical services to the
NHS since 2011
An example of a pathfinder project:
ophthalmology treatment centres
Contracted to provide
44 000 cataract operations
over 5 years; 36 000 provided
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 20
Short video clip on UK Mobile Units
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 21
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 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 23
SOUTH AFRICAN AREAS OF COLLABORATION WITH GOVERNMENT
Tabled multiple elective
waiting list proposals
HASA presentation to Health Portfolio
Committee ‘08 summarising
possibilities
Participate in 4 PPP’s
but they exclude actual clinical
delivery
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 24
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NETCARE’S INITIATIVES TO IMPROVE QUALITY OF CARE
MELANIE DA COSTA | DIRECTOR STRATEGY AND HEALTH POLICY
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 26
NETCARE HAS EMBEDDED THE TRIPLE AIM AS A FOUNDATIONAL PRINCIPLE AND PHILOSOPHY
Triple Aim
Best patient
experience
Best outcomes
Most cost
effective
“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
Improvement capability
• Science based improvement skills and processes
• Robust integrated technology
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 27
QUALITY LEADERSHIP FRAMEWORK
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INTEGRATED QUALITY BALANCE SCORECARD ACROSS ALL DIVISIONS
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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 catheter-associated urinary tract infections (CAUTI).
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 30
QUALITY: INTERNATIONAL BENCHMARKING OF PATIENT EXPERIENCE
1. HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Services
Definitelyrecommend
Medicationinformation
Dischargeinformation
Nursingscore
Painmanagement
2012 2013 2014 H1 2015 US HCAHPS
SA | Patient-centric quality performance vs. US HCAHPS¹ benchmark
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NETCARE’S INITIATIVES TO INCREASE AFFORDABILITY OF HEALTHCARE
MELANIE DA COSTA | DIRECTOR STRATEGY AND HEALTH POLICY
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 32
KEY COST COMPONENTS IN HOSPITAL CARE
37.6% Cost of drugs and medical consumables
43.1% Payroll
2.7% Catering
5.8% Administration
10.8% Other
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
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 33
GLOBAL COMPARISONS
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)
Nursing salaries (per month)
Cost of hospital build (per bed)
Consumable costs (drugs and medical devices)
• SA: ranges from R14 562 – R47 723 per month • UK: range from R32 637 to R92 000 per month • India: from R1 800 to R9 000, while in certain states, a minimum wage of R2 350
• SA: R2.5-R3.5m • UK: £1m (R23m) • India: R1m-R1.8m
• 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
• Netcare has sought to address shortage of nurses by: • Training >3000 nurses p.a. and • recruiting from India.
Nurse recruitment and training
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 34
SA PRIVATE HOSPITAL VS PUBLIC HOSPITAL BENCHMARKING
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
9 24
8
8 77
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Private hospital sector Public hospital sector
“Like-for-like” comparison for the operating cost per admission for the public and private sectors
Operating cost per admission (R)¹
29 0
17
30 4
41
Private hospital sector Public hospital sector
Development cost per m² (including escalation)²
4.7% difference 5.3% difference
CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION 35
SA PRIVATE HOSPITAL VS PUBLIC HOSPITAL BENCHMARKING
1. Source: Shivani Ramjee: Comparing the cost of hospitalisation across the public and private sectors in South Africa 2. http://www.iol.co.za/news/politics/private-hospital-wards-make-r40m-loss---da-1520608
9 24
8
8 77
5
Private hospital sector Public hospital sector
“Like-for-like” comparison for the operating cost per admission for the public and private sectors
Operating cost per admission (R)¹
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. 2
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THANK YOU!