Healthcare Global - May2015

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The Economic Ramifications of Cures

TOP 10: Emerging Trends in Alternative Medicine

TRANSFORMING

BIG DATA INTO BETTER HEALTH

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EDITOR’S COMMENT

Providing care in a digital world Tackling health challenges demands an approach that requires an integration of multi-layered health information and an elaborate ecosystem. How do we do that? With big data.

Harnessing the potential of big data represents an opportunity to transform healthcare, leading to new discoveries and economic benefits. It’s a topic that has been discussed time and time again, but with Europe’s rising health challenges, the time to integrate is now.

Speaking of the economy, in our feature “The Economic Ramifications of Cures,” we take a look at the most recent expenses in the medical industry (the numbers are in the billions) and reflect on whether prevention could be the answer to saving money and responding to the healthcare crisis.

Finally, as more individuals seek alternative methods to maintain their health in lieu of their doctor’s office, we compiled the top 10 emerging trends in alternative medicine that you can expect to see this year.

We hope you enjoy this issue and wish you the best of health!

Stephanie C. Ocano Senior Editor stephanie.ocano@healthcareglobal.com 3

CONTENTS

Features

30 6

MEDICINE

The Economic Ramifications of Cures

46

CHUM

Healthe Care

14 TECHNOLOGY

Big Data Transforming into better health

20 TOP 10

Emerging Trends in Alternative Medicine

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70

Hospital Bandeirantes Fundacion Cardiovascular de Colombia

82

Company Profiles CANADA 30 CHUM

AUSTRALIA 46 Healthe Care

BRAZIL

56

56 Grupo Centroflora

Grupo Centroflora

70 Hospital Bandeirantes

AMERICA LATINA 82 Fundacion Cardiovascular de Colombia 92 B.Braun Mexico 106 Clinica Bicentenario

USA 118 Pathology Associates Medical Laboratories (PAML)

106 92

Clinica Bicentenario

B.Braun Mexico

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Pathology Associates Medical Laboratories (PAML) 5

MEDICINE

THE ECONOMIC RAMIFICATIONS OF CURES What does it really cost to cure a disease?

Writ ten by: STE PHAN I E C. OCANO

MOST RECENTLY, RESEARCHERS were able to find a cure for the liver disease hepatitis C. How much did it cost? Roughly $4.5 billion according to the Medicare Payment Advisory Commission.

This was more than 15 times what Medicare spent the year before on older treatments for the disease.

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The extraordinary outlays for these breakthrough drugs, which can cost $1,000 a day or more, will be borne largely by federal taxpayers, who pay for most of Medicare’s prescription drug program. But the expenditures will also mean higher deductibles and maximum out-of-pocket costs for many of the program’s 39 million

seniors and disabled enrollees, who pay a smaller share of its cost, experts and federal officials told The Washington Post.

The new hepatitis C drugs have a higher cure rate—90 percent or higher—than previous treatments, as well as fewer harmful side effects.

Some studies have shown that, despite

their price tag, the drugs justify their cost based on the better quality of life they provide and the health expenses that patients avoid in the future.

Still, the drugs may not save money for Medicare, even in the long run. A recent study in the Annals of Internal Medicine suggested that only about one-quarter of the $65 billion needed to pay for the 7

MEDICINE

3.2 million persons in the United States have chronic Hepatitis C virus infection. new drugs for eligible patients (not just those on Medicare) would be offset by avoiding hospitalizations and other treatment costs. The vast majority of patients with hepatitis C don’t go on to get liver transplants.

Federal taxpayers cover the preponderance of the cost of treating patients in Part D, but enrollees also have to pick up a share, which can 8

May 2015

vary based on their drug usage. Once a Medicare enrollee spends $4,700 out of pocket on drugs – in this case, just a few days of a prescription – “catastrophic” coverage kicks in.

At that point, Medicare picks up 80 percent of the cost, the health plan pays 15 percent, and the patient pays the remaining five percent.

Some costs probably will be passed

T H E E C O N O M I C R A M I F I C AT I O N S O F C U R E S

along to Medicare beneficiaries who don’t have hepatitis C, in the form of higher deductibles and maximum outof-pocket costs, said Jack Hoadley, a research professor in the Health Policy Institute at Georgetown University.

For example, next year the standard drug deductible in the program—the amount a patient has to spend before coverage kicks in—will increase to $360 from $320.

The out-of-pocket maximum, at which catastrophic coverage begins, is also going up to $4,800 from $4,700. Beyond that, insurance company premiums may also increase somewhat, though increases could be offset by changes in the use of other drugs. Rates have not yet been announced for 2016.

Is There a Solution?

Unsustainable growth in medical spending has sparked interest in the question of whether prevention saves money and could be the answer to the health care crisis. But the question misses the point. What should matter (for both prevention and treatment services) is value – the health benefit per dollar invested.

An option of longstanding interest is prevention –interventions that prevent or delay the occurrence of the very diseases that drive these costs. There are three kinds of prevention.

Primary prevention can be accomplished by modifying unhealthy behaviors (e.g., smoking, physical inactivity), which cause many diseases and account for 38

‘next year the standard drug deductible in the program—the amount a patient has to spend before coverage kicks in—will increase to $360 from $320’ 9

MEDICINE

New hepatitis C drugs have a 90 percent survival rate.

Can we prevent hepatitis C?

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percent of all deaths in the United States, administering immunizations to prevent infectious diseases, and reducing exposure to harmful environmental factors.

Secondary prevention can reduce the severity of diseases, such as cancer and heart disease, through screening programs that detect the diseases or their risk factors at early stages, before they become symptomatic or disabling.

Tertiary prevention – the effort to avoid or defer the complications of diseases after they have developed – is the current focus of medical care.

The health benefits of prevention are intuitive – it is wiser to prevent a disease than to face its consequences at a more advanced stage – but for many years policymakers, politicians, and professionals have also advanced the economic argument that prevention saves money.

Prevention is seen as the touchstone of a redesigned system focused on improving health outcomes.

Health is a good, and goods – whether they are national security, clean water, or a new car – are not purchased to save money. They are purchased for the nonmonetary

F E AT U R E A R T I C L E S H O R T E N E D H E A D L I N E

People have their temperature taken at Canton Fair.

Guangdong province was identified as a front line to prevent the deadly Ebola virus from entering China.

‘The health benefits of prevention are intuitive – it is wiser to prevent a disease than to face its consequences at a more advanced stage’

benefits they provide.

The proper question for prevention – and, ultimately, for all of health care – is not whether it saves money but whether it offers good value on the dollar. For a given disease, which strategy – prevention, a new diagnostic test, or a better treatment – offers the greatest benefit per unit cost? Finding the best ways to enhance health for the 11

MEDICINE same cost is common sense, and it is common practice in other countries, such as Canada, the United Kingdom, France, and Japan.

Looking Ahead Questions about costs are often waived for disease care. The question posed for prevention— will it save money?—is rarely applied to an imaging procedure, a new antibiotic, or a surgical procedure. Although

some payers will consider CE studies and eschew coverage when CE is poor, many coverage decisions (and drug approvals by the Food and Drug Administration) occur without consideration of costs.

Various factors explain how this double standard came to be, but the economic crisis in health care calls for more critical thinking. At a time when the economy and the lives of American families are deeply affected

The costs and benefits of a hepatitis C drug are finally balancing out

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T H E E C O N O M I C R A M I F I C AT I O N S O F C U R E S

by medical spending, policymakers who ask whether prevention can save money or reduce spending must pose the same questions for disease treatments. For all forms of health spending, they should ask the following questions: • Is the intervention effective in improving health outcomes, and is it based on sound evidence? • If it is effective, does it offer good value per dollar spent?

• Can other options achieve better results, the same results at lower cost, or possibly yield net savings?

Across the board, the economic crisis requires a comprehensive examination of how to shift spending from services of dubious economic value to those with high CE or net savings. Whether those services are preventive or otherwise is less the point than the value they provide for the dollars spent.

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TECHNOLOGY

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T HE A L

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TECHNOLOGY EUROPE faces rising health challenges due to demographic changes, an increase in communicable diseases, an inefficient R&D process in the biomedical research domain and an increase in disease complexity, at least according to the Medical Sciences Committee of Science Europe.

Tackling health challenges demands an approach that requires an integration of multi-layered health information and an elaborate ecosystem. What is that approach? Big data.

In its latest report, Science Europe consolidated the outcomes of a

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two-day workshop co-hosted with the Italian National Institute for Nuclear Physics. Ongoing initiatives aimed at crafting a health Big Data ecosystem were showcased to help participants actively engage in discussions on how to develop such a health Big Data ecosystem in Europe.

Participants recognized that tackling Europe’s big health challenges needs a more systemic approach. Such an approach requires combining multiple health-related dimensions represented by big data from the molecular level to the integration of information related to

T R A N S F O R M I N G B I G D ATA I N T O B E T T E R H E A LT H

‘Tackling health challenges demands an approach that requires an integration of multi-layered health information and an elaborate ecosystem’

individual environments and lifestyles.

It was also recognized that the main challenge for transformation of data into knowledge to improve health at the individual and population levels requires new analytical tools to discover novel relationships and patterns in a very heterogeneous data set.

Developing such an ecosystem in Europe relies on data sharing between multiple stakeholders, from public and private organizations involved in biomedical R&D to other disciplines (for example ICT, social sciences) that must put citizens and patients at its center.

