Brazil presentation the CCA Forum12

Brazil Healthcare Market &

ASAP Launching

Andre Gibrail ASAP member of Board of Directors AxisMed COO - Chief Operating Officer

17th. October 2012

The Forum12 1

Brazil in Brief - Overview

Estereotype

Soccer Caipirinha Samba

Rio de Janeiro Pele Amazon

The Forum12 2


• 11 million people

• 19.8 million pets

• 6.5 million vehicles

• 148 Universities

• 110 museums

• 160 theaters

• Unique town w/ 4 Tiffany’s stores

• Largest fleet of helicopters, jet aircrafts and cabs

São Paulo City

The Forum12 3

http://www.vidadeturista.com/wp-content/uploads/2011/01/aniversario-sao-paulo-2011-457-anos.jpg


São Paulo City

• 1st. “Japanese city” out of Japan

• 1st. “Portuguese city” out of Portugal

• 1st. “Spanish city” out of Spain

• 3rd. “Lebanese city” out of Lebanon

• 3rd. “Italian city” out of Italy

The Forum12 4


5 The Forum12


6

Area:8.5 million km2 – 5th largest

Inhabitants:193 million (2009)

Government: Presidential federal republic

President: Dilma Rousseff

Official language: Portuguese

Currency: Brazilian Real (BRL)

Urban Rate: 84%

Nativity Rate: 15,77 / 1.000 inhabitants

Child Mortality Rate: 22,5 / 1.000 inhabitants

Life Expectancy: 73.4 years

HDI – Human Development Index: 0,699 (high human development)

The Forum12

http://pt.wikipedia.org/wiki/Ficheiro:Brazil_(orthographic_projection).svg


7

Economically Active Population: 62%

GDP : US$ 2.4 tri 7th largest

GDP per capita: 12,144 USD

Inflation 2011: 6.5%

Interest rate: 7.4%

Exports: US$ 256 bi 2011 – Commodities, airplanes, vehicles

Imports: US$ 226 bi 2011

S&P/Moody´s rating: Investment Grade

The Forum12

http://pt.wikipedia.org/wiki/Ficheiro:Brazil_(orthographic_projection).svg


8

Economy: Stable with significant growth

Population: Annual Income Increase

Broadening of the “middle class”

39 million people became middle class in the last 10 years

High growth of total outstanding credit in financial market

Government social programs decreased extreme poverty

Economic Momentum

The Forum12


9 Source: Secretaria de Vigilancia Sanitaria - Brazil 2025

2050

2000 1980

From 1980 to 2000:

• Fecundity: 4.4 to 2.3

children per woman

• Elderly population

growth 107%.

• Meanwhile growth rate

for group under 14 yrs

of age only 14%

9

Demographic Analysis Proportion of Elderly Population

The Forum12


10

Source:

IBGE/PNAD 2003 Source: IBGE/PNAD

2003

Chronic Diseases

31.7%

69.4%

80.5%

The Forum12


Source: IBGE, 2008

(1) Include: Tendinitis or tenosynovitis (5.0%), chronic kidney disease (3,3%) and cancer (2,5%)

Chronic Diseases

Demographic Analysis

The Forum12 11


12 12

• Public sector – SUS (Unified Health System) – Government-run public healthcare system

– Around 150 million people

– Universal and comprehensive care (From basic prevention to organ transplants)

– Family Health Program: multidisciplinary teams responsible for attendance families at circumscribed regions.

• Currently covers 95% of total (5.290) city councils

• Private sector – 48.7 million people

– Business Models: • Self-Managed Plans,

• Health Maintenance Organizations,

• Health Co-Operatives of Physicians, and

• Health Insurance Companies

Brazilian Health Care Model – Public x Private Sector

The Forum12


13 13

• Regulatory Agenda – 9 themes

– Financial Model of the sector – looking for best ways to finance the elderly

– Ensuring access and quality of care – quality and quantity of network providers based on the number of members

– Payment model to suppliers – starting discussion on P4P

– Pharmaceutical assistance – bring PBMs initiatives for people with common chronic diseases

– Incentive to competitiveness – standardizing and making public main KPIs

– Access to information – making ANS’s website and publications become a reference for the stakeholders: members, health plans, providers and society

– Old contracts – Incentives to adapt the contracts signed before the regulation

– Care to the elderly – Incentives to provide a preventive and holistic care

– Integration between private and public sector – Members ID

unification to reduce overlays

ANS – Healthcare National Agency

The Forum12 Source: ANS


14 14

• Disease Management and Wellness Promotion

August 2011 – ANS publish 2 “Regulatory rule making” to incentive the implementation of disease management and wellness programs by Health Plans.

