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Capio France
Capital Market Day
March 15th, 2016
Philippe Durand, Head of Capio France
Agenda
2016-03-16Capital Market Day, March 15th, 2016 2
A changing market
How we address it
Some additional perspectives
A changing market
3
INEFFICIENT ORGANISATION
- Too long AVLOS
- Too many beds
- Too many providers
UNDERMANAGED ORGANISATION
- Technical rather that client oriented
- Few performance indicators
- Employees not aligned with business
VOLUMES GROWTH
- Population aging
- New techniques & treatments
- New consumption behaviours
FINANCING SHORTAGE
- Cost growth > GDP growth
- 6 € billion € per year
- Price decreases
Challenging, but there are some levers and opportunities!
Capital Market Day, March 15th, 2016
Financing shortage = market under price pressure
• Healthcare spendings growth tends converges close to GDP growth
• How is the tariff built ?
• Limited visibility over the next years but 2017 likely to be c.-1%
2016-03-16Capital Market Day, March 15th, 2016 4
Annual % of increase (decrease) 2016
ONDAM - national healthcare spendings (value) 1,75
Volumes regulation (*) -1,70
Government cost cutting plan -1,05
Take back of tax and social cuts (only for private providers) -0,65
Prudential coefficient (**) -0,50
Total price increase (decrease) -2,15
(*) The price effect is set after cutting for a normative volume increase
(**) Applicable in case national volumes are higher than the 1.70% planned
Our strategy acts on methods and organisation!
5
INEFFICIENT ORGANISATION
- Too long AVLOS
- Too many beds
- Too many providers
UNDERMANAGED ORGANISATION
- Technical rather that client oriented
- Few performance indicators
- Employees not aligned with business
VOLUMES GROWTH
- Population aging
- New techniques & treatments
- New consumption behaviours
FINANCING SHORTAGE
- Cost growth > GDP growth
- 6 € billion € per year
- Price decreases
We can continue to make the difference on this market!
Agenda
2016-03-16Capital Market Day, March 15th, 2016 6
A changing market
How we address it
Some additional perspectives
How we address it !
2016-03-167
Our 2 strategic pillars have positive effects on performance!
The first pillar is MODERN MEDICINE
8
INEFFICIENT ORGANISATION
- Too long AVLOS
- Too many beds
- Too many providers
Protocolized medicine
Centered on patient rather than technique
Shorter AVLOS
Increase of ambulatory care
Higher patient satisfaction
Ambulatory is the future for hospitalisation!…
2016-03-169
From 41% to 100%
depending the units !
From 12% to 78% on
simple cholecystectomy!
The transfers to ambulatory will continue!
Best of class celebrations
2016-03-16Capital Market Day – March 15th, 2016 10
• Total knee replacement – Day case – Ste Odile clinic (Haguenau)
March 2012
• Total hip replacement – Day case – Paulmy clinic (Bayonne)
November 2012
• Colectomy – Day case – Sauvegarde clinic (Lyon)
February 2013
• Hysterectomy – Day case – Cèdres clinic (Toulouse)
November 2013
• Lumbar disc hernia – Day case – Sauvegarde (Lyon)
July 2014
Regroup facilities to improve leverage
2016-03-1611
Increasing
productivity Closing beds Merging
BELHARRA :
Regroup 3 existing clinics
Into a new building
ST VINCENT :
Regroup Orangerie rehab
beds into St Vincent clinic
ORANGE :
Regroupe Provence clinic
on Orange clinic
ATLANTIQUE :
Regroup Mail clinic onto
Atlantique clinic
DOMONT – BOIS
ROCHEFORT:
Two dedicated daycare
centres
QUINT FONSEGRIVES:
Regroup 2 existing clinics
in a new building
MEDIPOLE:
Regroup 2 existing clinics
+ 4 clinics from Mutualité
into a new building
Done
To come by 2018
Increased synergies – lower fixed costs – nicer environment
3 programmes were sponsored by Regional Health Authorities
Build a star network around our core units
2016-03-16Capital Market Day, March 15th, 2016 12
A clear footprint in each region, including strong
partnerships with own and other players
A clear footprint in each region
Example of the Bayonne area
2016-03-1613
• Belharra : core unit with
emergency, ICU,
maternity, …
• Aguilera : moving from
surgery to geriatric
medicine; dedicated to
expand our offer in the
South West of the area
• Jean Le Bon : mostly
ambulatory, dedicated to
expand our offer in the
North of the area
• Cardio center : focused
factory, JV with the
public hospital (75%
Capio)
Offer the best medical service to the population through
focused and coordinated centres
1
1
2
2
3
3
4
4
A clear footprint in each region
Example of the Ile de France area
2016-03-1614
• Claude Bernard : core
unit with emergency,
ICU, maternity, …
• Domont : turned into
ambulatory centre
• Parisis : under
restructuring,
hospitalization
transfered to Claude
Bernard, then turned to
full ambulatory
Offer the best medical care North of Paris
and capture additional volumes usually moving to Paris
1
2
3
The digital footprint (E-fitback)
2016-03-16Capital Market Day, March 15th, 2016
15
• Connect the patient to
us before and after
treatment
• Before : improved
patient preparation
• After : secures patient
follow-up
Overall improves:
- service level
- Productivity
- Quality data capture
- long-term connection
to the patient
Already sponsored by
2 Regional Health Authorities
The second pillar is modern management
2016-03-16Capital Market Day – March 15th, 2016 16
UNDERMANAGED ORGANISATION
- Technical rather that client oriented
- Few performance indicators
- Employees not aligned with business
• Clear organisation
• Reporting per care unit
• Trainings
• People development
A clear organisation
2016-03-16Capital Market Day – March 15th, 2016 17
Main unit Manager
Hospitalisation
Unit
Daycare
Unit
Operating
theatre
Obstetrics
Unit
Dialysis
Unit
HR ManagerModern
MedicineManager
Finance Manager
QualityManager
• Management and
support functions
to help!
Empowered
line managers
A new approach in this business
to improve decision-making on the field
People development!
• Employees
– Strategy & model implementation
• Care Unit and support managers
– Strategy & model implementation
– Management skills
– People assessment
• Main Unit managers
– Management skills
– Union relationships
18
A unique system of training programme in the French healthcare
Agenda
2016-03-16Capital Market Day, March 15th, 2016 19
A changing market
How we address it
Some additional perspectives
Accelerate development in geriatric medicine
2016-03-1620
• A huge market need / not under price pressure
• With limited experience of short stay treatment in France
• Experience launched in Aguiléra (May 2015)
A business line which will expand in new regions in 2016
After 6 months :
Number of patients 448
Number of days 3,540
AVLOS 7.9
Sales 1,127 K€
Additional initiatives to strengthen performance
• Sales development
– Consultation centres created in 2015 (La Rochelle, Tarare)
– Psychiatric home care (new authorization in Toulouse in Sept 2015)
– New rehab authorization in La Rochelle (launch Q4 2016)
• Productivity
– Purchasing (reduced number of references, selected implants, …)
– Optimized workflows on key processes (healthcare, support
functions)
2016-03-16Capital Market Day – March 15th, 2016 21
Conclusion
Prices decrease, BUT:
Operating model is designed to drive productivity
Strategy is supported by Regional Health Authorities
All but 4 units have together fully compensated the 2015 price
decrease
Management was strengthened in units with major discrepancies
Model + new perspectives for sales development and
productivity should allow to continue to compensate for the 2016
tariff decrease
2016-03-16Capital Market Day – March 15th, 2016 22
Conclusion
A motivated management team !
2016-03-16Capital Market Day – March 15th, 2016 23