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TECHNOLOGY Challenges (and Solutions) for Big Data Integration Leveraging big data represents an opportunity to advance different fields across the biomedical sciences and healthcare industries including personalized medicine, systems biology, clinical research, drug discovery, drug development and public health.

Five challenges were identified from the participants: 1. Health-related data are fragmented across multiple and unconnected data sources (patient registries, bio-banks, social networks, and others).

2. There is no clear code of practice for data sharing. Data are stored in databases that belong to multiple institutions and stakeholders across the biomedical research and healthcare fields.

3. The prevailing biomedical R&D model is segmented into basic, preclinical and clinical research silos. This ‘compartmentalization’ of the biomedical R&D and healthcare data chain, with value expected for the citizen/patient as a passive end-user, is a major 18

May 2015

hurdle to a data-sharing culture.

4. There is as yet no clear code of practice to ensure personal privacy while preserving openness in data sharing.

5. Current funding and career appraisal systems for biomedical researchers mainly recognize investigator-driven research.

Mechanisms recognizing collaborative inter-disciplinary networks are in their infancy.

But recommendations to these challenges were offered.

Legal: Introduce appropriate legal and ethical frameworks to support data-sharing while developing appropriate security and oversight measures to reduce the risk of personal data loss (for example the European Data Protection Regulation).

Big data presents other challenges with respect to ownership and liability that will need to be resolved.

Society: Increase citizen and patient involvement in the management and processing of their own health data and restore public trust in science (such as health data co-operatives).

Organization: Develop codes of conduct and research practices

that define rigorous quality control mechanisms for all aspects of data handling, from collection and annotation through to storage and sharing between organizations.

Develop funding opportunities for collaborative research networks and develop recognition and reward mechanisms for data sharing activities by individual researchers, especially in relation to career progression.

Investigator: Develop pilot experiments to showcase evidence-based benefits of sharing data for researchers from the public and private sectors.

The Future of Big Data in Health Harnessing the potential of big data represents an opportunity to transform biomedical science, leading to new discoveries and better healthcare for the European citizen, with the attendant economic benefits that this brings.

There is already much activity in Europe within the arena that is directly or indirectly related to big data.

Before proceeding further it would be sensible to map this landscape to understand what is already being done, where there are gaps, and where there are opportunities to potentially add value.

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TOP 10

EMERGING TRENDS IN

Alternative Medicine Can you guess the number one alternative medical practice?

Writ ten by: STE PHAN I E C. OCANO

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TOP 10

IT’S OFFICIAL, ABOUT a third of Americans seek alternative medicine out in lieu of their doctor’s office when it comes to their health – at least according to the National Institutes of Health.

Most Americans who use these nontraditional approaches do so as a complement to conventional care. Only about 5 percent of Americans use alternative medicine solely, according to the reports.

The data comes from the National Health Statistics Report – a survey the government completes to look at the health habits of a representative sample of the United States. They talked to over 89,000 American adults and over 17,000 children between the ages of 4- and 17-years-old.

Here are the top 10 emerging trends in alternative medicine based on those statistics and more.

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10

Yoga, Tai Chi and Qi Gong

All three forms have increased linearly over the three time points analyzed by the institutes. Some 21 million adults and 1.7 million children practice yoga. Adult interest in yoga more than doubled since 2002. Some 10.9 percent of adults did deep breathing exercises.

E M E R G I N G T R E N D S I N A LT E R N AT I V E M E D I C I N E

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Melatonin

The adult use of melatonin more than doubled from 2007 to 2012.

For children it was the secondmost used natural product. The body naturally creates melatonin to help regulate the sleep cycle.

People who have trouble falling asleep use it, as do people who struggle with jet lag. Some people also report using it to fight cancer.

9

Probiotics

Probiotic and prebiotic use was four times as high in 2012 as it was in 2007. Often, people take those to help with digestion or to protect themselves or their children from so-called “bad� bacteria.

Probiotics can be found in foods like yogurt. Prebiotics, the nondigestible carbohydrates that the probiotics eat, are in bananas, onions, garlic and honey.

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TOP 10

7

Acupuncture

According to the institutes, there was a slight increase in the use of homeopathic treatment and acupuncture during the time the study was conducted.

Some research results suggest acupuncture can alleviate pain.

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Reiki

Reiki – also called energy medicine – is an ancient hands-on healing practice which harnesses what believers call the Universal Life Force – the energy field that surrounds all beings, including humans.

Stephen Sinatra, a cardiologist and head of the New England Heart Center in Manchester, Connecticut, recommends Reiki when he believes an energy block is hindering a patient’s ability to heal.

An experienced Reiki practitioner can pick up on the part(s) of the body that may be blocked energetically and emotionally, he explains, which is “valuable feedback is for the patient.”

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E M E R G I N G T R E N D S I N A LT E R N AT I V E M E D I C I N E

5

Roseroot

Rhodiola rosea, also referred to as roseroot, has been used in traditional folk medicine to promote work endurance, increase longevity and promote resistance to several health conditions including fatigue, altitude sickness and depression.

According to a study published in Phytomedicine, the authors believe their findings suggest that roseroot extract may have modest antidepressant effects in some patients with mild to moderate depression although larger studies will be needed to fully evaluate the benefit and harm of the herb.

4

Fecal Transplants

Fecal transplants, using stool from a donor, have been successful at treating serious gut infections, researchers report.

It may sound distasteful but researchers have found that the transplantation of fecal matter successfully treated Clostridium difficile infections, which lead to recurrent cases of diarrhea and severe abdominal pain with thousands of fatalities worldwide every year, in patients.

The results, published in the journal Microbiome, revealed that healthy changes to a patients’ microbiome were sustained for up to 21 weeks after transplant, and has implications for the regulation of the treatment.

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TOP 10

3

Fish Oil Supplements

Fish oil is the most common natural product taken by children and adults, according to the National Institutes of Health.

Some 7.8 percent of adults used it in 2012. That’s an increase from 4.8 percent in 2007.

Fish oil is thought to lower the risk of heart disease, the No. 1 killer of Americans. It is believed the omega-3 fatty acids have anti-inflammatory effects and decrease risk of arrhythmia that can lead to sudden death.

Some people also take fish oil supplements to ease the pain of rheumatoid arthritis, to ease problems with allergies, asthma, anxiety, cancer, depression and other issues; the science is still out on its effectiveness with these medical issues.

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E M E R G I N G T R E N D S I N A LT E R N AT I V E M E D I C I N E

2

Coconut Oil

The ice bucket challenge for ALS raised a lot of awareness and money last year – but there’s still no cure. Duke University Dr. Richard Bedlack wants to change that. He runs one of the top ALS clinics in the world.

He’s worked with over 2,000 patients and is part of a review team of 95 scientists from 10 countries investigating new alternative therapies.

His top pick for further study?

Coconut oil. In ALS, motor neurons can’t make energy.

Once ingested, coconut oil converts into ketone bodies that can be used by cells as energy.

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1

Cannabis

Cannabis might help stop the progression of ALS, and treat symptoms like weight loss, muscle spasms and secretions.

In a 2001 review published in American Journal of Hospice & Palliative Care, the authors reviewed the existing literature.

They found that various symptoms caused by ALS have the potential to be alleviated by the use of cannabis.

There is also mounting evidence that cannabis can actually help fight various types of cancer as well as treat a myriad of other conditions like narcolepsy and eating disorders.

Collective Evolution put together a list of 20 medical studies that suggest cannabis can be an effective treatment and possible cure for cancer. Cannabinoids have been proven to reduce cancer cells as they have a great impact on the rebuilding of the immune system. While not every strain of cannabis has the same effect, more and more patients are seeing success in cancer reduction in a short period of time by using cannabis.

As the use of cannabis for medical purposes continues to be legalized, we predict that this will be the biggest trend in alternative medicine in 2015.

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CHUM

Montreal’s International Health Centre The CHUM stands out as a unique mega hospital development pole for its university academic mission, integrated care, research, teaching, technology assessment and modes of health intervention and health promotion.

Written by: Stephanie C. Ocano Produced by: Cedrick Adolphe

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C O M PA N Y N A M E

Reception

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ocated in the heart of Quebec’s largest city, the CHUM is an international reference for academic medicine and research. Its health research center (CRCHUM) is the largest in the university network.

Born from the merger of three founding hospitals (Hotel Dieu, Hopital St. Luc, and Hopital NotreDame) medical education and research has always been at the heart of its mission and vision. The hospital is now undergoing an extensive transformation towards 32

May 2015

a new teaching hospital facility and fulfilling its goal of becoming a major academic health center renowned worldwide.

The redevelopment project consists of three construction phases spanning a 10 year period. It is a complex redevelopment project in the city center, near Old Montreal, and has been procured under a 34 year private-public partnership (P3) agreement. The new CHUM is a state-of-the-art academic medical center that will include 772 beds, 39 operating rooms, a cancer center,

SECTOR

a research center and an education simulation center.

promotion and evaluation of technologies—today, more than 360 researchers and almost 450 Phase 1 students contribute to the largeThe CHUM Research Centre and scale production and international Integrated Education Centre is reputation of the center. contiguous to the new health center In March 2010, the approval was complex. It would not exist without given for the construction of a new the hospital. Conversely, the CHUM research center—preceding the would not be an international construction of the new CHUM. academic medical center without In the first phase of this project, six the research and education facilities. old research centers were merged Contributing closely to the five to consolidate the expertise of both components of CHUM’s mission— researchers and students. care, teaching, research, health “The research center was built for w w w. c h u m o n t re a l . q c . c a

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CHUM

Patient Room

$475M and was completed on time and within budget,” said Jacques Turgeon, CEO of CHUM, during a recent interview. “It has been operating since October 2013.”

