Ms. Margaret Bengzon

1. Ms. Margaret Bengzon President and Chief Executive Officer, Guam Healthcare Development Inc – Guam Regional Medical City

2. Opportunities for Health Human Resources in Guam and Micronesia 14 March 2012

3. Presentation Outline • Demand for Healthcare • Available Healthcare Human Resources • The Guam Regional Medical City • Opportunities Presented by GRMC • Conclusions

4. Demand for Healthcare

5. Guam’s healthcare spending per capita and as a % of GDP is quite low compared to U.S. and World averages – pointing to room for further growth. Historical and Estimated Healthcare Expenditure (HE) per Payor (in $ millions) 395 256 Source: GHDI and FCCM estimates; US Department of Commerce - Bureau of Economic Analysis; National Health Expenditures Report, 2009; World Bank Report, 2009

6. Guam’s population growth rate is higher than that of the U.S. and the World average. Guam’s median age exceeds World averages and is rising geometrically. Guam authorities project Population CAGR at 1.18% from 2010 to 2020. The number of persons over 65 is expected to approach 10% of the total population by 2030, from 7% today.

7. Guam’s disease burden is more severe than U.S. averages. Diabetes, heart disease and cancer are particular areas of concern. Cancer Incidences and Mortality* Top leading causes of death (2007) Guam* U.S. 100% 73% *Age-adjusted incidences/deaths per 100,000. The age-adjusted rates are rates that would have existed if the population under study had been distributed by age the same way as in the US population. Diabetes incidences • As of 2009, at least 40,000 people on Guam have diabetes (close to 25% of the population) Incidence Mortality • In the United States, only 8% of the population have diabetes (less than one in ten) • Poor oncology services on Guam may be a factor for the significant increase in mortality rates, even as incidence rates remained steady. Sources: Guam Cancer Facts and Figures 2003-2007 (June 2009), National Vital Statistics Report US Department of Health and Human Services 2007. CDC National Diabetes Fact Sheet 2007. Department of Health and Senior Services – Missouri.

8. Majority of Guam’s population have the capacity to pay for healthcare through third party private and public payors.

9. Neighboring Pacific Islands and growing tourism sector present additional demand for healthcare services. Commonwealth of the Northern Mariana Islands Republic of the Marshall Islands Guam Federated States of Micronesia Republic of Palau *Based on World Bank population figures ** Population estimates excludes the impact of the military build-up Sources: Guam Statistical Yearbook 2008, World Bank *FCCM estimates based on World Bank 2008 population figures

10. Available Health Human Resources

11. Guam has been designated a Medically Underserved Area due to deficiencies in the number of health professionals relative to the population served. Source: Office of Guam Medical Examiners, Kaiser Family Foundation Website, 2010 Data * Population Ratios Per 100,000 Population

12. Gaps in specialized care, especially in relation to the Island’s disease burden, have also been observed. Source: National Vital Statistics Report US Department of Health and Human Services 2007 ; Guam Subspecialists compiled by GHDi. * Per 100,000 Population

13. The Guam Regional Medical City

14. GRMC, the only private hospital on Guam, is scheduled for operation in June 2014, with total project cost estimated at US$ 216 million. Project Summary

15. GRMC will be strategically located in the most densely populated area of the island, Dededo, and within reasonable proximity to major tourist areas in Tumon Bay and US military bases. Close to 70% of the island population live in the Northern part of Guam Andersen Air Force Base Guam Regional Medical City Guam Regional Medical City Tumon Bay Guam Memorial Hospital Naval Hospital US Naval Station Guam population density map Number of Households Source: Guam Statistical Yearbook 2008

16. GRMC will be operated by PSI / TMC, a Joint Commission accredited organization with an established track record in healthcare quality, safety and innovation. • Operates the largest healthcare network under a single trade name in the Philippines, including a world-class 500-bed tertiary flagship hospital, 3 provincial hospitals and 20 outpatient clinics. • Serves some 40,000 inpatients and 1.2 million outpatients every year. • Engages 2,700 employees and 1,500 medical staff. • Has been accredited and re-accredited by the Joint Commission International, the most prestigious accrediting body of healthcare organizations. In its accreditation surveys, TMC has received perfect scores in key standards on service quality and patient safety. • With Centers of Excellence in Wellness, Cancer, Cardiovascular and Regenerative Medicine that are well-aligned with healthcare needs of Guam and the rest of Micronesia. • Has had a medical coordination office in Guam since 2008 to support the large and growing number of patients from Micronesia receiving care in its Manila site.

