3

A REFLECTION

A REFLECTION

5

THE SPANISH NATIONAL

HEALTH SYSTEM

The Spanish NHS is a universal system that covers the entire population.

It is financed by taxes.

It is inspired by the British NHS.

Decentralized system. Healthcare devolved to the regions. 17 regions in total.

The Valencia Region is composed of 24 health departments.

Each health department consists of 1 hospital + primary care centers.

The employees of the Spanish NHS are civil servants.

THE SPANISH HEALTHCARE MODEL

TRIPLE AIMImprove healthcare outcomesIncrease patients satisfaction

Lower costs

KEY IDEASFIRST ACCOUNTABLE CARE ORGANIZATION IN EUROPE

HOSPITAL TRANSFORMATION

PROVIDE BEST HEALTHCARE OUTCOMES

QUALITY SATISFACTION SUSTAINABILITY

ALIGNMENT CULTURAL TRANSFORMATION

▪ Processes▪ IT▪ Stratification/▪ Personalized care

▪ Capitation▪ Single Budget▪ Health is financed

▪ Shared goals▪ Networking consolidation

S T A K E H O L D E R S

P A Y E R S – P R O V I D E R S – C I T I Z E N S – P O L I C Y M A K E R S

WHAT IS BEST FOR THE CITIZENS?

INTEGRATION PAYMENT/BUDGET GOALS/INCENTIVES

ACCOUNTABLE CARE POPULATION HEALTH MANAGEMENT

11

GOVERNMENT

CLEAR DEFINITION OF THE TRANSFORMATION PROCESS

ACHIEVEMENT OF OBJECTIVES

GOVERNMENT’SOBJECTIVES

INCENTIVESFOR THE

PARTNERS

To achieve the best health conditions for the citizensReduction of the waiting lists

Greater healthcare quality, introduction of innovation in the systemInvestment guarantee in the long term

Capitated systemFree choice of center Healthcare integration modelCommitment to investment. Annual public control

PUBLIC INCENTIVES ALIGNMENTMODEL EFFICIENCY

HOSPITAL TRANSFORMATIONCULTURAL CHANGES

13

RIBERA SALUD MODEL

CAPITATIVE PAYMENT I

TRADITIONAL MODEL RIBERA SALUD MODEL

CAPITATIVE PAYMENT II

TRIANGLE OF SUCCESS

TRIANGLE OF SUCCESSCLINICAL MANAGEMENT

TRIANGLE OF SUCCESSPEOPLE

TRIANGLE OF SUCCESSTECHNOLOGY

• Health portal

• Delivery room- Online (Maternity webpage)

• APPs

• Touch ATMs

• Information by SMS

• Waiting times in the emergency room

• Simultaneous translation

• Information to family members

AVAILABLE TOOLS FOR THE CITIZEN

• Electronic medical record

• TRUCARE

• Integrated care processes

• Technology at the service of the professional

• Core Health. Access to the EHR from the mobile

• Telemedicine Telework in radiology

AVAILABLE TOOLS FOR PROFESSIONALS

• Innovation in technology and management Systems Quality evaluation

• Emergency response time

• Workloads between services and professionals

AVAILABLE TOOLS FOR MANAGERS

TRIANGLE OF SUCCESSPATIENT CENTERED

Presentacion_RSG_General_01_Portada.png

25

PHM

It is the efficient and constant managementover time the health needs of the population,through care coordination, diseasemanagement, preventive detection andproactive action

TRANSFORMATION AND INNOVATIONPOPULATION HEALTH MANAGEMENT PROGRAM AT RIBERA SALUD

26

27

3

Chronic patient managementProgram

e-Health tools

Cultural Change

Population Health Management Program

3

2

1

0

TRANSFORMATION AND INNOVATIONSTRATEGIC TRANSFORMATION

28

Ribera Salud has been working on a clinical classification based on risk adjustment systems which allows us to

building our own population pyramid and provides us with better information for more targeted care