Nowadays, there are 760 programs registered and approved by ANS covering 1.2 million beneficiaries.

Programs focus on: physical activities, healthy eating, cancer prevention, sexually transmitted diseases, osteoporosis, hypertension, diabetes, smoking cessation and obesity.

Another focus is the health of the elderly




15 15

• Disease Management and Wellness Promotion Results

– Reduced exposure to risk factors such as physical inactivity, inadequate nutrition

and smoke;

– Adoption of health habits;

– Increased functional ability;

– Increase use of preventive screenings and early treatment of cancer;

– Reducing rate of hospitalization for chronic diseases;

– Changes in habits and home environment to prevent falls in the elderly;

– Proven financial return on the investment made

by Health Plans in the Programs




16 16

• Disease Management and Wellness Promotion – Examples of Results

70.4% Reduction in the number of hospitalizations in the elderly

11.8% Reduction of fractures in people over 85 years old

18.8% Reduction in demand for care in emergency rooms

92.1% Patients with high BP controls BP

62.3% People who lost weight after 8 months

63.5% Diabetic patients controlled (glycated hemoglobin less than 6.5%)

83.3% Patients with controlled dyslipidemia (LDL <130)


Source: ANS The Forum12


17 17

• Disease Management and Wellness Promotion

“It is a paradigm shift: the goal to the health system should be promote health and, not only, to treat diseases. The ANS invites Brazilian society to participate in this change”. Mauricio Ceschin – President of ANS


The Forum12


18

Foundation of ASAP

The Forum12

Focus on disease and not on health

Lack of coordinated and sound practical actions

and theoretical content on health promotion and

disease prevention.

Lack of a forum focused on the consolidation of

best practices on health management

Lack of standardized actions and predefined

metrics.

1

2

3

4

Identifying the problem

The Forum12 19

Need of health indicators for measuring even more reliable

and impartial.

Doubts about the return of the programs of health

promotion and disease prevention.

Carrying out actions by companies, in an isolated

way, with poor integration

Communication failure with stakeholders regarding

the results and benefits of PHM.

5

6

7

8

Identifying the problem

The Forum12 20

Life expectancy of the population continuously increasing:

Technological advances in medicine;

Development of pharmacology;

Democratization of the access to information.

The challenges are magnified, bringing questions to health managers.

Challenges continue to face

The Forum12 21

How to transform a reactive model of health in a

proactive system?

How to define actions against the explosive growth

of chronic diseases?

How to disseminate and replicate best practices?

How to measure the quality of services and

outcomes?

How to manage the risks of health preventively?

How to optimize health costs without sacrificing

quality?

Questions

The Forum12 22

The Population Health Management

has all the virtues and strategies to address

these challenges.

Population Health Management-PHM

The Forum12 23

Population Health Management-PHM

Population Determinants

of Health

Access to healthcare

Environment

Genetics

Habits

Stratifying Risk

Intervening on health

Measuring Results

Healthy or risk not Identified

Risk Identified

In treatment

High complexity

Awareness and health

Promotion

Management of

Health Risks

Monitoring,

Orientation and

Support

Case Management

and coordination

Operational Indicators Health Indicators

Source: Adapted from CCA outcome guidelines #5

1 Economic, Financial,

and Actuarial

2 Analysis

Of Use

3 Organizatio

nal Productivity

4 Adherence

and satisfactions

with programs

5 Clinical and

Health Status

6 Prevention Indicators

7 Behavioral

Change

8 Quality of

life and well-

being

The Forum12 24

Foundation of ASAP

With a new vision of health,

ASAP is born with the clear purpose

to promote an alliance between all

stakeholders, working for the outcomes,

results and progress, as well as best

practices. This framework is clearly

understood and applied in health

promotion to different populations, with

results even more effective and viable.