Encompassing 68,000 square meters, the center is one of the largest research centers in North America and one of the first to bring together under one roof a comprehensive continuum of research.

Phase 2 and 3 The two subsequent phases of the project encompass the new teaching hospital facilities. The main hospital towers are scheduled 34

May 2015

to open in the Fall of 2016, and the 3rd and final phase includes a medical office building and 500 seat academic conference center.

The new CHUM will replace older facilities that currently sit on three sites— Hôpital Saint-Luc, HôtelDieu and Hôpital Notre-Dame. One of the facilities—Hôpital NotreDame—will remain as a regionaltype hospital with approximately 300 beds. Together with the new CHUM hospital development there will be a total of 1,072 beds in operation upon completion.

Hôtel-Dieu will likely be used as a long-term care facility in the future,

CANADA

Registration

according to Turgeon.

The new CHUM is being built on the existing site of the Hôpital Saint-Luc, within a couple of meters of the existing buildings.

“From a construction perspective, it’s very complex to be building so close to the existing hospital,” said Paul Landry, Project Director of the CHUM redevelopment project. “Complex construction logistics for a building that is over 3 million square feet and 22 stories in height.”

The selection of the site for the new CHUM was quite strategic, according to Landry. Right beside a major highway system, the new CHUM also links to a regional train system, solving transportation issues previously encountered on the existing older sites.

“We are quite pleased with the vertical scale

“We’ve gone through a very complex, very thorough, multiple years of planning” – Paul Landry

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CHUM of the new hosptal” said Landry. “It is designed so that right from the ground floor, or even the lower levels of parking, it’s a matter of taking an elevator and going straight up to one of 35 specialty clinics or of 26 inpatient units. The patient and staff displacement is very efficient.”

The third phase of the project is a doctors’ office building and a 500-seat amphitheater which sit on top of four stories of underground parking (1,350 parking spaces). The ambulatory care center encompasses the outpatient clinics with over 45 exam and treatment rooms.

Prior to commencing construction

CANADA

of Phase 3, the Hôpital Saint-Luc will be demolished and Phase 3 will be built in its place. Substantial completion of Phase 3 is scheduled for March 2020.

Focused Research The CHUM primarily provides care and subspecialty services to a regional and supra regional adult population.

“We have identified some themes that allow us to work amongst the best researchers in the world,” said Turgeon. “So we’re very aligned with the specialties we have in our hospital population.”

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CHUM

Among those specialties are oncology, breast cancer, ovarian cancer, endometrial cancer and prostate cancer.

“We’re also looking at dyskinesia, or neurological diseases of the movements,” added Turgeon. “So whenever there’s a movement associated with a disease, this is what we’re looking at. We’re also looking at immunity and transplantation to make sure to have most of the major transplantation programs, such as liver, kidney,

CANADA

lungs, heart and lungs, intestine and pancreas.” Moreover, the CHUM focuses on metabolic syndromes— diabetes, Type 2 diabetes, pancreatic transplantation and insulin replacement.

A Specialized Supply Chain Entirely new for the CHUM will be the implementation of an AGV system (Automated Guided Vehicles) that will transport supplies, soiled and recyclable materials throughout the 22-story hospital complex.

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Beckman Coulter vous remercie pour votre partenariat et félicite le CHUM pour son projet du nouveau CHUM!

We thank you for your partnership and we congratulate the CHUM on its New CHUM project!

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Together we can shape the future of the lab. With our strategic insight and innovation, we provide the solutions you need to meet the challenges your lab faces. © Copyright 2015 Beckman Coulter, Inc. Beckman Coulter and the stylized logo are trademarks of Beckman Coulter, Inc. and are registered with the USPTO.

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CHUM “Using dedicated elevators, approximately 70 Wi-Fi guided robotic AGVs will perform most deliveries up to the various logistics lobbies adjacent to the inpatient units” said Landry.

Furthermore, the new CHUM is quite different from current supply chain functions in that the CHUM has entered into a contract with another teaching hospital in Montreal—the McGill University Health Center—for an off-site central distribution facility.

“The whole supply chain has been re-planned and the AGV robots will be the transport mechanism for that

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supply chain,” added Landry.

Improving Operations One of the major features in the new CHUM will be the electronic integration amongst all 772 single rooms. “We’re trying to limit infections or transmission of infection from one patient to another,” explained Turgeon.

Another major feature is the stateof-the-art equipment in the 39 surgery rooms.

“We will become a center for tertiary and quaternary care, which means being specialized, and ultraspecialized, in some very specific

Reception w w w. c h u m o n t re a l . q c . c a

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Coin Viger

CHUM

diseases for better patient care.”

“While this is a huge megahospital development of some 3 and a half million square feet and quite vertical, it’s also a huge transformation of the hospital’s operations,” added Landry. “We’ve gone through a very complex, very thorough, multiple years of planning—looking at our work processes, new technologies, looking at how we can become more efficient at delivering care, so you know, there’s a large focus on this massive transformation that we have to undergo to move into this new teaching hospital complex.”

Communication challenges Even though the hospital will be ready to welcome its first patients in fall 2016, “we have to start communicating from now on with our patients. First of all, we have to promote the project as a major healthcare project. Secondly, we also have to reassure the patients and our employees about the transformation and the move. Since some patients will have their next appointment in more than a year, we

CANADA

have to plan ahead and find the best way to inform them as to where and when it will take place”, explained Irene Marcheterre, Communication and Information Access Director.

The construction site of the new CHUM is located in downtown Montreal which is an urban district, next to Saint-Luc Hospital; therefore communication programs for the community (residents and merchants of the area) and for the medical team of the existing hospital where prepared a few years ago and are still being applied.

The management of the negative or even harmful impacts (street closures, noise) had to be well planned and consider community sensitivities. “Therefore, we have special meetings for the locals twice a year where we provide information about the evolution of the project and respond – with the builder – to the questions from the public. We also plan other types of activities to facilitate our integration and to participate to the area revitalization”, said Irene Marcheterre.

There are also some communication challenges w w w. c h u m o n t re a l . q c . c a

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CHUM

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related to the human resources: “each of our three hospitals has its own culture. We have to mobilize the doctors, the health workers and all the administrative employees in order to have a successful transformation”, said Irene Marcheterre. Promoting the project is important, but more importantly is to listen to staff concerns and preoccupations, she adds.

What makes the new CHUM a one of kind major project is of course its architecture, well integrated to the urban fabric and the historical heritage of this district, but also its openness to art. The Quebec integration of art to the architecture policy makes sure that any public construction project allows a portion of its budget to public art. Therefore, the new CHUM will have 13 works of art (5 M$) within its walls to create a healing and calming environment.

Company Information INDUSTRY

Healthcare Global HEADQUARTERS

850 rue St. Denis Montreal, Quebec, Canada, H2X 0A9 FOUNDED

Not Disclosed EMPLOYEES

12,500 REVENUE

Looking Ahead “The major goal that I have as a CEO is to position this hospital as one of the major academic hospitals in the world, in order to be at the level of the major academic centers in the United States,” said Turgeon.

“There’s so much that awaits the patients at the end of this journey,” added Landry. “There’s a lot of exciting new technology that will be available to staff and patients, but the patient care will remain at the center of our mission”.

Phase 2 of construction is currently on schedule to be completed by April 2016.

$500M - $1B PRODUCTS/ SERVICES

Hospital

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Healthe Care:

The Leading Private Hospit Provider for Southeast Victo

With The Valley Private Hospital and South Eastern Pr its portfolio of 16 medical facilities, Healthe Care has private hospital with state-of-the-art technology, spe and a driving vision.

Written by: Stephanie C. Ocano Produced by: Rob Benson

tal oria

rivate Hospital in transformed this cialist services

H E A LT H E C A R E

O

ur vision for The Valley and South Eastern private hospitals is to become the major private hospital provider for southeastern Melbourne and Victoria.

Formed in 2005 with the intention to lead individuals to health, Healthe Care has become a reputable source across Australia for private healthcare.

With a philosophy rooted in empowerment and well-being, Healthe Care takes pride in delivering premium care to all its valued clients and patients through specialist services, 48

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facilities and innovations.

We recently spoke with CEO of The Valley and South Eastern private hospitals, Neil Henderson, who offered his insight into the success of the company as well as its plans for the future.

A Success Story When Henderson joined Healthe Care there was a lot of room for improvement in The Valley and South Eastern private hospitals.

But rather than fearing the challenge, he took it on headfirst. “I really wanted to contribute to the greater common good and

AUSTRALIA

develop something that I could sit back on and be proud of in years to come,” said Henderson of the early days. “What contributed [to the recent paramount success] was the recognition that the fundamentals were there for the two hospitals to transform into major players.”

And transform they did.

“The basic infrastructure of the buildings was there,” said Henderson, “but the spark that became the difference between mediocrity and rapid success was vision, leadership and belief.”

“Basically, what I did in 2012

was to determine that these two hospitals could develop and grow rapidly and I needed to build myself a team that would believe and be inspired by the vision to lead and motivate others to follow,” added Henderson.

The “others” Henderson referenced included doctors and staff, as well as stakeholders.