Demographics

CLINICAL CLASIFICATION

Frecuency RatesOther

RISKS

UnplannedCost

A11

A 12

A 21

A 22

B 11

B 21

C 14

C 15

D17

D 18

D 19

Level 3

Level 2

Level 1

Level 0

LEVEL OF RISKPOPULATION PYRAMID

TRANSFORMATION AND INNOVATIONSTRATIFICATION OF THE POPULATION

29

PHM

Each citizen has a health

plan adapted to their

needs, general condition

and chronic diseases

Each citizen is directly

involved in their care plans

The program includes

interventions for disease

prevention and health

promotion

Development of a

predictive model of the risk

associated with each

patient based on different

risk adjustment systems

Population

Predictive Personalized

Preventive Participatory

TRANSFORMATION AND INNOVATIONPREDICTIVE MODEL: 5Ps

TRANSFORMATION AND INNOVATIONPREDICTIVE, PROACTIVE AND TARGETED CARE.RIBERA SALUD POPULATION PYRAMID

DEMOGRAPHIC

RSG PATIENTS %PATIENT AGE INPATIENT EMERGENCY OUTPATIENT >0 %RSG IP DAYS COST RUB FRAILTY

A11 2.569 0,5% 77 1,38 1,52 10,1 1.784 69,4% 13,6 9.498 4,6 19,9%

A12 3.788 0,7% 66 0,91 1,26 13,3 1.650 43,6% 13,6 7.077 4,1 8,3%

A21 3.945 0,7% 74 0,79 1,13 8,1 1.896 48,1% 10,4 5.915 4,3 15,5%

A22 9.380 1,7% 66 0,25 0,72 7,9 1.200 12,8% 6,3 2.190 3,5 2,3%

B11 13.759 2,5% 69 0,32 0,77 6,0 2.956 21,5% 7,9 2.600 3,6 8,8%

B21 19.979 3,6% 61 0,19 0,72 5,8 2.523 12,6% 6,5 1.747 3,4 17,8%

B23 2.703 0,5% 42 0,10 0,64 6,1 203 7,5% 9,7 1.051 3,1 1,0%

C14 36.677 6,7% 50 0,09 0,62 4,8 1.997 5,4% 4,8 1.041 3,0 0,8%

C15 59.052 10,7% 49 0,05 0,53 3,5 1.746 3,0% 3,6 746 2,7 0,2%

D17 59.519 10,8% 35 0,03 0,75 2,0 1.375 2,3% 3,1 591 2,5 0,2%

D18 145.683 26,5% 34 0,01 0,33 1,3 715 0,5% 1,9 273 1,7 0,0%

D18 193.592 35,2% 40 0,00 0,00 0,0 0 0,0% 0,0 0 0,0 0,0%

TOTAL 550.646 100% 42,1 0,05 0,35 2,0 18.046 3,3% 7,3 592 1,6 1,1%

UNPLANNED INPATIENTUTILIZATION LEVEL COST OTHER

TRANSFORMATION AND INNOVATIONRIBERA SALUD POPULATION PYRAMID. COSTS

Presentacion_RSG_General_01_Portada.png

TRANSFORMATION AND INNOVATIONPOPULATION AND COST DISPERSION

Presentacion_RSG_General_01_Portada.png

PROBABILITY

TO

TA

L C

OS

T P

ER

P

AT

IEN

T

A11

A 12

A 21

A 22

B 11

B 21

C 14

C 15

D17

D 18

D 19

Level3

Level 2

Level 1

Level 0

PREDICTIVE, PROACTIVE AND TARGETED CARECOST PER PATIENT: A11

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WHO WE ARE

35

6,566 Professionals

751,184Capitated population

6 hospitals(4 University Hospitals)

82Primary Care centers

1,541beds

550 MM€Annual turnover

30%Savings for the government

84%Average patient satisfaction

47Quality Accreditations

133National and International awards

+140,000Health Portal users

MAIN FIGURES

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1999 2003 2006 2008 2011 20122009 2010 2015 20162014

1997

AlziraVALENCIA

(Until 2018)

First PPP tender in Europe

INAUGURATION OF HOSPITALS INTEGRATION

AlziraPRIMARY CARE INTEGRATION

First ACO in Europe

TorreviejaALICANTE

DeniaALICANTE

Laboratorio BR

MADRID

ManisesVALENCIA

(Until 2012)

TorrejónMADRID

(Until 2012)

VinalopóALICANTE

b2b saludVALENCIA

FlorenceCHILE

2017 2018

2020

ShareholderUSA

LimaPERÚ

AlziraVinalopóTorreviejaINCREASED

PARTICIPATION

PilotTrucare

PDGESLOVAQUIA

TorrejónMADRID

NefrosolDIALYSIS

2019

KSAACO

POVISAGALICIA

OB KlinikaPRAGUE

Santa JustaEXTREMADURA

RIBERA SALUDBACKGROUND

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Integration projects Single specialty projects Strategic projects

