Organizacin Sanitas Internacional (OSI) Presentation to Asian Development Bank. February 18 2016

Development of outcome-driven feasible healthcare projects

About OSI 01

Operational Highlights 02

Financial Highlights 03

OSI Business Model 04

OSI Public Health Management Background

05

OSI Target Sectors 06

OSI in South East Asia 07

OSI and ADB

08

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

OSI 01

Organizacin Sanitas Internacional (OSI) is a group of companies specialized in managing, assuring and providing healthcare through its own network of hospitals, health centers and accredited suppliers. OSI also consists of educational institutions and societal-oriented companies that complement its ability to offer wide-ranging health services.

Sanitas oversees the care of its members and patients by maintaining their health as well as identifying and managing risk and disease. We are leaders in comprehensive health services in the countries where we operate, and are widely recognized for our scientific, technical, ethical and human approach.

Created in Spain over 50 years ago and moved to Latin

America in 1980. Today, while growing in Latin and North

America, we continue to move forward with ongoing

development plans in Europe and Asia, where we work to

fulfill our mission.

2015 Development Colombia Venezuela Brazil Peru

December 2015

USA

2016 2017 Expansion Plan

East Europe

Asia

Mxico Guatemala

1 Location 1 Location 1,888.7

8.3

9.0

198

5

Members (thousands) Members (thousands) Members (thousands)

Affiliated Doctors (thousands)

Cities

Employees (thousands)

Cities Cities Cities

Members (thousands)

OSI Health delivery network OSI Health delivery

network OSI Health delivery network

Affiliated Doctors (thousands) Affiliated Doctors (thousands)

Employees (thousands) Employees (thousands)

Employees (thousands)

Affiliated Doctors

259.3

55 570 28

4.4 1.2

8

OSI Health delivery network

51

29

3

48

28

399.6 252.5

2.7 1.0

0.3

Hospitals

Primary Care Centers

Dental Centers

Ophthalmology Centers

Laboratories

Optical Centers

Affiliated Healthcare

Institutions:

2,634

Affiliated Healthcare

Institutions:

917

Cities 3

3 Primary Care Clinics

Laboratories

Pharmacies

Ophthalmology Centers

Dental Centers

Primary Care Centers

Hospitals

Optical Centers

Hospitals

Primary Care Centers

Laboratories

Laboratories

Primary Care Centers

1

4

3

1

1

2

5

1 2

2

2

Affiliated Healthcare

Institutions:

4,047

6

Affiliated Healthcare

Institutions:

219

Operational Highlights 02

Balance Sheet 2014 2013 2012 Income Statement 2014 2013 2012

Total Assets 1,010 967 755 Revenue 1,901 1,671 1,509

Equity 331 324 226 COGS (1,484) (1,323) (1,216)

Gross Debt 155 166 143 Gross Income 417 348 293

Net Debt 53 80 78 OPEX (430) (333) (299)

Other Non-Operating 18.1 (5.0) 6.0

Equity / Total Assets (%) 33% 34% 30% Net Income 5.3 8.9 (0.3)

Net Debt / EBITDA ( x ) 0.6 1.3 1.8 EBITDA 86.3 62.2 42.3

Financial Highlights 03

04

At Sanitas we have developed an inclusive health management model that responds to the local needs with:

Comprehensive health care

A health care network

Local health teams and staff

Risk-oriented health care approach

Integrated health information systems

Health outcome oriented

Standardized protocols and guidelines

Applied technology

Continuous training done by experts from OSIs university

Participative, because it empowers

the informed individual or active

patient to make decisions affecting

his/her health.

Personalized, because it takes into consideration the particular characteristics of the individual as a unique and unrepeatable human being.

Preventive, because it designs actions aimed at maintaining health.

Permanent is the fifth P included in the model. Health care should not be intermittent or conditioned; thus we rely on a continuous monitoring process.

Predictive, identifies the

potential occurrence of a disease and

takes appropriate action to prevent or

mitigate it.

OSI Business model 1. The 5 Ps of Health Management

04

Sanitass business model consists on providing a patient-centered, comprehensive, high quality and cost effective health care delivery model through the establishment of a

primary care center network that serves an assigned population

Specialized Medical Center

Basic Medical Center

Outpatient services

Primary Care oriented

One-stop clinic

80% of healthcare needs attended

Resource planning and allocation based on our know-how in

business performance metrics.