By recruiting and training a team of managers who were committed to said vision and culture, this inspiration was spread to each department where the managers imparted good leadership. In order to continue this spread of positivity, w w w. h e a l t h e c a r e . c o m . a u /

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B U I L D I N G T H E H E A LT H C A R E PROPERTIES OF THE FUTURE Australian Unity Real Estate Investment (AUREI) is proud of its long standing partnership with Healthe Care.

Since 2006, Healthe Care has been a tenant in the Australian Unity Healthcare Property Trust (HPT).

The HPT is Australia’s largest and most successful healthcare real estate investment trust and currently owns a portfolio of 27 hospitals, medical centres and healthcare-related properties across Australia.

A Healthe partnership with an experienced capital partner As the demand for healthcare services increases in line with Australia’s rapidly ageing population there is significant scope to expand, improve and upgrade existing hospitals and medical centres to meet this growing demand. The HPT has undertaken, and continues to work on, a number of developments that provide win-win outcomes for patients, the wider community and investors.

Development Snapshot:

Brunswick Private Hospital,

Brisbane Waters Private Hospital,

Victoria

NSW Central Coast

$9.1 million re-development completed in May 2012 – delivering 67 new beds for rehabilitation and general medical services.

Property purchased for $16.2 million in July 2014. $5.6 million to be spent on re-furbishing the 78 bed general hospital complex.

The Valley Private Hospital,

Townsville Private Clinic,

Mulgrave, Victoria

Queensland

$23 million development, delivered 38 new beds, four new operating theatres and an endoscopy room (Stage One). $14.6 million development will deliver 60 new beds and a multi-deck car park (Stage Two). $15.6 million development to construct additional medical consulting suites (Stage Three).

Property purchased for $5.5 million in October 2014. $7.5 million to be spent converting the property into a 60 bed mental health hospital to cater for increased demand for mental health services in the area.

Further Information The Australian Unity Healthcare Property Trust is issued by Australian Unity Funds Management Limited ABN 60 071 497 115, AFSL 234454.

The information here is general information only and does not take into account the financial objectives, situation or needs of any particular investor.

Before deciding whether to acquire, hold or dispose of a product, investors should read the Trust’s current Product Disclosure Statement (PDS).

A copy of the PDS can be obtained by calling 13 29 39 or visiting australianunityinvestments.com.au.

PROP0008-201504

H E A LT H E C A R E

AUSTRALIA

the “Love Your Work” program was instituted to recognize individuals that were doing something above and beyond their line of duty.

“At the end of the day, if people are being recognized for their hard work, they are likely to be more motivated to do their job,” reiterated Henderson.

strong bond to one another and the hospitals’ vision, a high level of delegation from corporate to local decisions and some high-tech equipment that is rarely seen in competitor hospitals.

Investing $4 million, The Valley Private Hospital built the world’s first fully hybrid operating theatre integrated with a Siemens Zeego Exclusive, World-First 3D imaging system, a Maquet Technology theatre system and a Magnus table.

There are four aspects of Healthe The move was so groundbreaking Care that make it distinct from other that teams from both Siemens and private hospital care providers: Maquet in Germany traveled to the a strong emphasis on strategic hospital to admire and marvel at the visioning, a strong team with a world first.

SUPPLIER PROFILE

AUSTRALIAN UNITY REAL ESTATE INVESTMENT

Australian Unity is a mutual company providing healthcare, financial services, retirement living and aged care accommodation and services to more than half a million Australians.

From health insurance and preventative health programs through to investments, banking and retirement solutions, we provide services that maintain the security and dignity of our customers throughout their changing life stages.

Over the past decade, the Australian Unity Real Estate Investment team has become one of Australia’s premier unlisted, direct property fund managers. It currently owns and manages more than 50 properties in the healthcare, retail and commercial sectors across Australia and has more than $1.9 billion in funds under management.

The Australian Unity Healthcare Property Trust is one of the largest and most highly regarded unlisted property funds in Australia. It has a diversified tenant base and holds a quality direct portfolio of 27 healthcare properties across Australia, valued at over $660 million.

Website: www.australianunityinvestments.com.au

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C O M PA N Y N A M E

Additionally, the hospital also recently built a brand new 10-bed, state-of-the-art intensive care unit with the latest technologies, built a new ward, four new operating theaters, and then added an EOS, Nobel Prize winning, spinal imaging system from France.

Storz in Germany were the first to develop a 3D camera for 52

May 2015

laparascopic surgery and The Valley Private Hospital acquired this as well.

When asked what it felt like to own such impactful technology that no one else has yet, Henderson replied with three words full of enthusiasm: “I love it!”

“It (the technology) has enabled us to do a few things,” he added. “For

SECTOR

“We are a vibrant, growing and excited organization with a big future—which creates lots of opportunities to participate in.”

– Neil Henderson, CEO

one, it has been critical to change the perception of the hospital from where it was to where it is. It has made people sit up and notice that we are serious and do what we say we will do. It also enables us to attract top specialists in the field because they want to use that technology—which adds to the reputation and prestige.”

Looking to the Year 2020 “We are a vibrant, growing and excited organization with a big future—which creates lots of opportunities to participate in,” said Henderson.

Healthe Care’s vision for The Valley and South Eastern private hospitals is to grow overall, but its goal for the year 2020 is to own 50 w w w. h e a l t h e c a r e . c o m . a u /

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H E A LT H E C A R E

“[The technology we use] enables us to attract top specialists in the field.”

– Neil Henderson, CEO

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percent of the market of the 1.2 million people living in southeastern Melbourne and Victoria.

This exponential growth would require going from the current 260 hospital beds to 560 by said year across 3 campuses.

Currently, 60 beds are being built at The Valley Private Hospital and the following 60 beds will be built at South Eastern Private Hospital—which will take the current total to 380 hospital beds by 2016, well on track to realize the 2020 vision.

Company Information INDUSTRY

Healthcare HEADQUARTERS

Sydney NSW, Australia FOUNDED

2005

“The spark that became the difference between mediocrity and rapid success was vision.”

EMPLOYEES

Healthe Care: 5,000; Valley / South Eastern: 1,000

– Neil Henderson, CEO

Healthe Care has committed significant funds to redevelopment projects. Undertaking extensive refurbishment of patient accommodation and adding additional services, Healthe Care’s aim is to build facilities with strong partnerships and service integration that deliver innovative programs, provide flexible care options and support patients well beyond their hospital stay.

For those after the best private hospital care there is in Australia, the choice is Healthe Care.

PRODUCTS/ SERVICES Healthe Care’s philosophy is simple: to make and keep people healthy. By providing the right tools and information alongside a range of health services and solutions, Healthe Care empowers its patients to take control of their health. With a portfolio of 16 hospitals, 5,000 employees and 1,600 hospital beds (for now), Healthe Care is the third largest commercial group in Australia.

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Centroflora:

Partnerships for a Better World

Through practices that promote a sustainable growth, local development and biodiversity conservation, the group is a leader in the natural active pharmaceutical ingredients (APIs) market

Written by: Flรกvia Brancato | Produced by: Karla Sohn

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hrough practices that promote sustainable growth, in the tradition of the socio-environmental corporate program “Partnerships for a Better World,� Grupo Centroflora gathers in its portfolio around 200 products destined for the health, personal-care, and food and beverage markets.

Using technologies that isolate, extract, concentrate and dry differentiated natural ingredients and active ingredients of highly aggregated value, with assured quality and traceability, the company is a leader in its sector.

During its more than half a century operating in the botanical extract market, the goup has been a heavy hitter since its first product, artichoke extract, utilized in the production of a medication that treated digestive disturbances related to hepatic functions.

Pharmachemical unit - ParnaĂ­ba, PI

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Management President:

Peter Andersen Technical-Scientific Director:

Ricardo Dias FinacialAdministrative Director:

Plant Extracts unit

Mauro Tavares

Structure and Production Centroflora’s product line possesses diversity in its presentations and standardizations, covering items of the smallest technological complexity to what are known as pharmochemicals, which are considered active pharmaceutical ingredients (APIs) of high purity. Among the ones that stand out are the standardized botanic extract, for phytotherapeutic use in the nutrition segment, essential oils of pharmaceutical grade, dehydrated pulps, and isolated active natural ingredients, like pilocarpine salts and quercetin.

In order to manage production, the group relies on an ample distribution network present in more than 70 countries and a high volume of exportation. “More than 60% of our sales are exports to the most developed and demanding markets in the world,” said President of Grupo

Pharmachemical Unit Director:

Guillermo Perez Salicrup

“In Brazil, Centroflora takes the spotlight in the natural pharmaceutical API market” – Peter Martin Andersen, President of Grupo Centroflora

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Plant Extracts unit facade - Botucatu, SP

Centroflora, Peter Martin Andersen. In the international market, despite pilocarpine—for pharmaceutical use—being the top export, 80% of the exported volume is geared towards the nutraceutics segments, which showcase the Barbados cherry, guaraná berry, açaí berry, yerba mate and green coffee extracts.

At the national level, the company is considered mainstream. According to Andersen, some medicinal plants are responsible for the positive exposure. “In Brazil, Centroflora takes the spotlight in the natural pharmaceutical API market, featuring Passiflora incarnata—a medicinal plant traditionally used as a sedative and sleep aid—as well Cordia verbenacea, a Brazilian medicinal plant utilized as an antiseptic healing agent and natural anti-inflammatory.”

