Quality through specialization

1. Quality through specialization

2. GHP exclusively establishes Centers of Excellence • Built on the vision of contributing to society via ‘quality through specialization’ • Seen as the preferred place of treatment for a specific patient condition with a focus on long-term patient outcomes • Critical volume of patients to reach high levels of specialization • Based on a multidisciplinary approach with the patient in the centre • Built on effective and standardized processes and protocols with Swedish Care Culture at its core • Integrated with research and education stakeholders and actively contribute to both

3. A brief overview of GHP… • Quality through specialization • Swedish Care Culture • Value to society • Global Health Partner is a Swedish registered public company focusing on providing healthcare solutions and have been active since 2006. GHP is Sweden’s third largest private specialized healthcare provider. • Today GHP operates four hospitals with ~1000 employees in the United Arab Emirates as well as 18 own specialist hospitals with ~500 employees in the Nordics. All our units are leading in quality and patient outcomes. • GHP is built on three main pillars: • Best patient outcomes for optimal cost – by focusing on patients medical conditions • Collaborative patient centered culture with strong structural capital to support clinicians • GHP and our clinicians are stewards who care about our patients and the communities wherein we act

4. GHP Nordic specialist hospitals locations 1 12 GHP UAE hospitals 4 1 3 1 3

5. GHP’s current specialty hospitals / CoE’s Dental Spine Arrhythmia Orthopaedics / Sports Medicine Diabetes Bariatrics Urology Gastro General Surgery Maternal Health Care

6. GHP’s current specialty hospitals / CoE’s Largest private provider of specialist dentistry in Sweden 2 438 Spine surgeries in Sweden 4 447 Orthosurgeriesin Sweden 3 018 Ortho & Spine surgeries in Denmark Total 9 903 Surgeries yearly ACO with Sweden's largest health insurance company Agreements with key sport organizations Dental Spine Largest private provider in Sweden with 467 AF ablations with two surgeons yearly Arrhythmia Orthopaedics / Sports Medicine UAE based clinic with >34 000 patient consultations Diabetes Bariatrics ~400 bariatric surgeries per year World leading surgical technology for BPH developed with Boston Scientific 11 732 gastroenterological procedures per year Urology Gastro General Surgery Maternal Health Care Developing Center of Excellence in SKMC | Ajman 1 087 general surgeries annually Based on latest available data per clinic

7. What does ‘Quality through specialization’ mean to us? By specializing on the medical conditions of our patients, we provide the optimal quality for each patient and provide the most value for society

8. 99,0% Felt confidence in the doctor they got to meet Quality through specialization leads to better results – in complication rates, patient outcome- and satisfaction Complication rate of atrial fibrillation Average days of sick leave after spinal surgery Selected patient satisfaction data 99,6% Feel that they have been treated in a respectful way by their doctor % 99,0% Would recommend the clinic to others Source: SvensktBråckregister 1999-2013, Sveusryggkirurgi rapport, Indicator health tracking 2013, on behalf of Stockholms County Council, GHP:s patient survey from GHP Gastro Center Skåne2014, GHP:s patient survey from GHP Ortho Center IFK-kliniken 2014

9. GHP provides value to all Healthcare Stakeholders Insurance providers Accountable Care solution provider Partnering with insurance providers to deliver accountable care solutions Example: GHP Collaborative Care Governments Operate & Manage partner Hospitals Provide knowledge and operate units for public or private entities Example: Sheikh Khalifa Medical City | Ajman Investors & Clinicians Establish and develop our own clinics Partnering with clinicians to establish leading specialist hospitals Example: GHP Spine Center Stockholm

10. People, culture and transparency are the pillars of quality We live and breathe the stewardship culture of Swedish healthcare, culture is our tool for providing high-quality and cost-efficient care • Long tradition of delivering high quality, economically viable healthcare • Based on collaborative and meritocratic culture with little need for hierarchy • A transparent and continuous development culture is key for providing true quality improvement over time

11. Organize by medical condition • Full cycle of care focus • Specialize in the patients condition and needs Teamwork centered around the patient GHP realizes value based healthcare via ‘Quality through specialization’ • Measure relevant outcomes Enable measurement / supporting IT • Transparency • Innovate to deliver better outcomes

12. How do we motivate healthcare providers to optimize value?

13. Healthcare systems today are mainly based on ‘fee for service’ which does not focus on value • Promotes providing unnecessary service for patients • Promotes high volume of any patients • Promotes ‘easy’ patients • Promotes low cost / high revenue services • Does not promote value • Does not focus on the patients full care episode • Does not promote comparability between providers • Does not promote cost efficiency

14. How we measure ‘results’ in healthcare today • HbA1c – for diabetes patients • Adverse effects • Waiting time • Number of beds • ALOS • Guidelines followed • Etc.