The Forum12 25

Objectives of ASAP

Main objectives of ASAP are:

Bring together companies and

institutions

that operate, manage, and interact,

either directly and indirectly to

Population Health Management.

Provide knowledge to stratify

and reduce risks

in a systematic manner,

within scientific methodologies

with proven results and gains.

The Forum12 26

The CCA is an institution

recognized internationally that,

in the last decade, led the

convergence of U.S. companies

and other parts of the world who

work within the value chain of

PHM, establishing standards and

metrics that become

reference for the Industry.

Partnership

The Forum12 27

Launching of

ASAP

Launching of

ASAP on the

web

Timetable

2012: ASAP “flight departure”

September/12

The Forum12 28

Launching of

ASAP

Launching of

ASAP on the

web

FORUM CCA

Pos CCA

Forum event

Goal: Achieve

42 members to

ASAP

“Tropicalization

light” of CCA

material –

Outcomes

Guidelines”

Timetable

2012: ASAP “flight departure”

September/12 October/12 November/12 December/12

The Forum12 29

Timetable

2013 to ASAP

In 2013, we plan to :

Consolidate the importance of its creation;

Build the initial technical basis;

Attract new members.

The Forum12 30

Launching of

monthly

electronic

newsletter

with scientific

content

1st. ASAP

Workshop

Hire a new

technical

manager /

coordinator

Research to

demonstrate the

maturity of the

Brazilian market in

PHM

1st.

ASAP Forum

Monthly visits to the

companies that run

PHM programs in

Brazil

Visit to

CCA

Timetable

March/13 April/13 May/13 June/13

1st. Semester of 2013

January/13

The Forum12 31

Visit to

CCA

3rd. ASAP

Workshop

2nd. ASAP

Workshop

Launching of

Good Practices

Guidelines

Offering

package for

managers to

participate in the

CCA Forum13

Goal: Achieve 100

members Participation in

the Fórum of

CCA and road

show

Timetable

2nd. Semester of 2013

July/13 August/13 September/13 October/13 November/13 December/13

The Forum12 32

Foundation of ASAP

Members of the Board of ASAP

Fábio Abreu

Paulo Marcos Souza

Michel Daud Filho

Maurício da Silva Lopes

Luiz Carlos Monteiro

Paulo Hirai

Maria Cristina Nader

Claudio Tafla

Marilia Ehl Barbosa

José Antonio Diniz de Oliveira

Fernando Fernandes

Regina de Arruda Mello Blanco

Pedro Luis Gonçalves Ramos

Antonio Pedro de Oliveira

André Gibrail The Forum12 33

Foundation of ASAP

34 34

Summary of Brazilian HealthCare Market Growth Opportunity

The Forum12

Foundation of ASAP

35 35


The Forum12

Foundation of ASAP

36 36


The Forum12

Rising demand for private coverage

Foundation of ASAP

37 37


The Forum12

Market Consolidation Opportunity

Top 15 plans cover 40.8% of the

private market while 1,163 cover the

other 59.2%: Consolidation

opportunities exist

Foundation of ASAP

38 38

Is there a room for PHM in this Market?

High growth potential

Can be applied to both private and public sector

Chronic diseases are responsible for more than 70% of deaths

WHO forecasts deep changes in Brazil´s epidemiological profile from

2005 to 2015:

Large market to explore

More than 10 million people will die due to a chronic disease

Deaths caused by chronic disease will rise 22%, specially by diabetes

which will rise 82%

ANS is focused on promoting PHM

The Forum12

“ It is not because things are difficult that we do not dare,

it is because we do not dare that things are difficult.”

Roman Stoic philosopher Seneca

The Forum12 39

www.asapsaude.org.br

Andre Gibrail

[email protected]

Thank you.

The Forum12 40

Brazil presentation the CCA Forum12

Health & Medicine

Transcript of Brazil presentation the CCA Forum12