Investor Day June 2018 Date Presentation name Agenda Mental - - PowerPoint PPT Presentation

Date Presentation name

Investor Day

June 2018

Agenda

• Mental healthcare market
• Akeso’s journey
• Unique treatment programmes
• Management team
• Funders
• Akeso facilities

Date

Date

Mental healthcare market

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 population1
• 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

* Psychiatric and addiction hospitals

Acute Hospital (57/58) Behavioural* Hospitals (55) Public Sector eg. Tara, Weskoppies etc Esidemeni and NGO’s

Acute vs mental health hospital: differentiated product offering

A week in the life of a dual diagnosis patient (Addiction plus psychiatric)

Acute vs mental healthcare hospitals: differentiated product

• ffering

Netcare and Akeso psychiatric offering

Akeso Stepping stones Akeso Montrose Manor Akeso Kenilworth Akeso Milnerton Akeso George Akeso Pietermaritzburg Akeso Umhlanga Akeso Alberton Akeso Parktown Akeso Randburg Netcare Vaalpark Netcare Rand Netcare Mulbarton Netcare Linmed Netcare Linksfield Netcare Krugersdorp Netcare Garden City Netcare Bell Street Netcare Akasia Netcare Jakaranda

Akeso market share

1. South African Society of Psychiatrists 2. Council for Medical Schemes to December 2016 vs Akeso February 2017

Psychiatric beds Psychiatric & addiction beds Psychiatrists Private funder market

28% 21% 40%1 30%2

2 472 beds 3 697 beds 480 Drs R1bn

Date Presentation name

Akeso’s journey

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85 218 290 404 432 529 654 741 811 872 928 Total number of beds

2008 - Randburg 2011 - Alberton Parktown - 2012 2013 - Kenilworth Clinic Stepping Stones -2013 Pietermaritzburg - 2011 2015 - Montrose Manor 2016 - George Milnerton - 2015 Umhlanga - 2016 Arcadia - 2018 2017 - Nelspruit

Akeso’s history and value proposition

Akeso’s history and value proposition

2008 - Randburg 2011 - Alberton Parktown - 2012 2013 - Kenilworth Clinic Stepping Stones -2013 Pietermaritzburg - 2011 2015 - Montrose Manor 2016 - George Milnerton - 2015 Umhlanga - 2016 Arcadia - 2018 2017 - Nelspruit

Bulk of Akeso’s network is greenfield builds +/- 20% capacity added in 2017/18 +/- 65% occupancy including new facilities

Date Presentation name

Unique treatment programmes

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
• ccupational 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 (6 group sessions per day

• ffered)

Individual therapy in specialised units Family or conjoint therapy

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

• utside of a psychiatric institution)
• Very strong focus on mindfulness training

Date Presentation name

Management team

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

Date Presentation name

Funders

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.

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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.

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Date Presentation name

Annexure

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: Screening + treatment and care 801 893 939 1 202 840 909 1 603 787 879 1 924 545 455 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