PleasureMuito to prazermeet you SomosWe are aD’Or D’Or Consultoria:Consultoria An: especialista Insurance emandseguros Benefitse Specialist benefícios We are part of the Rede D’Or São Luiz Group . THOUSAND ACCREDITED HOSPITAL BEDS ONCOLOGY CLINICS HOSPITALS HOSPITALS . THOUSAND THAN THOUSAND HOSPITAL BEDS NEW PROJECTS UNDER EMPLOYEES HOSPITALS UNDER CONSTRUCTION EXPANSION Rede D’Or São Luiz Hospitals Rio de Janeiro São Paulo BrasíliaBrasília (Federal (DF) District) Recife Bahia Maranhão Our Figures More than R$ Over 400 80Million Collaborators Revenue 1.5 million Our investors R$ de vidasadministeredadministradas lives 2 Billion dePremium prêmio Some of Our Clients Property/Casualty What is your need? D’Or always has a customized solution for your case. And this makes all the Portable Valuables Insurance Home Insurance Pet Insurance difference. Did it fall, get wet, break down? We’ll help you To take even better care of your home, Friends are to be taken care of. Check prevent it. ask for an exclusive quotation. out the special conditions to take good care of your pet. Car Insurance Life Insurance Travel Insurance Private Pension Differentiated advantages so you will only worry Your future is a serious matter. How If being protected is your priority, you Your trip will give you only about planning it in a personalized way? about the road. can count on us. unforgettable moments. In a good way... D’Or Surety Bond DedicatedHeadcountHeadcountdedicado and Agility ReinsuranceAgilidade • Bid, Performance, Advance Payment and Supply Bonds • Court and Custom Bonds • Concession Bonds CustoCost Bond Types Our Services and differentials What we offer What we offer in addition • Access to the largest hospital network in Brazil; Operational Management • Service agility; Access • Monitoring of cases and hospitalizations; • Concierge project under development. Market Assessment • We are a fundamental player for insurance companies; • We are on the premium and insurance claim side; Consulting Strength • The D’Or Consultoria portfolio includes more than 1.5 million lives. Risk and Health Management • IRIS and CRYSTAL – preventive insurance claim management and auditing of medical accounts (a market innovation); Technology • App for the end user; Marketing • Operational system integrated to the providers’ database and Human Resources operational systems. The use of data intelligence to tackle risks and reduce costs in healthcare Brazilian Healthcare Market Market Overview (# of Lives) 0.9 MM Philanthropy ✓ Public System is funded by the Federal Government but managed locally by state or municipalities 142 MM 17.4 MM Public Cooperatives ✓ Private Health Care Market is regulated by System the ANS Only (SUS) o coverage has been standardized Market Size o price adjustments for the individual segment (aprox. 22%) 18.1 MM 209 MM Group Medicine/HMO Universal are controlled Public System o group contracts can only be 47 MM Private purchased through employers, Health Care unions and professional 6.0 MM associations Insurance Co’s ✓ Second Largest Market in the world 20 MM Closed, Gov. 4.6 MM Funded Self Entities Administered Large Employers Brazilian Healthcare Market: Private and Public Lives Cost • Private health: o Smaller portion of lives 47,435,915 o Much higher cost per member per month o 156,000 beds 115.3 bi o +80% financed by employers 149.0 bi • Public health: o Larger number of lives 142,000,000 o 337,000 beds o Informal employment, small and/or Public Private Public Private rural businesses and unemployed population o Serious financing problems Public Healthcare in Brazil UNIVERSAL COVERAGE EQUITY All the public network Equality of Services, would serve the everyone would have population in universal access to the same type of nature, without coverage throughout restrictions or provisions Brazilian territory of coverage; NETWORK PROVIDERS MILITARY NOT INCLUDED The SUS includes not only Medical subsystem of the the federal health armed forces remain networks, but also public isolated, not part of the networks of states and SUS municipalities Private Healthcare in Brazil Beneficiaries of private healthcare plans Dec/2000 – Jun/2016 •Growth from 2000 to 2014 •Brazilian economic crisis causes reduction on lives covered by private plans •1,9 million users left the system, mostly because of unemployment •Millions downgraded their healthcare plans Sources: ANS 2016 Private Sector: Players National Healthcare Agency Healthplan Broker Employer Users Providers (ANS) Private Sector: Players and Services Broker Employers Worksite health programs and obligations Business Inteligence and Analytics EmployeesUsers Wellness and Disease Management Programs Doctors Lab tests Imaging tests Hospitals Support on HR Policies, Market Quotation and Negotiations Regulatory services: ANS and ANVISA Healthplans Healthcare Market in Brazil – Private Sector Medical Inflation x Official Inflation Rate Healthcare Market in Brazil Demographic Transition Number of young people (0-14 years) and old people (60 years or more) and Aging Rate Brazil: 2000 - 2060 Healthcare Market in Brazil Large number of healthplans, but Number of healthcare plans most are regional Dec/2000 – Jun/2016 Handful of healthplans with quality and national coverage Safe and up-to-date medical providers are mostly concentrated in SP and RJ Medical representative institutions withhold information technology advances and strongly protect physicians Few data to analyse quality and cost-effectiveness of providers and healthplans Shift of funding responsabilities from public → private sector Sources: ANS 2016 Healthcare Market in Brazil • Others Issues: o Asymmetry of information; o Judicialization; o Fee-for-servisse. • Deep understanding of health profile of STRATEGIC employees and families MANAGEMENT And what • Alignment of health benefits’ policies and other HR actions does • Integrated approach for all data available HEALTH • Detailed maping of risks and improvement INFORMATION TECHNOLOGY oportunities ‘doing right’ • Monthly evaluations of costs • Focus on stimulating preventive measures mean? instead of fighting high cost medicine TARGETED ACTIONS • Effective communication with Employees/Beneficiaries to enhance positive behaviors Trends 2019/20 Economy • The era of merges and acquisitions: 40% of private equities went for health • Substitutes for biological medications: lower cost per unit but larger number of patients Technology • Mobile care: healthcare mobile tools are bursting and Brazil is avid for more • Medical devices call for more attention towards information safety • New databases should be integrated to rise new insights on how to better manage populational and individual health Behavior and value-based approach • Upcoming changes on how we pay for healthcare (cost-based to value-based) will drive providers towards more quality and efficiency • This value-based approach will require a better understading of community health and needs • Behavior health actions are top strategy for payers to avoid waste, control costs and enhance health Savings in the 1st year R$700thousand R$300thousand R$900thousand Health programs integrated to the Hospitalization management Control of elective surgeries Pregnant Women’s Program outpatient facilities R$ million R$ million Health Programs: By Your Side 708 Benefit policy 19 in 7 months rearrangement and Actions in the 3 prevention contribution in the spheres: break-up process of primary > secondary > tertiary companies belonging to the group Savings R$1.3million Second medical opinion Globo Network R$14.2million Price adjustment negotiation R$3.6million Price adjustment negotiation Case 1 Avoided cost of R$ 21,8 millions (15% of total claim) -2,83% 5,46% VCMH Bradesco 2016/2017: 19,77% 2017/2018: 17,13% Case 2 Avoided cost of R$ 9,4 millions (6% of total claim) 11,53% 11,13% VCMH Bradesco 2016/2017: 19,77% 2017/2018: 17,13%.