An Affordable Healthcare Outlines for a Public Hospital December 2012

1. An Affordable Healthcare Outlines for a Public Hospital December 2012

2. Healthcare Business: An Overview

3. Competitive Advantage for the Healthcare Industry • Penetrate New Markets: Evaluate opportunities in different geographies, in other parts of the value chain, and through new lines of business • Grow Revenue: Ensure optimal pricing, optimize product/service portfolios, and expand distribution channels • Track Competitors and Drive Differentiation: Track competitors' product developments, customer markets, and geographic expansion; identify unique and sustainable product and brand positioning • Acquire and Retain Customers: Develop a deeper understanding of customers' diverse requirements and unmet needs • Predict and Respond to Market Dynamics: Monitor, forecast, and proactively respond to trends in regulations, technology, and emerging business models http://www.bostonanalytics.net/business_research_analytics/healthcare_analytics.html

4. Healthcare Value Chain Healthcare Business Research Tools Product Development Regulatory Approval and Reimbursement Healthcare Delivery Genomics Pharmaceuticals Regulators Physicians Proteomics Diagnostics Governments Pharmacies Metabolomics Payors Hospitals http://www.scientiaadv.com/blog/2011/01/11/was-2010-the-engagement-year-between-pharmaceutical-and-diagnostic-companies/

5. Healthcare Development Sustainability Optimization Clinical Workflow Resources & Logistics Information Technology Proactive Procedures Prevention Programs http://lumetrasolutions.com/integrated-solutions/value-convergence/

6. Payor Issue Classic Approach Cost Payers Finance Intermediate Providers Distribution Intermediate Producers Innovation Payers Consumer Driven Healthcare Finance Intermediate Public Healthcare Retail Healthcare New Approach Personalized Healthcare Providers Producers Distribution Intermediate http://www.healthonomics.org/2007/11/healthcare-value-chain-new-business.html http://www.cross-check.com/blog/bid/158182/Medical-Payment-Services-Help-with-Rising-Costs

7. Obamacare: Complexity of Healthcare http://www.generationamerica.org/obamacare/

8. Healthcare Spending in E&NA

9. Healthcare @ GDP http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

10. Healthcare Reform Hospitalization: In most countries, this just means care that takes place in a hospital. The US is in outlier, in this case, though. Here, doctors might be employed by a hospital, or they might contract with one. In the latter case, a doctor would use hospital facilities but be paid by patients (or insurers). OECD counts this as ambulatory care. Ambulatory care: Care that happens outside of hospitals, which may include general out-patient services, specialist practices and private clinics. Public health: Efforts, usually on the part of governments, to manage the well-being of a population, for example vaccination campaigns, education and disease response. Pharmacies and medical goods: Drugs, syringes, stents, wheelchairs and other purchased goods related to health care. Administration: The overhead costs of health care, from billing to building maintenance, essentially everything not related to patient care in a system. In the U.S., "administrative costs" includes the cost of managing public programs such as Medicaid and Medicare, as well as the administrative costs of the private health insurance industry. Data Sources: OECD Health Data 2009, World Health Organization World Health Report 2000. http://www.pbs.org/newshour/indepth_coverage/health/healthreform/july-dec09/chart_08-18.html

11. Cost Breakdown http://healthcare-economist.com/2011/02/24/patient-centered-health-spending-categories/

12. An Indian Breakthrough “Frugal” Constraint-Based Innovation Rethinking entire production processes and business models Henry Ford's Style The First is to contract out ever more work NarayanaHrudayalaya Hospital in the “Electronics City” district of Bangalore, has 1,000 beds (against an average of 160 beds in American heart hospitals), and Dr Shetty and his team of 40-odd cardiologists perform about 600 operations a week. The Second money-saver is to use existing technology in imaginative new ways. Dr Shetty has performed more than 15,000 heart operations and other members of his team more than 10,000 A health-insurance scheme, working with various local self-help groups, that covers 2.5m people for a premium of about 11 cents a month each The Third way to cut costs is to apply mass-production techniques in new and unexpected areas A sliding scale of fees is used for operations so that richer customers subsidize poorer ones Hospital group reports a 7.7% profit after taxes Reverse Innovation http://www.economist.com/node/15879359?story_id=15879359

13. A Hospital Type of Hospital Medical Centers & Clinics Departments Emergency & Trauma Mobility & Reach-out Logistics and Supply Chain Medical & Technical Staff http://www.reverehc.com/Consulting.html

14. EPC Cost Plan Creating Fable 2.0 Like its predecessor, the Fable 2.0 hospital is an imaginary facility located in a medium-sized American city. It is a new three-hundred-bed regional medical center built to replace a fifty-year-old institution. Fable 2.0 provides a comprehensive range of inpatient and ambulatory services. It is located on a donated urban site, so the cost of the land is not included in the calculations. Fable 2.0 is approximately 600,000 square feet (2,000 square feet per bed) and costs $350 million to construct. Construction costs have increased substantially since 2004. According to Turner Construction, the average cost per square foot in an average city has more than doubled, from between $170 and $185 per square foot, to approximately $450 per square foot today. While construction costs in some areas are significantly higher or lower, we chose $450 per square foot as our baseline. Fable hospital's leadership promotes superior clinical quality, safety, patient-focused care, family friendliness, staff support, efficiency, community responsibility, and ecological sustainability. Reflecting the latter goal, Fable 2.0 decided to achieve a sustainable building that met LEED's gold-certified level using a range of construction and operational initiatives. http://baydim.com/BayDim02HospitalCosts.htm http://www.medscape.com/viewarticle/736012_3 American Hospital Association Resource Center Blog

