Investor Day June 2018 Date Presentation name
Agenda • Mental healthcare market • Akeso’s journey • Unique treatment programmes • Management team • Funders • Akeso facilities Date
Mental healthcare market Date
Market overview – inpatient psychiatry • Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015 • On average, just 3% of government health budgets are invested in mental health, varying from less than 1% in low-income countries to 5% in high-income countries • SA inpatient mental health spend is R1bn vs R151bn total private healthcare spend • Increasing by 15% pa (CMS 2014/2015/2016) • 2.4 psychiatric beds per 10 000 population in SA private market • Benchmark: • OECD 7 per 10 000 population • Gauteng DoH recommends 8 per 10 000 population 1 • University of Cape Town (2002) recommends 5.8 per 10 000 population • Japan 27 per 10 000 population • USA 3 per 10 000 population 1. Integrated Health Planning Framework (2006)
Mental healthcare market • Within psychiatric treatment, regulatory and funding requirements also distinguish between different types of psychiatric treatment Esidemeni and NGO’s Behavioural* Hospitals Acute Hospital (57/58) Public Sector eg. Tara, (55) Weskoppies etc * Psychiatric and addiction hospitals
Acute vs mental health hospital: differentiated product offering
Acute vs mental healthcare hospitals: differentiated product offering A week in the life of a dual diagnosis patient (Addiction plus psychiatric)
Netcare and Akeso psychiatric offering Akeso Randburg Netcare Bell Street Netcare Krugersdorp Netcare Akasia Akeso Parktown Netcare Jakaranda Netcare Linksfield Netcare Garden City Netcare Linmed Akeso Milnerton Akeso Alberton Netcare Rand Netcare Mulbarton Akeso Kenilworth Netcare Vaalpark Akeso George Akeso Montrose Manor Akeso Stepping stones Akeso Umhlanga Akeso Pietermaritzburg
Akeso market share Psychiatric & Psychiatric beds Psychiatrists Private funder addiction beds market 30% 2 21% 28% 40% 1 R1bn 3 697 beds 2 472 beds 480 Drs 1. South African Society of Psychiatrists 2. Council for Medical Schemes to December 2016 vs Akeso February 2017
Akeso’s journey Date Presentation name
Akeso’s history and value proposition Total number of beds 928 872 811 Arcadia - 2018 741 2017 - Nelspruit 654 Umhlanga - 2016 2016 - George 529 Milnerton - 2015 432 404 2015 - Montrose Manor Stepping Stones -2013 290 2013 - Kenilworth Clinic 218 Parktown - 2012 85 2011 - Alberton Pietermaritzburg - 2011 2008 - Randburg 11
Akeso’s history and value proposition Bulk of Akeso’s network is Arcadia - 2018 greenfield builds 2017 - Nelspruit Umhlanga - 2016 2016 - George Milnerton - 2015 2015 - Montrose Manor +/- 20% capacity added in 2017/18 Stepping Stones -2013 2013 - Kenilworth Clinic Parktown - 2012 2011 - Alberton Pietermaritzburg - 2011 +/- 65% occupancy including new 2008 - Randburg facilities
Unique treatment programmes Date Presentation name
Akeso unique offering : Our major objectives To work together and continuously improve our services that keep those people we care for well in their everyday lives To achieve (and measure) the outcomes that matter to individuals and their families/formal and informal support structures To acknowledge that “parallel processes” exist in mental health services – the experience of staff within the system influences how they work with people using the services
Integrated model of care • Multi-disciplinary healthcare team made up of a variety of allied professionals specifically occupational therapists and clinical psychologists with the support of social workers, art, music and dance therapists, addiction counsellors, biokineticists, somatic experiencing teachers and others • We approach healing in a holistic way focusing on the physical, emotional, intellectual and spiritual • We always work as a team • Each person is individually assessed on admission and we aim to create an integrated care pathway into the discharge space • We aim to reduce the distress brought on by the symptoms and increase functionality to enable a reintegration into society (biggest challenge is participation in society) • Groups range from skill-building (teaching) to process (skill application), activity-based, experiential, goal-directed, recreational, reflective, motivational
Our Treatment Units • General psychiatry • Dual diagnosis • Adolescents • Geriatrics • Eating disorders • High care/special observation • Post natal depression • Under 12 years • Outpatient programmes: • TAG (Akeso graduates) • YAG (young Akeso graduates)
Patient streams • High functioning (blue) • Medium functioning (orange/green) • Low functioning (red) • Patients can and do move between units and streams
Types of therapy Mostly group based Individual therapy in Family or conjoint therapy (6 group sessions per day specialised units offered)
Models of therapy • Our basic framework is Dialectical Behaviour Therapy • Evidence and skills based ie. to teach people skills to regulate their nervous systems • Focus on both acceptance and change equally • Reduces self-harming behaviours and reinforces life-affirming behaviours (the end goal is to find a life worth living, making a contribution to society outside of a psychiatric institution) • Very strong focus on mindfulness training
Management team Date Presentation name
Executive • Allan Sweidan is the co-founder of Akeso and the current Managing Director. Allan has been with the group since 2004 • Magriet Holder is the Group Clinical Officer . Magriet has been with the Akeso group since 2011 • Sandy Lewis is Group Head of Therapy Services, and has been with the group since 2012 • Thomas Lewis (no relation) is the Group Financial Manager who has been with Akeso since 2013
Funders Date Presentation name
Medical scheme perspective on psychiatric inpatient funding • Schemes, regardless of plan, provide up to 21 days of inpatient care per annum for mental illnesses for their members. • There are 11 separate Prescribed Minimum Benefit categories for acute psychiatric conditions, each with its own set of Prescribed Minimum Benefits. 23
Medical scheme perspective on psychiatric inpatient funding – psychiatric hospital networks • Psychiatric networks have been introduced since 2017 • A few schemes (e.g. Fedhealth and Discovery) have very recently introduced separate networks of psychiatric facilities • Most schemes (e.g. GEMS, Old Mutual) have general networks that include psychiatric facilities • The Fedhealth psychiatric network only includes Code 55 specialised psychiatric facilities • The merger may increase the number of potential anchor providers from two (NHN and Life) to three (Netcare, NHN and Life) for schemes building psychiatric networks but which are willing to include general hospitals that offer psychiatric care. 24
Annexure Date Presentation name
Market size – NHI potential opportunity • NHI first phase priority: cost of implementation Year 1 Year 2 Year 3 Year 4 Mother and woman – pregnancy 5 668 836 834 5 697 181 069 5 725 666 974 5 754 295 309 Mother and woman – breast cancer 4 845 749 609 5 854 456 429 6 888 155 297 7 017 520 185 Mother and woman – cervical cancer 987 576 714 1 211 375 324 1 334 205 349 1 423 655 945 School health 658 263 779 920 533 542 1 737 393 319 1 737 393 319 Elderly – hip and knee arthroplasty 136 116 450 136 797 032 137 481 017 138 168 422 Elderly – cataract surgery 318 182 400 198 864 000 198 864 000 218 864 000 Mental health users: 801 893 939 1 202 840 909 1 603 787 879 1 924 545 455 Screening + treatment and care Disability and rehabilitations 42 000 000 105 000 000 262 500 000 656 250 000 Childhood cancer 778 728 434 875 288 568 945 215 203 1 007 250 433 14 237 348 159 16 202 336 873 18 833 269 038 19 877 943 068 Source: Department of Health
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