The production plants are divided into the Drying, and Vegetable Extraction, units, both located in Botucatu, São Paulo state, and the Pharmacochemistry Unit, located in Parnaíba, Piauí state. The company 60

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has also invested in agribusiness. In Parnaíba it grows Cordia verbenácea, a plant utilized in the production of a unique oil which is the ingredient of the Acheflan line, from the Brazilian laboratory Ache. The company’s steady growth is a reality and forecasts maintain a positive curve. “In 2008 we built an essential oils unit inside the farm and near the agricultural production area.

And last year we acquired, from Boehringer Ingelheim, the manufacturing technology of an API group which will result in important technological advancements for the company and for the country over the next years,” stated Andersen. These new molecules will be produced in the pharmacochemistry unit in Piauí, where the company has invested in overhauling and expanding production capacity to serve around 100 new clients who are located mainly in the U.S. and Europe.

Beyond unit expansion, Grupo Centroflora has been developing partnerships over the past years. In 2012, it acquired a 100% equity share in the company Phytobios from Natura, and Grupo Orsa, which facilitated the reconstruction of the company’s strategic innovation. “Phytobios is currently responsible for all small-scale research projects,” explained Andersen. Also, in 2014, Centroflora and CMS, a Swiss company, formed a joint venture called Centroflora CMS--operating out of Luxemburg--focused on the global distribution of APIs.

Yerba Mate harvest, Partnerships for a Better World

Essential Oils unit Parnaíba, PI

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Passiflora incarnata, Partnerships for a Better World

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“Partnerships for a Better World” Andersen clearly states: “The integration of a productive chain, through the Partnerships for a Better World program is, without a doubt, the biggest differential at Centroflora.” The program was created in 2002 and its main guidelines are: 1) To promote the conservation and sustainable use of biodiversity through partnerships that generate value to its stakeholders; 2) To facilitate industrial-scale supplies of vegetable raw material with traceability and sustainability; 3) To foster family agriculture, forestry stewardship, local development and ethical biocommerce.

Currently, there are more than 4,000 people involved in the culture, or harvest, processes of vegetable-origin raw material for Centroflora; spread out in the south, southeast, north and northeast regions. The purchase of planned crops is guaranteed through the Partnership Contracts established between Centroflora and its clients and producers.

The focus for partnerships with medicinal plants’ suppliers are rural communities, associations, cooperative societies and family farmers who are selected based on technical sustainability criteria. The species selected for cultivation go through botanical, agronomic and feasibility analyses ensuring the promotion of the desired species. The Partnership deal offers raw-material suppliers, not only technical support and technology transfers, but also training and strengthening of productive deals. All partners follow organic agriculture principles. “The Partnerships deals are

“The Partnerships deals are concluded with the benefits to all agents in the production chain in mind, which goes beyond financial aspects” – Peter Martin Andersen, President of Grupo Centroflora w w w. c e n t ro f l o r a . c o m . b r

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Agricultural unit - Parnaíba, PI

concluded with the benefits to all agents in the production chain in mind, which goes beyond financial aspects. The main benefits are the promotion of family farming, local development, biodiversity conservation, products’ traceability and mitigation of supply shortage risk,” Andersen concluded.

More projects Among many others, some projects developed by the company, especially in environmental accountability, are noteworthy. Created in 2002 by Grupo Centraflora, the Floravida Institute is a non-governmental organization whose mission is to expand crossover socio-environmental initiatives in the health, environmental and local development fields. With its headquarters located in Botucatu and a branch in Parnaíba, the Institute has a multidisciplinary staff working on the sustainability of the company’s active 64

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regions.

One of Floravida’s projects, dubbed “The School Goes to the Forest,” is part of an environmental education program aimed at sustainable development. On its dirt trails, the Institute hosts student groups who are touched by the experience.

Additionally, Centrofauna is a scientific regional unit for the handling, rehabilitation and triage of wild fauna. Its objective is to rehabilitate wild animals recovered from illegal captivity and trade, or through voluntary surrender, and release them back into their natural habitat. They also have a training program focused on animal cruelty and wildlife captivity prevention.

“We try to invest between USD $3 to $4 million annually in our factories. The focus is always to improve the extraction, dehydration and controls process” – Peter Martin Andersen, President of Grupo Centroflora

Floravida Institute - Botucatu, SP

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Xxxxxxxxxx

Jaborandi Enhancement Project

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Quality Control Laboratory - Botucatu, SP

Lastly, aiming at using biodiversity ethically, the Jaborandi Appreciation Program (Programa de Valorização do Jaborandi) is focused on generating income, environmental education and the social organization of the Jaborandi extracting communities. For this program, Grupo Centroflora received the 2013 Banco do Brasil Foundation’s Social Technology Award, among other acknowledgements in its five years of existence. The program’s methodology has been replicated by other productive chains, such as Guaraná and Fava D’Anta.

Trends and Challenges While the market tendencies are more focused on anxiolytics and natural laxatives derived from medicinal plants, the pharmaceutical and food sectors are focused on energy drinks made with Brazilian ingredients like w w w. c e n t ro f l o r a . c o m . b r

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Peter Martin Andersen, President

yerba mate, guaraná or green coffee. The industry faces several hurdles.

The innovation with Brazilian biodiversity is still a big challenge, considering the current regulatory scenario of access to the genetic patrimony. “For over five years we have been actively participating in discussions on the theme, supporting the approval of a new milestone that will promote access and allocation of benefits, and development of intellectual property and national industry,” emphasized Andersen.

And the challenges continue. “Brazil has been an important API producer for the pharmaceutical industry in the past. Over the last 25 years, this industry has been decimated due to the lack of incentives, unfavorable currency exchange rates and a low corporate culture,” added Andersen.

In comparison, currently the country imports more than 95% of its pharmaceuticals’ active ingredients.

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Company Information INDUSTRY

Pharmachemical HEADQUARTERS

Botucatu, São Paulo E S TA B L I S H E D

1957 EMPLOYEES

270 PRODUCTS/

t of Grupo Centroflora

SERVICES

The national production of newly acquired molecules from Boehringer Ingelheim meets the need for a national political incentive towards modernizing the Brazilian factories and increasing the national competitivity.

Grupo Centroflora’s pharmachemical unit is one of the only national companies certified by FDA EDMQ (Electronic Document Management Quality ). To maintain open roads ahead, Andersen concludes, “We try to invest between USD $3 to $4 million annually in our factories.

The focus is always to improve the extraction, dehydration and controls process.”

Standardized vegetable extract, essential oils, dehydrated fruit pulps and isolated active ingredients of vegetable origin

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Hospital Bandeirantes:

70 years of excellence and tradition in healthcare

The institution, a complete hospital complex, offers services in many specialties, mainly the Centers of Reference in Cardiology, Oncology, Diagnosis and Neurosurgery Written by: Flรกvia Brancato | Produced by: Karla Sohn 71

H O S P I TA L B A N D E I R A N T E S

W

ith over three thousand physicians and two thousand additional staff, the goals of Hospital Bandeirantes (Bandeirantes Hospital) are to maintain itself as a benchmark in the hospital sector and preserve the quality of clinical and surgical treatments. Hospital Bandeiras admits 16,000 patients and performs 11,000 surgeries annually, offering expert humanized assistance.

With nearly 70 years of recognized service in highly complex and varied services like neurosurgery, cardiology, diagnosis and oncology, the institution is a winner of a certificate for excellence from the National Accreditation Organization (ONA.) Last year it also became only the sixth

Hospital Bandeirantes architecture

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hospital in Brazil to be certified Diamond by Canadian Qmentum International.

Always concerned with innovation that creates solutions in assistance and health promotion, Hospital Bandeirantes bases its strategic planning on trend and market expectation analysis, infrastructure innovation and modernization, customer needs, continued improvement of its human capital and policies that reduce its impact on the environment.

ENVIRONMENT AND PROFESSIONAL RESPONSIBILITY “Bandeirantes consolidates its business model and at the same time incorporates actions and projects that cover the reduction of the impacts of its activities on the nature and on the community. It invests in eco-efficient technologies and internal programs of environmental awareness,” points out Rodrigo Fernandes Teixeira Lopes, CEO of Hospital Bandeirantes.

Based on service, safety, excellence and a commitment to its employees, the institution is recognized as a Green Hospital, a distinction supported by its use of sustainable resources like Water for Reuse and Ecoefficient Autoclaves.

As a result, our own Áurea Barros was nominated for

“Bandeirantes consolidates its business model and at the same time incorporates actions and projects that cover the reduction of the impacts of its activities on the nature and on the community.”

– CEO of Hospital Bandeirantes, Rodrigo Fernandes Teixeira Lopes

GE Great partnerships have the power to transform reality GE Healthcare is by your side to ensure quality health for more people and to create new opportunities for the future of Brazilian medicine.

For this reason, GE is always doing more: • It offers cutting-edge technology to meet hospital needs • It has domestic production of input devices • It invests in Brazil’s health sector by supporting education initiatives • It promotes Research and Development in the country

produtos.saude@ge.com www.gehealthcare.com.br

JB30350BR

GE Healthcare. A partnership that goes beyond technology.

BRAZIL

the list of 100 Most Influential People in Healthcare. Through investment in equipment and personnel training, the hospital aims at consolidating a harmonious management model while continuing to create solutions for challenges in its sector.