Electronic medical records

Referrals and counter-referrals from network

20% of healthcare needs attended

Integrated medical data with the network

General Hospital

OSI Business model 2. Distributed Network

OSI Business Model 3. Role of Medical Centers in the healthcare network

04

HIGH QUALITY: Supported by Lab,

imaging and specialized diagnosis

ACCESIBILITY health teams, facilities location, comfort and appointments management

EFFICIENCY AND COST CONTROL

COMPREHENSIVE continuous and coordinated

attention among the different complexity levels,

PATIENTS SATISFACTION

Health facilities that bring a one stop

clinic solution, by delivering

outpatient health services in an

integrated, coordinated, timely and

efficient way, altogether aiming at the

patients health value and operational

efficiency.

ONE STOP CLINIC

OSI Business Model 4. Sanitas Health Centers 04

Reduce the number of low-complexity emergency consultations at hospital centers

Enable access to health services

Integrate care in order to optimize the use of

high-complexity resources

Develop healthcare programs for patients with chronic diseases

Solve the most frequent health problems

OSI Business Model 6. Sanitass Health Centers objectives 04

04

Efficiency - HIGH quality / LOW Cost.

Keeping our patient healthy and, preventing complications.

Promotes the systems efficiency.

Resoluteness Handles al least 80% of health needs.

Health maintenances, prevention and risk management, episodic events care, chronic illness management.

Adopts protocols and guidelines for prevailing diseases.

Coordination of the different levels of the health care system: reference and counter reference.

Standardized and repeatable model.

OSI Business Model 7. Characteristics

04

Use of expensive resources Curative Medicine Specialist /physicians Unintegrated medical records Disease Focus Emergencies mostly treated at hospitals.

Cost efficient Preventive medicine. Multidisciplinary health team. Integrated medical records in a network Patient Focus Emergencies treated at the appropriate level

Traditional model Sanitass model

OSI Business Model 8. A comparison vs Traditional model

04

Specialized Clinic Hospital I - II

Hospital III IV

Medical Centers

Level III 5% - 10% of the demand. High cost.

Level II 10% - 20% of the demand.

Level I 80% health demand of the demand.

OSI Business Model 9. How we handle health care complexity level

Risk Based Model

04 OSI Business Model 10. Base on Risk Management

Integrated Medical Centers

Network

Health Insurance, Accessibility

Broad Customer Approach

Adaptive Health Plans

Ample Service

Panel

Primary Care

Specialty Care

Vaccinations

Imaging & diagnostic

Laboratory

Walk-in urgent care

Prescriptions Wellness Programs

Dental Programs

Premium Products

Group Insurance

Individual Insurance

Family Insurance

Other Specific Products

Public Plan Management

Basic Health Insurance

Health Management

Drivers

Key Success

Factors

Alignment of goals between insurer and provider

Interdisciplinary Medical Team and competencies

Complexity and chronic disease management

Healthcare promotion and prevention activities

Risk Screening and Management

Disease Management

Health Maintenance

Community

Members

OSI Business Model 11. Summary of Business and Value Model 04 A vertically integrated approach Integrated Insurance / Healthcare Services Health Value management Multiple complexity approach, focus on primary care Adaptability to multiple health systems (public, private, mixed).

In 1993, the sanctioning of Law 100 promoted healthcare under the following values:

Efficiency: best use of financial and social resources

Universality: protection for all.

Solidarity: mutual-help.

Fullness: sufficient coverage.

Unity: common goal.

Participation: community involvement.

Providers

Insurers

Government SGSSS

Public Health Market Structure

FOSYGA

EPS Private +80%

EPS Gov.

Contributions

Capitations

Network Private

Network Integrated EPS Network

Network Gov.

Third Party Network

Budget

Contributions

Subsidized

OSI Public Health Management Background 1. The Colombian Experience (1) 05

Providers

Insurers

Government

+ 1.5 million POS members

insured

51 dedicated Primary Care centers for POS members

Clnica Universitaria Colombia

Primary Care Network

Public Health Market Structure

Sanitas provides insurance, health

management and provides services to

Mandatory Health Plan (POS) members

through EPS Sanitas and Clnica

Universitaria Colsanitas respectively.