RIBERA SALUDTHE GROUP

SOME FIGURESEMERGENCY EVOLUTION

cesarean section rate

91,45% 60,70%

60,71% 53,17%

2018

Flu vaccination coverage in those over 64 57,00% 51,85%

18,65% 24,00%

SOME FIGURESINDICATORS

Presentacion_RSG_General_01_Portada.png

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0

10

20

30

40

50

60

70

80

90

100

Torrevieja Vinalopó Denia Torrejón

consultations

43 31 49370

10

20

30

40

50

60

70

80

90

100

Torrevieja Vinalopó Denia Torrejón

surgery

51 46 63 43

57 NHS*

93 NHS*

* SNS: Junio 2018.

Concesiones de Ribera Salud: Junio 2019.

SOME FIGURESWAITING TIMES

The report issued by the official audit

(Sindicatura de Comptes) on the

concession of Manises with data of all

the concessions throws the following

conclusions:

• 25% savings in current public health

expenditure in relation to regional

hospitals

• Better care results

• Higher investment per capita

• Increased user satisfaction

• Improve control measures by the

Administration

SOME FIGURESGOVERNMENT AUDIT REPORTMANISES HOSPITAL

TORREVIEJA

ELCHE-CREVILLENTE

The report’s conclusions clarify in nouncertain terms the extraordinaryvalue of the model of public-privatepartnership, which the Ribera Saludgroup has represented, led anddefended.

Among its conclusions are the 30%savings for the public coffers (whichthis report calculates to be €45 milliona year), a 38-day waiting list comparedto the 120 days of the public system(resulting in improved citizens’ welfareand quality of life), lower mortality,longer life expectancy, higherinvestment per citizen and higherquality. Ultimately, we are providinggreater quality and greater excellenceat a lower cost.

SOME FIGURESGOVERNMENT AUDIT REPORTTORREVIEJA HOSPITAL

According to data from the Ministry of Health and Universal Health, the citizens of the concessions have greater satisfaction than the departments of direct management.

Concessions Rest

* Source: Own elaboration based on the data provided in the management report of 2015 of the Health Counseling

http://www.san.gva.es/documents/157385/6697729/Mem%C3%B2ria+de+Gesti%C3%B3%202015.pdf

SOME FIGURESAUDITOR’S REPORT ON THE VALENCIAN COMMUNITY HEALTH DEPT.

http://www.san.gva.es/documents/157385/6697729/Mem%C3%B2ria+de+Gesti%C3%B3%202015.pdf

SOME FIGURESRECOGNITIONS

San Luis

Crevillente

Carrús

Dr.Sapena

Alberto García

El Pla

Patricio Pérez

Hospital

Universitario

del Vinalopó

• 2/10 hospitals in Spain• 2/3 public hospitals in Spain• 1st hospital in Valencia Region

7 PRIMARY CARE CENTRES 2 HOSPITALS

• 7/13Pc centres in Spain• First PC centres in Valencia Region

Hospital

Universitario de

Torrevieja

*Source: http://www.acreditacionfada.org/index.php?page=jc-jci(19/06/11)

SOME FIGURESINTERNATIONAL RECOGNITIONS

http://www.acreditacionfada.org/index.php?page=jc-jci

• Offloading of the public budgets.• A lower-than-average costs

public management of a public service (25% less).

• Investments are the concessionaire’s responsibility during the management period.

• Capitated payment. Transfer of financial risk.

• Innovation in technologies and systems management.

• Contribution of complementary HR.

FOR THE LOCAL GOVERNMENT

• Job security. Innovative salary system.

• Opportunity for development and a professional career.

• Teaching and Research.• Commitment to

technology.

FOR THE PROFESSIONALS

• Perceived quality. Humanization of care.

• Personalized treatment. Greater privacy and comfort.

• Greater accessibility. Quicker response time.

• Free choice of hospital and doctor.

• Technology informs and educates the patient

• 94% do not know the AlziraModel.

• 91% are satisfied with the health care provided

FOR THE CITIZEN/PATIENT

RIBERA SALUD ADDED VALUEADVANTAGES OF THE MODEL

CONCLUSIONSREFORMS

Which is easier, healthcare reform or climbing Everest?

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THANK YOU