According to Lopes, training employees is essential to maintaining its service quality. “We focus on a whole and specialized medical staff and constant academic updating available through the Teaching and Research Institute. Our Corporate Education also offers specialization training and post-graduate programming,” he explains. “Working in several areas, focusing on service excellence, highly complex medical expertise and employee well-being is our great differential,” adds the CEO. Hospital Bandeirantes’ professional improvement process encourages the employee to constantly improve themselves. So the hospital conducts internal and external actions including technical and behavioral training and leadership development. The purpose of it all is to support employees’ short and long-term education at any of several schools in the market.

MRI control room

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H O S P I TA L B A N D E I R A N T E S PROCESSES AND TECHNOLOGY Process Control Hospital Bandeirantes uses exclusive software to expand service, safety and quality, simultaneously reducing waste and increasing productivity.

Integration of this software into the hospital management system and its application to the Surgery Center enables the optimization of services, generating more time to assist the patient. One of the main advantages of deploying this software throughout the entire service process of the Surgery Center is that we can monitor the patient from bed to bed.

Patient Safety To secure patient safety throughout, the hospital uses electronic medicine and material dispensers in its semi-Intensive Care Units, Intensive Care

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ICU

Units and the Diagnosis Center. The state-of-theart automation equipment stores, controls and organizes items, providing guarantees and safety in the administration of medicines; not to mention expediting patient assistance. The electronic dispenser also reduces waste and provides increased stock control.

Cisco Cisco is a convergence network that focuses on structuring and modernizing the telecommunications of the institution. Its scope

“Working in several areas, focusing on service excellence, on high complexity and employees’ well-being is our great differential” – CEO of Hospital Bandeirantes, Rodrigo Fernandes Teixeira Lopes

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H O S P I TA L B A N D E I R A N T E S

PET/CT scanners

comprises network assessment, solution design, implementation, maintenance and monitoring of the data network, IP telephony, unified communication, implementation of infrastructure for video conference, wireless, logic security, physical safety, distribution of contents and monitoring.

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Management Executive Director: Rodrigo Fernandes Teixeira Lopes Institucional Relations Director: Dr. Marcelo Medeiros Administrative Director: Reynaldo Neiva Clinic Director: Dr. Mario LĂşcio A. Baptista

Zeiss Pentero Microscope The Zeiss Pentero microscope, the top investment in its kind of technology, is the only one to offer full integration between surgery and intra-operative diagnosis tests such as brain angiography (fluorescence system) which assists the surgeon in successfully performing surgery. The system allows w w w. h o s p i t a l b a n d e i r a n t e s . c o m . b r

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Hemodynamics room

photographing and shooting the entire procedure with Full HD technology, enabling the sending of every image to the patient’s electronic medical record.

However, Lopes continues to emphasize safety and quality routines. “Bandeirantes implements prevention protocols and follows medical protocols according to the best hospital practices. It evaluates its patients through prognostic scores that help assert the treatment, in addition to following indicators of effectiveness of the implemented protocols,� he explains. The hospital also has a notice system incorporated in all the units.

Finally, its risk management committee, comprised of a multidisciplinary 80

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Company Information INDUSTRY

Medicine and Healthcare HEADQUARTERS

São Paulo - Brazil E S TA B L I S H E D

May 7th, 1945 EMPLOYEES

1.700 PRODUCTS/ SERVICES

team, monitors the effectiveness of the prevention protocols.

As for the future, growth is the trend. “In the coming years, we will work not only to consolidate our reference specialties, but also on an increasingly solid perspective of investment in the offer of hospital and ICU beds. Our plans include the restructuring of the emergency room, seeking to improve customer service and maintaining our standards of excellence,” concludes Lopes.

Diagnosis Center, Urgencies and Emergencies, Reference Centers, High Complexity Service, Surgical Center, Check-up, Outpatient Specialties

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Complete

coverage in specialized medical attention Colombian Cardiovascular Foundation’s available services and products are a result of a true calling to fulfill medical needs to the most patients possible.

Written by: Mateo Rafael Tablado, Associative Editor Produced by: Lucy Verde, Director of Latin American Projects at WDM Group Interviewee: Dr. Víctor Raúl Castillo, CEO of FCV of Colombia

F U N D A C I O N C A R D I O VA S C U L A R D E C O L O M B I A

T

Heart Institute

he origin of the Colombian Cardiovascular Foundation (FCV) goes back to early 1980s field trips, when doctors Franklin Quiroz and Raul Castillo would take foreign visitors to rural towns in the Santander Department, in northeast Colombia, and notice the necessity of providing attention for cardiovascular ailments, especially among children. The FCV non-profit was founded in 1986 and began operations in facilities lent by other hospitals until 1997, the year in which the first Instituto del Corazon opened in Floridablanca, near the city of Bucaramanga.

panoramic view

“With the consolidation of other medical specialties, Colombians will have a complete alternative in healthcare services quality and cost” – Dr. Victor R. Castillo, CEO for FCV Colombia

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The 1998-2002 Financial Crisis: The Catalyst for Expansion The turn of the century was a difficult time for Colombian economy, the financial crisis affected most government agencies, including the Institute of Social Security, FCV’s main supporter. This prompted the Foundation to offer the most services and products possible its resources could provide, in order to generate enough cash flow to maintain ongoing operations.

Strategic Business Units FCV’s Strategic Business Units income is reinvested in the Foundation; this way, new business units are created to satisfy patients’ demands. Current business units are: · FCV’s own hospitals · Hospital and surgery supplies · Bioengineering laboratory

L AT I N A M E R I C A

· Hospital management · Medical air transport · Telemedicine · Design and construction · Corporate University · Product sales · Event production and marketing Awards and Certifications In 2001, the FCV became the first Colombian hospital to earn ISO 9001 certifying, not long afterwards it was also certified by The Joint Commission, among other accolades and compliance certificates.

Outreach to the Community FCV works with children from low-income families, providing them access to healthcare; low-income patients from the inner country are

Surgical procedure

Key People

Víctor Raúl CEO Dr. Castillo is the current CEO at Colombia’s FCV. The surgeon attended the Juan N. Corpas University medical school, in Bogota. His postgraduate studies took place at del Valle University and specialized in cardiovascular surgery at Pontifical Bolivarian University, in Medellin. Besides Dr. Castillo’s practice as general surgeon at Ramon Gonzalez Valencia and Social Security Institute hospitals, his experience includes upper management positions at Bucaramanga Surgical Institute and the city’s Chamber of Commerce (of which he’s currently president). He has also worked for COLCIENCIAS (ministry for science and health-related technology); and besides performing as a surgeon at FCV, he is also the foundation’s CEO. Dr. Castillo has attended conferences, symposiums, courses and congresses worldwide as a speaker. His work has been awarded accolades such as the “Meritory Citizen Order” from the Government of the Santander Department, the Merit Honor from FCV and a special recognition award by the Colombian Cardiology Society.

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Patient rooms

“Partnerships with our suppliers have resulted in mutual benefits, efforts that go beyond financial profit” – Dr. Victor R. Castillo, CEO for FCV Colombia 86

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provided of lodging, feeding and transportation.

FCV also produces the yearly Bucaramanga Marathon, first ran on 2004.

Strategic Partnerships FCV works with other organizations specialized in different aspects of healthcare. Boston Scientific is their main supplier for therapy-related products.

Deployment of latest-generation technology arrives from partnerships with Colciencias government agency for science and technology, as well as from SENA (National Learning Service).

Under Construction: a Top Level Medical Center FCV’s most ambitious project up to date is already under construction, the FCV

SECTOR

Waiting hall at tomography unit

Medical and Dentistry Center and Colombia International Hospital. The center’s site has just been declared a tax-free zone, attractive for medical tourism; the project also includes a hotel and convention center.

These facilities are scheduled to open during 2015.

FCV CEO Victor Raul Castillo and Orlando

Dr. Victor R. Castillo, CEO for FCV Colombia shared some details in the following interview about the foundation’s assets and resources, which combined result in a top-notch, competitive health institution.

Sardi de Lima, Spain Ambassador to Colombia

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International, which could be -in your opinionthe three main factors for FCV’s leadership within the area?

Dr. Víctor Raul Castillo: A core value we share is being able at defining where exactly do we want to go, by planning ahead and working persistently in every goal; this attribute has resulted in important steps forward taken by our institution. Another factor is being open to initiatives in favor of the area’s health sector brings us recognition as successful organization and also as a trigger to other actions benefitting not only our institution, but rather our entire community. And the third one is counting with a committed human team, able to support our institutional development.

BRAL: As it happens with the partnership shared by FCV and Pharma, in which ways have other joint efforts improved the ability to provide medical attention, prescriptions, products and deploy latest-generation technology?

VRC: Partnerships with our suppliers have resulted in mutual benefits, consolidating efforts that go beyond financial profit. It’s not just about quality and costs; the best that comes out of these alliances are the multiple opportunities for developing research and continual improvement projects.

FCV Heart Institute main entrance

“We count with a committed human team, able to support our institutional development” – Dr. Victor R. Castillo, CEO for FCV Colombia

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First-born Intensive Care Unit

BRAL: Once the Colombia International Hospital project opens (projected for 2015), what other new services and developments await for Colombia’s population?

VRC: Our population will be able to rely on a world-class hospital without leaving the country.

Through the partnerships we could establish at our Oncology department, specially the one agreed with UPMC (University of Pittsburgh Medical Center), Colombian nationals will have access to services from one of the world’s leading institutions in oncology. In the same way, this will happen with other medical specialties

Trusted experts in global sourcing, supply chain, logistics, and inventory management for small production components.

