Transcript Kuwait Healthcare Reform 2009 Presented by Julie B. Decker Managing Director, Lynxcom Partners Operating Partner, Director of Healthcare Practice, FocalPoint Partners  Healthcare Market and Growing.

Kuwait Healthcare Reform 2009
Presented by Julie B. Decker
Managing Director, Lynxcom Partners
Operating Partner, Director of Healthcare Practice,
FocalPoint Partners

Healthcare Market and Growing Costs

Defining the Alternate Site of Care

Home Infusion

Ambulatory Infusion Centers

Hospice

Home Health
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
FocalPoint Partners – Operating Partner & Director Healthcare Practice
• Largest independently-owned investment bank in Southern California, founded
in 2002, with offices in Los Angeles and New York
• Run by seasoned veterans, with backgrounds in:


Distressed markets
•
Law

Turnaround management
•
Public accounting

Private equity
•
Strategy consulting

Investment banking
•
Senior lending
LynxCom Partners – Managing Director
• Healthcare consulting firm based in San Diego providing M&A advisory, global
sales development, marketing organizations, financial turnaround with
expertise in:

Alternate site and home health
•
Payer relations, reimbursement and regulatory affairs

Biotechnology and life sciences
•
Business development and operations

Pharmacy, nursing and DME
•
Healthcare information services
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2007
• Total healthcare expenditures were $2.4 trillion USD
• $8,000 per person
• 16% of the GDP
2008
• National health expenditures expected to rise 6.9%
2017
• Spending expected to grow to $4.4 trillion USD
• 20% of the GDP
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Healthcare Expenditures as Percent of Gross Domestic Product
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Rx Drugs and
Technology
• Greater cost of new
drugs and devices
• Orphan drugs
• Biologics
Population
Aging
• Costs associated with
age
• Shifting costs to
Medicare/public
sector
Consumer
Demand
Intensity of
Services
• Longer life spans
• Chronic diseases
• Oncology
• Diabetes
• CHF
Increasing
Healthcare
Costs
• Direct to consumer
marketing
• Consumer attitudes
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2007 Total Expenditure = $2.241 trillion USD
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Emphasizing the importance of
•
•
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•
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Alternate site of care
Disease management
Outcomes, benchmarking, quality
Compliance, patient management
Preventative care
ER triage, admission diversion, bed day reduction
Alternate site of care developed as way to reduce costs
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Plans looking for alternate
site of care
• Vertical integration of health plans
• PBMs
• Specialty pharmacy
• Infusion pharmacy
• Diabetic supplies
Increasing need for outcomes
data for disease management
Industry consolidation
Preparation for new drug
launches
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TRADITIONAL SITES OF CARE

Hospital Inpatient

Physician Office

Hospital Outpatient
ALTERNATE SITE OF CARE


Aggregating disease-specific
patients into centers to provide
cost effective care
Hospital without walls
• Dialysis
• Surgery Centers
• Infusion Centers
• Home Care
• Skilled Nursing facilities
• Emergency Room
• Urgent Care
• Retail Clinic
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 Pharmacy-based, decentralized
patient care
• Expertise in sterile drug compounding
• Provides care to patients with acute or chronic
conditions in home and alternate sites
 Services
include:
• Professional pharmacy services
• Care coordination
• Infusion nursing services
• Supplies and equipment
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 4,000
pharmacies nationwide
 Market size $12 Billion
 Types
• Hospital based infusion pharmacy
• National chains
• Independent - local and regional
 Most
are Accredited by JCAHO, CHAP,
ACHC
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USP 797-Compliant Sterile Compounding
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Located in lab draw centers, surgery centers, physician office:
anywhere outside of the hospital to service and train patients

Often providing ongoing therapy for
chronically ill patients
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Rheumatoid arthritis
Multiple sclerosis
Neuromuscular disease
Immune deficiency
Crohn’s disease
Psoriasis
Oncology

Common drugs provided
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ABC
Rituximab
Remicade (3)
IVIG
Orencia
Tysabri
Methotrexate
SoluMedrol
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
Administration of infusible and injectable therapies
• Biologicals
• Oncology therapies
• Anti-infectives



Patient and caregiver instruction on self-injection
PICC and peripheral line placement
Additional clinical services
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Clinical trials
Hospital inpatient bed-day reduction programs
Diagnostics and imaging
Vaccinations and flu shots
Wound care
PT/OT
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AIC
Patient
4
Nurse
Nurse
Patient
3
Home
Infusion
Patient
2
Physician
Physician
Office
One to many
relationship (4:1)

Reduces costs

Improves efficiencies

Patient
Patient

Patient
1
Manages the nursing
shortage
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X
X X XMDX
XX
X X X XXX
X
X
X
MD
X
X
X
X
X XXX X X
X XXX
X XMD
X
X
X
X
X
MD
X

XX X
X
X MD
XX
X X X XXX
X
X
X
X
X
X
AIC placement
determined by
understanding
utilization:
• Patient population
• Disease
MD
• Drug/Therapy
• Physician Spend
• Geography
= AIC location
MD = prescriber location
X
= patient location
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 End
of life and palliative care
• Major healthcare costs are at the end of the
patient’s life
• Hospice offers cost savings by treating terminal
patients at home
 Rx, RN, pain management, social services
 Covered
as a Medicare benefit in 1986
• Adopted by commercial payers
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 Utilized
during last 6 months of life
 Difficult
to determine prognosis
When given a choice, patients choose to be
home instead of tethered to a hospital bed
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 High-touch
patient care in the home
• Low cost alternative to facility-based care
• Provides access to care for the homebound and
non-ambulatory
 Licensed
in accordance with State or
local law
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Services include:
Skilled
nursing: RN,
LVN
Physical
therapy
Medical
social work
Occupational
therapy
Home health
aides
Speech
therapy
Wound care
and ostomy
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 How
to decide which patients are
appropriate for alternate site
• Clinical factors: high-risk, severity
• Home setting: appropriate assessment
• Support/caregiver factors
 Understanding utilization
• Patient populations and costs
• Disease states
• Utilization of drugs and services
• Geographic distribution of patients
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 Medicare
 Medicaid
 Commercial
payers
• ER Triage
• Bed Day Reduction
 Reimbursement
is covered in alternate
sites of care
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 Understanding
patient populations is key
 Know the costs associated with the major
diseases and therapies
 Building hospitals without walls will
reduce administrative costs
 Patients respond positively to care in the
home
 Alternate site improves patient wellbeing
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