17. GHHDF, a long-time champion of the hospital project, serves as a vital link between the developers and the local community. GHHDF Officers Peter R. Sgro, Jr.  J.D. President & Board Chairman Frank Arriola  M.S.S.M: Vice-President Frances Taitague-Mantanona M.H.A; Secretary John Onedera CPA; Treasurer GHHDF Board of Directors Peter R. Sgro, Jr. J.D. President & Chairman, International Group, Inc. Katherine CalvoSgroM.B.A..  EVP & Chairman, Payless Markets, Inc. Ruth Gurusamy R.N., M.N. Administrator, Health Services of the Pacific John Onedera CPA. Partner, Ernst & Young Art Mesa: Veterans’ Advocate, Small Business 2010 Veteran of the Year. Mayor Roke Blas. Mayor, Municipality of Sinajana Richard Lai: Director of the Chinese Chamber of Commerce. Frank Arriola M.S.S.M; CEO of Pacific Rim Brokers, Inc. Mary Torre. President, Guam Hotel & Restaurant Association Hidenobu “George” Takagi.  President. Takagi & Associates Larry Lizama M.D. Internal Medicine Kia RahmaniM.D. General, Vascular and Oncologic Surgeon  Frances Taitague-Mantanona. Masters in Health Administration Thomas Shieh, M.D. Fellow American College of Obstetricians & Gynecologists John Ray TaitanoM.D. MSS FACP Internal Medicine David Silva, EMBA. General Manager, Century Insurance Guam Ernesto V. Espaldon, Jr. President, Sun Foods Int’l dba Lina Leon Guerrero: General Manager of Marianas Physicians Group • The Foundation has developed key relationships : • Local and federal government agencies • Military and veterans’ groups • Medical and allied medical organizations • Insurance companies • Educational institutions • Business and community leaders

18. GRMC will augment bed capacity and deliver world-class healthcare services that respond to the specific needs of the Region. Hospital Beds Facilities 380 361 130 43 158 Services

19. Project development and construction will proceed from 2011 to 2014. Hospital operations will commence mid-2014.

20. Opportunities Presented by GRMC

21. Peak employment during construction will number 290. Some 75% of staff will be sourced on-island.

22. At full operation, GRMC will employ 58 hospitalists and 396 allied medical and support staff. In addition, GRMC will credential some 250 medical staff across all clinical services. “Rural hospitals provide a source of high-tech jobs for young people who might otherwise leave communities heavily dependent upon natural resource-based industries and tourism. Rural hospitals also provide an anchor for other health care jobs, such as physicians and pharmacists that, in the absence of the hospital, may not be available.” Healthy Hospitals. Healthy Communities. The Economic Impact of Wisconsin’s Hospitals, 2008.

23. GRMC will provide an attractive platform for staff to advance personal and professional aims.

24. GRMC has made provisions for a competitive salary package to attract and retain qualified medical staff. Physician Staffing for GRMC Salary Benchmarking Guam • Budget of US$300,000per hospitalist per year is competitive relative to island and mainland salary levels • Number of Hospitalists = 58 • Number of Credentialed Consultants = 250 Sources: Guam Memorial Hospital Staffing Pattern as of May 2011, Medical Group Management Association 2009

25. Recruitment efforts will be directed at medical and allied medical professionals in Guam, the U.S. mainland and the Philippines. • Guam Professionals • Access to top quality facilities and services • Opportunities for professional capacity development, teaching/mentoring and research • Estimated • number: 283 • Philippine (U.S. Boarded) Professionals • Better income-generating potential • Robust practice platform but closer to the Philippines • Estimated number: 1,500 Sources: Association of American Medical Colleges, American Medical Association,, Guam Board of Medical Examiners, The Medical City, The Economist.

26. In partnership with Regional providers, GRMC will facilitate access to federal incentives to practice in medically-underserved locations, as well as advocate for the institution of parallel programs at the local level. Federal Government Local Government • Scholarships • Loans • Research Grants • Loan Repayment Programs • Matching of State-Funded Programs • Visa Waiver Programs • Preferential Reimbursement Rates • Tax Credits • Locum Tenens

27. GRMC will leverage its existing network of educational institutions, as well as develop linkages with the University of Guam, to provide professional staff with extensive opportunities for capacity building, teaching/mentoring, and research.

28. In conclusion , If we build it, they will come. ”Field of Dreams” The rising tide raises all the ships. ”Anonymous”

29. Thank you.