Doing now what patients need next

L AT I N A M E R I C A

such as gynecology, neurosurgery, orthotics and others, as soon as upcoming alliances are set by FCV, bringing alternatives in service quality and cost.

BRAL: In your own projections, where do you see FCV five years from today? What plans do you have to accomplish such goals?

VRC: Five years from today, FCV is becoming Colombia’s most prominent health institution, not only because of the length of provided medical services and demographic reach, but rather by its activities’ social impact, benefitting the community in its entirety, specially population sectors scattered through hard-to-reach parts of the country’s geography, mainly people lacking access to decent medical attention. Five years from now, FCV must be our country’s most important social endeavor.

Within the next five years, we hope our University Foundation becomes fully operational, with a complete medical specialty program and our social security company underway. In this same period, the Tech Development Center should be patenting higher volumes of medical products and instruments along with other local initiatives, as part of Colombia’s most important healthcare cluster. Our services’ scale should be large enough to provide attention for children and adults separately. By then, we will have 12 own medical centers across the country, while managing 50 top-level hospitals.

Company Information NAME

Fundacion Cardiovascular de Colombia INDUSTRY

Healthcare, hospitals HEADQUARTERS

Bucaramanga, Departamento de Santander, Colombia FOUNDED

1986 EMPLOYEES

2,800 REVENUE

US $110 million WEBSITE

www.fcv.org

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The Experience of

175 years in Global Healthcare

Written by: Rebecca Castrejón, Editor Produced by: Lucy Verde, Director of Healthcare Projects at WDM Group Interviewee: Carlos Jiménez, CEO of B.Braun México 92

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B. Braun MĂŠxico has distinguished itself as an innovative firm in the health sector. Since setting up in Mexico it has won the trust of clients and medical institutions which have incorporated B. Braun devices to improve their surgical procedures.

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B. BRAUN MEXICO

B

. Braun Mexico is a subsidiary of the global company B. Braun Medical Inc. (B. Braun) which has more than 175 years of experience in the health market. B. Braun has devoted itself to health care and the advance of medicine through innovation in state-of-the-art medical and pharmaceutical devices.

Apps B. Braun

They develop products that range from surgical technologies to orthopedics to neurology to hemodyalisis therapy to regional anesthesia to infectious disease control, among others.

Operations in Mexico Even though B. Braun products have been sold in Mexico since the sixties, the multinational didn’t set up in the country until 1993 through a partnership with the Mexican Institute for Social Security (IMSS) to produce osteosynthesis, opening its production plant in Mexico State and corporate offices in Mexico City.

Traceability

The company supports the Mexican Aesculap Academy Foundation and has a subsidiary charged with supplying products and services for primary and holistic anesthetic care and intensive care; as well as devices for the mobile patient, named B. Braun Medical All the while, it’s a corporate member of chambers and associations like the National 94

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Chamber of the Pharmaceutical Industry (CANIFARMA), the Mexican-German Chamber of Commerce and Industry (CAMEXA), the Mexican Association of Innovative Industries in Medical Devices (AMID), and the Association of Medical Device Companies (ASEMED.) Mexican Aesculap Academy Foundation: Specialized Medical Education B. Braun’s efforts in medical education arrived in Mexico in 2002, followed by the opening of the Aesculap Academy in 2004. The academy fosters the training and updating of the Mexican medical community through courses on the cutting edge of medicine, viewing of surgical procedures streamed in real-time, seminars led

B. Braun Mexico present at the regional Latin American

Key Peoplee

Carlos Jimenez CEO of B. Braun Mexico By 1986, the executive had joined the company after graduating with a bachelor’s degree in Dual Education Systems, specializing in Industrial Business Administration in which he expanded his knowledge of production, marketing and management.

He served in a variety of posts at B. Braun before becoming the subsidiary’s leader in Mexico. His last position was Marketing and Latin American Product Development Manager from 1998 to 2008.

Additionally, he’s president of the Mexican Aesculap Academy, a foundation in the education sector which supports the medical specialization of Mexican health professionals. The executive is also Vice President of the Mexican Association for the Innovative Medical Device Industries (AMID) and a member of the GermanMexican Chamber of Commerce and Industry (CAMEXA.)

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B. Braun Aesculap designs a device for the sealing of cups

“We are differentiated by the degree of innovation we are achieving, launching many new products and offering improvements to the Mexican health market” – Carlos Jimenez, CEO for B.Braun México

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by international experts and events in one of the more than 50 countries where Aesculap Academy operates.

The courses are offered in a variety of specialties to physicians, surgeons, interdisciplinary personnel, nursing professionals, and medical, operating room and sterilization technicians.

“We are differentiated by the degree of innovation we are achieving, launching many new products and offering improvements to the Mexican health market,” stated Carlos Jimenez, CEO of B. Braun Mexico, who has been with the German medical company nearly 30 years.

Jimenez leads the Mexican subsidiary managing

Critical care with our infusion bombs

the financial, commercial and productive aspects of the company.

Distinctions in the competition market Innovation, efficiency and sustainability are B. Braun’s three pillars for solutions in the medical market. For the company, to innovate does not mean launching something more complicated. They realize that complicated innovations increase risk. In terms of efficiency with the client, the company seeks to offer technical assistance based on a shared interest through personalized tutorials. Finally, when it comes to sustainable development it is achieved by coexisting responsibly with clients, its community and the environment.

Hemodialysis equipment

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B. BRAUN MEXICO

Professionals committed to health

Digitalizing the Mexican health industry B. Braun has grown at the pace of the new technologies, implementing electronic applications for the global health market. Such innovations start within the company through its B. Braun Knowledge Center, an internal platform for disseminating strategic information from the German group. “Our employees have access to our spending reports from their mobile phones or tablets through an internal mobile app, creating a culture of use of electronic media,� added the CEO. Furthermore, the company has applications for its clients and industry professionals, with 98

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friendly mHealth technology tutorials which display a significant part of the B. Braun products selection, as well as user manuals and medical goals for each solution.

There is another type of medical applications that B. Braun offers the patient, that due to Federal Commission to Protect from Sanitary Risks (COFEPRIS) regulations, have not been launched in Mexico.

The company is also a pioneer in the use of hospital software to increase efficiency in access to medical resources and facilitate the clinical process.

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Aesculap Academy

B. BRAUN MEXICO

L AT I N A M E R I C A

A transparent company As one of the most important suppliers of medical devices in the global market, B. Braun seeks to be closer to the medical community and its business partners. This is why corporate transparency is one of its main values. For example, B. Braun makes its annual corporate report public online.

“Our brand is very close to its users, clients and partners. We are a multinational with a culture of transparency, that shares its data and is open with its associates,” said Jimenez.

Another example of its digital transparency is B. Braun’s presence on social media and its successful recruitment of industry professionals thanks to the publicizing of its corporate culture on mediums like LinkedIn. Socially responsible and committed to the national well-being B. Braun Mexico is active in its social context.

Its commitment to the national well-being is such that they donate more than five percent of their annual sales to education programs and community service. They also donate medical devices to the Mexican Red Cross, sponsor teaching materials at neighboring schools and lend a hand in the many education programs

Instrumental

“Our brand is very close to its users, clients and partners. We are a multinational with a culture of transparency, that shares its data and is open with its associates” – Carlos Jimenez, CEO for B.Braun México

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B. Braun Mexico sponsored the event “GROW 2015, Courage with Attitude” for its human

offered by the Mexican Aesculap Academy Foundation.

One of its focuses is supporting the German Industry Board for Culture in Mexico which arranges cultural exchanges. “We want to build a bridge between two cultures and countries that are so different economically,” expressed Jimenez.

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Through the Mexican Aesculap Academy Foundation, in 2014 B. Braun provided 115 educational programs reaching more than 1,600 health professionals, among them nurses, biomedical engineers, surgeons, specialists and other industry personnel.

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resources

Progress in its Mexican product line By the end of 2015, B. Braun Mexico hopes to launch a variety of medical components as part of its efforts to consolidate its commerce in the country.

Among the principal innovations awaited in for the mid-term are: 1. 3-D camera system: Provides sharper and wider vision for the surgeon, as well as ease-ofuse (less fatigue, more security) diminishing the margin of error in minor invasive surgery.

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B. BRAUN MEXICO which protects tissues because access is optimized.

3. Semi-rigid system for column vertebrae: B. Braun’s new system achieves joint stability in dozens of local vertebrae without restricting their movement.

In constant creation and

Supplying quality

improvement of medical devices with an eye to the future

B. Braun’s supply chain is under constant quality control. This practice is part of the company’s “Sharing Expertise” policy. The company ensures the highest production quality

L AT I N A M E R I C A

since it makes 99 percent of the products it sells worldwide.

The CEO emphasized that its suppliers play an important role in its innovations: “The suppliers play an essential role as far as supplying materials and electronic components. We understand that all of our final products, particularly our innovative devices and software have been a result of a successful synergy with them.”

Company Information NAME

B. Braun Mexico INDUSTRY

Medical devices and injectable pharmaceuticals HEADQUARTERS

Growth projections

Toluca, Estado de Mexico y Ciudad de México, Mexico

B. Braun has grown annually by at least 20 percent. By the end of 2015 it’s actually projecting a growth of 30 percent. With this growth it also expects to double its number of employees to 600 in the next four years.