15. What patients actually care about • Will I survive my medical condition? • What will my quality of life/autonomy be? • Can I undergo the treatment? • When can I go back to work? • Am I paying the right amount for my treatment? • Will I get a fast and correct diagnosis? • Can I avoid any future complications related to my condition?

16. What governments / insurance providers care about • Are our healthcare providers providing high-quality care to my patients? • Are our patients getting the care we are paying for? • Which of the providers are best? • Do our providers have the necessary specialization / competence to fill the needs of my patients?

17. A simple formula for value – powerful consequences • Outcome for patient • Value • Cost to deliver outcome

18. Outcome focus unites all stakeholders in common goals • Outcomes define success for clinicians and the organization • Outcomes makes it necessary to collaborate around a condition • Outcomes highlight value-enhancing cost reductions • Outcomes makes it necessary to follow the full cycle of care • Outcomes put the patient in the center of care

19. Outcomes are also focused on the patient journey Subjective factors Patient experience Objective factors Medical results and complications

20. Outcomes focus on patient needs throughout the care cycle Example outcomes: Lower back pain Acute complications Major surgical complications Disease recurrence Need for reoperation Need for pain medications Disability Work status Back and leg pain Health related quality of life Patient reported health status

21. Specialization leads to better quality and patient outcomes 1-year mortalityodds Ratio 4.0 Hospitals with >100-200 cases/year have lower mortality for hip surgery 3.0 2.0 1.0 0.0 1-25 26-100 101-200 >200 Hospital annualcaseload 168 US hospitals Source: BCG

22. Providers respond with increased care production volume to counter decreasing price More care activities drives costs for payers -government, insurer & private Several issues are due to the vicious circle of volume based remuneration models Growing patient demand for Quality & Availability Payers answer with care procurement based on price per activity or lower remunerations per activity to combat the rising costs

23. Fee for Service gives no incentive to invest in the factors which really could drive quality and cost in the system Invest in preventive care Digitalization Develop Care chains

24. Healthcare stakeholders targets are not always aligned with fee for service remuneration systems • Providers: • Patients: • Payers • Private: Optimize care and earnings based on the remuneration systems that are in place • Public: Optimize care based on the available budget and remuneration systems (depending on financing model) • Seek best quality care and quality of life • Seek to have no ‘unnecessary’ waiting times or treatments • Seek to minimize personal expenditure • Seek to optimize value for money (Quality vs. Cost) • Seek to have control over payments • Seek to have comparability of providers • Seek continuous service improvement

25. Promotes providing unnecessary service for patients • Promotes providing ‘right’ services for patients Healthcare systems remunerate providers mainly based on ‘fee for service’ which does not focus on value • Promotes high volume of any patients • Promotes specialization Current model logic Future model logic • Promotes patients with similar conditions • Promotes ‘easy’ patients • Promotes low cost / high revenue services • Promotes efficient care chain • Promotes value • Promotes minimal transparency • Focus on the patients and their full care episode • Focus on optimizing discrete services • Encourage comparability between providers • Low comparability between providers • Promotes best quality / cost • Promotes remuneration optimization

26. Sports Medicine A GHP Center of Excellence

27. GHP’s largest area is related to the treatment of all kinds of functional impairments of the skeletomuscular system Professional athletes center Clinic for professional athletes and their issues in training, ortho and spine Orthopeadic specialty hospitals Six clinics treating all areas of Orthopedic issues including life-style & sports medicine focus with several affiliations to athletic organizations Spine specialty hospitals Four clinics treating all areas of Spine / back issues including lifestyle