15. Apollo Hospitals - India http://www.apolloglobalprojects.com/images/news_pdf/Financing%20Healthcare.pdf

16. Healthcare in Africa

17. Diseases in Africa Treatable diseases continue to blight the future The continent’s continuing struggle with communicable diseases such as HIV/AIDS and tuberculosis (TB), parasitic diseases and poor primary and obstetric care has been a major factor in stalling the development and the extension of healthcare services in African countries at the most basic level. The future of healthcare in Africa, A report from the Economist Intelligence Unit, sponsored by Janssen

18. Life Expectancy in Africa The future of healthcare in Africa, A report from the Economist Intelligence Unit, sponsored by Janssen

19. Healthcare Spending in Africa The future of healthcare in Africa, A report from the Economist Intelligence Unit, sponsored by Janssen

20. Payors in Africa The Business of Health in Africa, IFC, World Bank Group

21. Healthcare Funds in Africa Consistent with international trends, this growth in GDP will drive a greater demand for health care and an increase in per capita expenditure on health related goods and services Based on projected economic and population growth rates, the health care expenditure in Sub-Saharan Africa is expected to grow from $16.7 billion in 2005 to $35 billion in 2016 an annual growth rate of 7.1 percent per annum. This report also estimates that around $25–$30 billion in incremental investment will be required for the physical assets (hospitals, clinics, distribution warehouses, etc.) needed to meet this increased demand over the next ten years. The Business of Health in Africa, IFC, World Bank Group

22. Healthcare HR in Africa The Business of Health in Africa, IFC, World Bank Group

23. Healthcare Investment in Africa The priorities include: 1. Developing mechanisms for creating and enforcing quality standards for health services and medical product manufacturing and distribution; 2. Including as many of the population as possible in risk pooling programs; 3. Channeling a portion of public and donor funds through the private health sector; 4. Enacting local regulations that are more encouraging of a private health care sector; and 5. Improving access to capital, including by increasing the ability of local financial institutions to support private health care enterprises. The Business of Health in Africa, IFC, World Bank Group

24. Comparison of Unit Cost ANALYSIS OF HOSPITAL COSTS: A MANUAL FOR MANAGERS, by Donald S. Shepard, Ph.D., Dominic Hodgkin, Ph.D. and Yvonne Anthony, Ph.D. , September 29, 1998, Institute for Health Policy, Heller School, Brandeis University

25. Cost of Hospital Care for HIV/AIDS Patients Côte d’Ivoire, 1995 * This row represent totals for columns with heading beginning with “Total,” and averages for other columns. + All monetary amounts are in thousands of F CFA, where 1,000 F CFA equals US $2.00. ANALYSIS OF HOSPITAL COSTS: A MANUAL FOR MANAGERS, by Donald S. Shepard, Ph.D., Dominic Hodgkin, Ph.D. and Yvonne Anthony, Ph.D. , September 29, 1998, Institute for Health Policy, Heller School, Brandeis University

26. Hospital Construction Cost Model http://www.maps-jo.com/www.maps-jo.com/Calculate_Gross_Hospital_Area_Construction_Cost.php

27. Proposal Outlines

28. Theme Approach Investment & Development Management The Hospital Facility Feasibility Plan Patient Fully Insured Government Free Paid Combined Seed Investor Self Paid Donors Investment Structure Impact Investor CAPEX Operator Funds OPEX Volunteer NGO Recoveries

29. Critical Success Factors (CSFs) Sustainability Framework Marketing & Sales Resources & Training Logistics & Supply Chain Project Management Optimized Design Solutions Procurement Governance Operations Management Information Management Systems Performance Monitoring

30. Financial Model Outflows Sustainability Inflows Initial Investment Investment Plan CAPEX Optimization Insurance Policies OPEX Growth Subscriptions Recovery Plan Innovation Self-Paid Patients Investment Plan

31. Facility Model Capital Investment Land/Plot Conceptual Master Plan Development Baselines Statuary Permits Target CAPEX US$ 150k/Bed Minimum Area 50,000 m2 160 Ward Bed 20 Single Bed 20 Double Beds Construction Cost US$ 2,000/m2 Served Population 200,000 Capita Target OPEX US$ 2,000/Case FAR 0.4 Single Story ICU 10 Beds FF&E Cost US$ 2,000/m2 CSR, Vocational and Volunteer Programs Target Profitability 5% Accessible to Public Transit ER 200 Visits/Day GFA 20,000 m2 100 m2/Bed Compliances to WB. IFC, UNDP & ADB Codes Strong Payors Programs Public Basic Infrastructure OP 20 Clinics EPC Contract 18 Months Independent Operating Corporate

32. Timeline H1/Year -2 H2/Year -2 H1/Year -1 H2/Year -1 H1/Year 1 H2/Year 1 ESC Corporate & Capacity Building Organization Strategy & BD Finance HR Legal Procurement Logistics Engineering Quality Sales Marketing Internal Audit Medical Operations Marketing & Sales Operations Hospital EPC, FF&E and FM Procurement of Contractors, Operators & Suppliers EPC EPC DLP FF&E FF&E DLP FM Operator Corporate Social Contribution Plan Planning CSR Programs Implementing CSR Programs

33. Thank You