netcare presentation to healthcare market inquiry · pdf filenetcare presentation to...

1

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


improve quality of care


increase affordability of

healthcare

Examples of co-operation with public sectors


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

4

HOW NETCARE INTERACTS WITH OTHER STAKEHOLDERS


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.


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

7

NETCARE INITIATIVES TO IMPROVE ACCESS


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


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


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

11

EXAMPLES OF CO-OPERATION WITH PUBLIC SECTORS


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


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


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


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


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


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


Short video clip on UK Mobile Units


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


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

25

NETCARE’S INITIATIVES TO IMPROVE QUALITY OF CARE



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


QUALITY LEADERSHIP FRAMEWORK


INTEGRATED QUALITY BALANCE SCORECARD ACROSS ALL DIVISIONS


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).


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

31

NETCARE’S INITIATIVES TO INCREASE AFFORDABILITY OF HEALTHCARE



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


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


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

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

29 0

17

30 4

41


Development cost per m² (including escalation)²

4.7% difference 5.3% difference


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


“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

36

THANK YOU!

netcare presentation to healthcare market inquiry · pdf filenetcare presentation to...

Documents