28. Postoperative rehab exercises • Supporting exercises • Conservative training We focus on delivering modern care solutions to support patients through all stages of their care – including apps • Physical fitness exercises GHP Physiotherapy app Our care solution provides over 400 exercises designed by our specialist physiotherapists in order to provide a platform for care with unique programs adapted to patients with their physiotherapist GHP Healthy Living app In order to promote lifestyle change, GHP is developing the ‘Healthy living app’ where oxygen uptake capacity is the basis for individual plans and follow-up of lifestyle improvement for at risk patients • Inspiration regarding healthy living • Simple exercise programs and targets • Analysis and statistics to track progress

29. Spine Stockholm – 31% of all Sweden's elective spine surgery Selected by patients Share of all Swedish elective cervical spine surgery Excellent outcomes Follow-up complications - 30 days after surgery

30. GHP’s Spine patients have the least sick leave – by far Total average Lumbar Hernia Total average Spinal stenosis

31. Ortho Stockholm – Leading outcomes for Joint replacements KneeReplacement Hip Replacement

32. We organize our care based on the patients medical condition, with the patient in center for the full cycle of care • Patient Medical Condition Activity 1 Activity 2 Activity X • Best outcome • Full patient care cycles

33. About Stockholm Spine Center • Staff • Efficiency • 40 beds • 4 OP theatres • 13 sub-specialized spine surgeon consultants including neurosurgeons • 5 rehab / pain consultant physicians • 2 anesthetists • 69 nurses • 19 physiotherapists • 14 admin./ secretaries • >1 600 surgical spine procedures • >7 000 visits to spine surgeon • >10 000 visits including other caregivers • Physiotherapists • Anesthesiologist • Nurse coordinators • Psychologist, counselor, etc. Stockholm Spine center

34. Examples from GHP’s Ortho Center Stockholm • Resources • Efficiency • 28 beds • 3 OP theatres • 8 orthopaedic consultants (4 TJR, 3 arthroscopists, 1 hand surgeon, 1 foot surgeon) • 2 anesthetists • 22 nurses • 7 physiotherapists • 2 admin./ 2 secretaries • 8100 outpatient visits • 1758 surgical procedures • 821 day surgery procedures • 937 overnight stay procedures • 845 TJR- area of expertise • 19 ACL • ALOS 3.2 days

35. Example from GHP’s Clinics – OrthoCenter combines high-quality orthopedic care with a sports medicine profile • The care at OrthoCenter • As all GHP’s clinics OrthoCenter has specialists for all phases of care and in the patients medical condition • For OrthoCenter that means specialists in all types of sports and repetitive stress injuries. • The large production volume (with over 12 000 specialist visits per year) and high specialization means that you as a patient is treated by an orthopedic surgeon with extensive experience in your particular injury • Common treatments include meniscus surgery, cruciate ligament operations, CAM operations, prosthetic surgery, shoulder surgery and foo related surgery. Orthocenter Göteborg

36. GHP & many of our clinicians are engaged in collaborations within sports medicine and athletic organizations Selected Sports Medicine Physicians Selected Collaborations Swedish Olympic committee & GHP Collaborates with SOC and their Top Talent program regarding sports medicine and care at GHP’s clinics Dr. Matilda Lundblad Specialist physician sports medicine and PHD student in sports medicine within UEFA elite injury study team physician for Kopparbergs/Göteborgs FC Swedish Paralympic committee & GHP Collaborates with the SPC & Elite-athletes school regarding sports medicine and care at GHP’s clinics Dr. Lennart Sugiardjo Specialist Orthopedic surgeon and leading physician for the Swedish Football federation, and Sweden’s women U23 football team Team Denmark & GHP GHP collaborates with Team Danmark with over 1000 of their elite athletes regarding sports medicine and care at GHP’s clinics Dr. Fredrik Bergström Specialist Orthopedic surgeon and physician for Sweden’s mens U21 football team, team physician for Frölunda Indians Hockey team

37. GHP’s Accountable Care Organizations Since 2015 we have an exclusive value based ACO concept with one of Sweden’s largest insurance providers - Skandia, including all hip, knee and back problems for their Stockholmcustomers – a model that is being expanded to other geographies and clinical areas Care coordination • Patient selection • Medical Care flow • Treated patient • Feedback

38. GHP going forward

39. Quality through specialization