OSI Public Health Management Background 1. The Colombian Experience (2) 05

498 hospital beds for POS members

High blood pressure

International studies establish a coverage of 60 70 % and a control level of 70 80 %. Notes:

In-program patients: Patients diagnosed with HBP that have had their blood pressure controlled over the last 6 months.

Diagnosed patients: Patients currently diagnosed with HBP.

Controlled patients: Patients with SBP

Diabetes Mellitus

International studies establish a optimal coverage between 60 70 % and a optimal control level of 40 50 %.

Notes:

In-program patients: Patients diagnosed with Diabetes and control consultations over the last 6 months.

Diagnosed patients: Patients currently diagnosed with Diabetes.

Controlled patients: POS-only high-risk final users controlled (stage 5 with HB1C

126 114

54 64

10

INDONESIA PHILIPINES VIETNAM COLOMBIA OSI COLOMBIA

Maternal Mortality Rate (per 100,000 live births)

23 22

17

14 12

INDONESIA PHILIPINES VIETNAM COLOMBIA OSI COLOMBIA

Infant Mortality Rate (per 1000 live births)

5.400 infants are dying every year in SEA 3.000 mothers die every year giving birth

Most of them are preventable

OSI Public Health Management Background 2. Challenging Health Indicators (Maternal and children mortality) 05

Source: World Bank 2015 and OSI

OSI Public Health Management Background 2. Challenging Health Indicators (Performance Indicators) 05

0

1

2

3

4

5

6

04/1

3

07/1

3

10/1

3

01/1

4

04/1

4

07/1

4

10/1

4

01/1

5

04/1

5

07/1

5

Waiting Times (General Consultations) days

Oportunidad Mximo

Performance Indicators

Sanitas as an ideal partner in the public health sector

Relevant background in Public Health Management.

Vertically integrated to seek efficiency and improve patients health and user experience

Capacity to work with proprietary country-wide healthcare network and third party providers

Capacity to manage proprietary broader health products and public coverages

Strategically focused on providing access to healthcare in high-volume, low-income, high-footprint countries with Basic Health Coverage health plans.

Multi-country experiences to gain better understanding of local needs and best practices.

Health indicator oriented.

Sustainable long term growth model, paced with the populations health goals.

Capacity to collaborate in health regulation and coverage system definitions and improvement with governments, based on Colombian experience.

OSI Public Health Management Background 3. Summary 05

We focus on partnering and involving both public and private sectors, generating developmental opportunities with cross-participation

Public

Sector

Private

Sector

ADB

Healthcare network operators aiming at efficiently balancing healthcare services and facilitating access to their network with an appropriate health plan.

Health Insurance Companies willing to reduce medical cost and access to broader insured base with a lower income product or public insurance compatible

Multilateral Institutions: as entities acting as financial sponsors and stewardess of the implementation a viable country-scale inclusive healthcare solution, not as mere financiers of health infrastructure.

Central, regional or local governments, public health and social security agencies willing to resolve the populations health needs, efficiently manage budget / health expenditure and transfer financial and economic risks to private sector while accomplishing the health mandate

OSI Target sectors 06

Development of Primary Care Network with local partners.

Involvement in improvement and management of regional government facilities.

Indonesia

Philippines

Vietnam

Developments Goals and outcomes

Acquisition and capitalization of an existing medical center as an expansion platform

Negotiations to take on operation of a provincial network of hospitals and cross-municipal healthcare facilities through a PPP scheme.

Development of a no-balance billing oriented maternity clinic network.

Increase service delivery efficiency and overall network outcome

Improve network health outcome through 5P model implementation

MDG as a central element

Development to paediatric services and family primary care

Provide quality services under BPJS rate schemes

Increase management efficiency and accountability of financial and health indicators

Increase low participation of private sector in healthcare industry and implement primary care priority

OSI in South East Asia Current Relevant Developments 07

We acknowledge ADB is willing to grow its healthcare lending portfolio while increasing the

externalities with a stronger involvement in the value chain, leading to Projects

Comprehensive integrated

Viable and efficient

Health outcome-driven

with a broad scope (involving health access and services) and broad geographical footprint

defined, structured and managed professionally with positive economic and financial results.

with clear and measurable health indicators

focused on the least privileged and with the involvement of the main stakeholders

in which ADB has a creating and steering role and is identified together with other sponsors

OSI and ADB Our understanding of ADBs Health Strategies and Goals 08

Inclusive Healthcare

Beyond Financing: ADB added value and Brand recognition

Joint objective and efforts lead to successful development

Project Debt Funding (infrastructure and equipment)

Guidance

Branding

Institutional Support

Opportunity generation, project definition and development

Primary care product definition and commercialization

Efficient healthcare network operation

Join tablework:

o Project feasibility

evaluation

o Due Diligence

o Internal Approvals

PPP definition

Equity funding

Project steering

Asia Development Bank

Sanitas

OSI and ADB Collaboration Proposal 08

Example Collaboration Structures for Public Health Sector

Public Ownership with ADB Funding

Government PPP Vehicle

ADB

New Medical

Center

Network

Insured

Members

Existing

Network

Capitation

or other

Transfer

Sanitas Management

Funding

Coverage

Steering & Stewardship

Improvement

Appropriations

Ad-hoc Public Private Partnerships Existing framework enabled private

sector participation in public health

New regulatory enabling framework

OSI and ADB Collaboration Proposal 08

Example Collaboration Structures for Public Health Sector

Private Ownership with ADB Sanitas Co-Funding

Government Sanitas

ADB

New Medical

Center

Network

Insured

Members

Existing

Network

Co-Funding

Coverage

Capitation or other

Management

Improvement

Appropriations

Ad-hoc Public Private Partnerships Existing framework enabled private

sector participation in public health

New regulatory enabling framework

OSI and ADB Collaboration Proposal 08

Contact Jaime Escallon Vice President Sales International Division +57 315 344 9857 jdescallon@colsanitas.com Pablo Ochoa de Zabalegui Country Director Philippines +63 917 323 62 89 pablo.ochoa@ph.sanitas.me

Annexes

A1 Relevant Sanitas Medical

Centers

18.02.16 Health centers 30

Hospitals

Clnica Reina Sofa (Bogot - Colombia) Clnica Universitaria Colombia (Bogot - Colombia)

Unit # Beds

Pediatrics 24

Adults 91

Labor & Recovery 6

Maternity 5

Maternity 11

Intensive 4

Basic 8

Minimum 3

Neonatal NICU 15

Intermediate Care 3

Intensive Care 6

Cardiovascular ICU 0

ICU 9

Pediatric NICU 0

Total Beds 150

ORs Surgery Rooms 8

Unit # Beds

Pediatrics 44

Adults 198

Labor & Recovery 12

Maternity 0

Maternity 12

Intensive 6

Basic 13

Minimum 6

Neonatal NICU 25

Intermediate Care 6

Intensive Care 13

Cardiovascular ICU 15

ICU 34

Pediatric NICU 6

Total Beds 319

ORs Surgery Rooms 10

January 21, 2016 CONFIDENTIAL 31

Relevant Sanitas Medical Centers A2

Clnica Iberoamrica (Barraquilla - Colombia)

Unit # Beds

Pediatrics 8

Adults 62

Labor & Recovery 5

Maternity 0

Maternity 5

Intensive 7

Basic 4

Minimum 3

Neonatal NICU 14

Intermediate Care 0

Intensive Care 8

Cardiovascular ICU 2

ICU 10

Pediatric NICU 0

Total Beds 99

ORs Surgery Rooms 7

Clnica Sebastin Belalczar (Cali - Colombia)

Unit # Beds

Pediatrics 14

Adults 43

Labor & Recovery 0

Maternity 0

Maternity 0

Intensive 4

Basic 4

Minimum 0

Neonatal NICU 8

Intermediate Care 0

Intensive Care 5

Cardiovascular ICU 0

ICU 5

Pediatric NICU 0

Total Beds 70

ORs Surgery Rooms 6

January 21, 2016 CONFIDENTIAL 32

Hospitals

Relevant Sanitas Medical Centers A2

Clnica Santa Paula

(Caracas - Venezuela)

Clinisanitas Bucaramanga

(Colombia)

Clinisanitas Doral

(Florida - USA)

Clinisanitas #96

(Bogot - Colombia)

EPS Sanitas UAP

(Bogot - Colombia)

Clinisanitas Colina Campestre

(Colombia)

January 21, 2016 CONFIDENTIAL 33

Other hospitals and ambulatory centers

Relevant Sanitas Medical Centers A2