FOUNDED

1993 in Mexico 1839 global EMPLOYEES

The parent company has observed the high growth the country has experienced as well as its manufacturing muscle. It’s considering future investments and the construction of a new industrial enterprise by 2018. The strategic vision is for the country to be an exclusive B. Braun manufacturer of global market products.

300+ REVENUE

USD $80- $100 million WEBSITE

www.bbraun.com.mx

“We are looking to launch new products in osteosynthesis with titanium alloy, expand our portfolio with implant and column solutions, increase sales, our technical support and manufacturing,” concluded the CEO. w w w. b b r a u n . c o m . m x

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High Complexity Solutions that Enhance the Quality of life in Chile Private health care clinic with first class services as part of the healthcare network and holding of the Chilean Chamber of Construction (CCHC), improving quality with their mission and social role.

Written by: Rebecca Castrejon, Editor Produced by:Lucy Verde, Director of Healthcare Operations Interviewee: Alfredo Oliva, General Manager of Clinica Bicentenario S.P.A.

C L I N I C A B I C E N T E N A R I O S . P. A .

C High-tech equipment

Modern infrastructure and latest equipment

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linica Bicentenario SPA was founded as an initiative of the Chilean Chamber of Construction (CChC), with the vision of providing highly complex medical services with first level standards and the latest technology for the middle-class healthcare market in Chile. This institution has experienced steady growth since its launch in March 2011. In just four years the clinic set up 268 beds to serve about 19.102 visits per year (according to 2014 statistics), and more than 63.000 visits since its inception.

Such excellence achieved in such a short period of time earned them an accreditation in quality management this past July 2014, three years after implementing all protocols and rules required by the Superintendency of Health in Chile. “Despite being new, we are already accredited and accept education agreements with undergraduate and graduate students from the University Diego Portales in Chile. We became the first high complexity clinic to get certified in clinical trials,� said Alfredo Oliva, General Manager of Clinica Bicentenario. Oliva is a commercial engineer with more than 17 years of experience in the healthcare industry. The entrepreneur has worked at the management level of major medical organizations and has been part of Clinica Bicentenario since its inception.

L AT I N

Committed to Quality and Human Care Not only is the clinic based in one of the most innovative infrastructures in the Chilean healthcare sector—based on its advanced machinery and unique medical equipment— but the company encourages the continued specialization of its nurses and technicians.

As part of the healthcare holding “Red Salud” of the Chilean Chamber of Construction (CChC), an association that has been operating for more than 60 years, Clinica Bicentenario is an active member of a healthcare network of institutions whose mission is the welfare of the population in Chile. CChC’s members follow a comprehensive medical-attention plan

Clinica Bicentenario headquarters in Chile

AMERICA

Key People

Alfredo Oliva General Manager of Clinica Bicentenario S.P.A Oliva is a commercial engineer with a Bachelor’s degree in Business Administration and a certificate in Marketing and Services. The executive has more than 17 years of experience in the healthcare industry, specifically in the insurance business or ISAPRES. He has also been on the management and administration of clinics during a period of seven years, as worked as Administration and Finance Manager for Clinica Davila based in Santiago de Chile.

Oliva has been part of Clinica Bicentenario since its inception in 2011, strengthening the procedures and methodology that would lead to the progressive growth of this medical center.

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C L I N I C A B I C E N T E N A R I O S . P. A . focused on the patient and always provide the highest health standards and humanitarian principals possible.

Additionally, they have a medical center where medical and surgical specialists treat diseases such as chemotherapy, chemotherapy and vaccination services, among others. This modern medical center is located in a 20-story building, and nine of these are destined to consultations.

Valuable Specialists High complexity care: neurology

“This clinic was designed to be a high complexity institution and, therefore, its doctors

L AT I N

are at the forefront. We have the latest equipment, our staff is highly trained and each specialist has the required competence in their work,” said Oliva.

Making their practice more competitive for the benefit of their patients, the hospital and the country, high and medium-complexity specialists at Clinica Bicentenario attend medical seminars, in addition to those offered in partnership with universities. Recently, the clinic offered an international course, transmitted remotely, taught

by Dr. Rocco Calabrese on cochlear implants.

Among their main services are:

1. Cardiovascular Medicine: with the support of 40 specialists that perform more than 300 monthly echocardiography studies. The clinic also has a laboratory that provides imaging studies, catheterization, angioplasty, implants and biopsies.

AMERICA

“We have a very important relationship with our suppliers, both local and foreign, mainly with laboratories that provide consumables and medicines” – Alfredo Oliva, General Manager for Clinica Bicentenario S.P.A.

2. Emergency Services: this unit is open 24/7 and attends any critical case. There are doctors and technical staff, six exam rooms for pediatrics and 16 for adults; as well as observation, animation and triage rooms.

3. Gynecology-Obstetrics and Maternity: this area has specialized services 24/7 during pregnancy. Contains four pavilions with six pre-delivery rooms and one integrated w w w. c l i n i c a b i c e n t e n a r i o . c l

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C O M PA N Y N A M E

Medical Center with more than 60 leading specialties

“We became the first high complexity clinic to get certified in clinical trials” – Alfredo Oliva, Gerente General de Clínica Bicentenario S.P.A.

delivery chamber (SAIP), as well as an emergency unit. It also provides gynecological services.

The unit contains one examination room, one monitoring room and a portable ultrasound machine. In terms of personnel, the clinic has auxiliary nurses, midwives and support staff to meet the needs of future mothers.

4. Endoscopic Procedures: available treatment for cystoscopies, long colonoscopies, long endoscopies and prostate biopsies.

5. Neonatal, Adult and Pediatric: the adult unit consists of an intensive care unit, an intermediate care unit and a medical surgical unit.

Pediatrics has two areas: intensive and basic care.

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SECTOR

Endoscopic procedures

6. Laboratories: This unit contains the latest generation of clinical technology, including the 128-channel scanner, which is the only equipment of this magnitude within the Chilean healthcare district. Their clinical staff provides the most integral diagnostics in cooperation with Megasalud laboratories, also part of CChC Network. In neurology, the lab also services sleep, epilepsy and botulinum toxin studies, among others.

Comprehensive Healthcare with Advanced Technology

Main view of Clinica Bicentenario in Santiago

They have digitized their operations through electronic medical records or RCE, and via Health Information System (HIS) that delivers

de Chile

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C L I N I C A B I C E N T E N A R I O S . P. A .

In five years they expect to have a total of 450 beds

Chemotherapy for adults and children in Clinica Bicentenario

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prescriptions, diagnoses, requirements and medication reviews for inpatients and outpatients.

Through HIS, medical personnel can visit the patient’s history, ensuring to find the latest information online. Meanwhile, its accounting department is also linked to the system through ERP—control and business management—software.

HIS is interconnected with pharmacies, medical suppliers and has the capability of transmitting medical programs towards ISAPRES (insurers in Chile). Health Information System Is also integrated with the radiology system (RIS/ PACS) and the laboratory system (LIS), which helps the doctor have an online track of the patient’s care.

L AT I N

AMERICA

“Clinica Bicentenario started with all these electronic programs, which puts us at the forefront in Chile compared to other hospitals that do not have this advantage,” said Oliva.

Social Initiatives Towards Upgrades

Sampling Unit of Clínica Bicentenario

Clinica Bicentenario actively participates in community programs, following its commitment of welfare and providing healthcare services to low-income families. For example, employees held an event for families of premature babies in celebration of life on the anniversary of the clinic.

Bicentenario also facilitates care for people with disabilities in agreement with the nonprofit organization Teleton.

Supply Chain, an Important Part in Every Healthcare Aspect The clinic joins forces with suppliers for a common goal, as these strategic partners teach courses depending on the technology or material supplied, and as part of the value chain of the company.

“We have a very important relationship with our suppliers, both local and foreign, mainly with laboratories that provide consumables and medicines,” said Oliva.

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C L I N I C A B I C E N T E N A R I O S . P. A .

Aggressive Goals for 2020

Bicentenario cafeteria

In 2011, the administration had planned two initial stages, the first one ended in 2014 after completing 268 beds within the medical center.

However the clinic will reach its full capacity after the second phase is in operation, which would mean the opening of four pavilions more, with the inclusion of imaging units, and adding beds to complete the target of 433. The General Manager estimates this to happen in the next 2-4 years, enabling 165 single, intensive and duplex beds.

L AT I N

“The first thing we must do is to consolidate our growth and position in this market, with public and private insurers, plus some companies. We also have training and staff development courses in order to solidify our quality service,” said the General Manager.

AMERICA

Company Information NAME

Clinica Bicentenario S.P.A. INDUSTRY

“This clinic was designed to be a high complexity institution and therefore their doctors are at the forefront, we have the latest equipment, our staff is highly trained, and each specialist has the required competence in their work”

Hospitals HEADQUARTERS

Estacion Central, Santiago, Chile FOUNDED

2011 EMPLOYEES

1,200 REVENUE

USD $90 million WEBSTE

www.clinicabicentenario.cl

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PAML

- Pathology Associates Medical Laboratories

With a focus in diagnostics with national corporate headquarters in Washington, PAML is a recognized leader delivering healthcare solutions.

Written by: Stephanie C. Ocano Produced by: Tom Venturo

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PA M L

PAML Lab

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H E A LT H C A R E

PAML General Administration

Our goal is to do anything and everything to help you as a provider to succeed in delivering the highest quality of care.

This is the ideology behind PAML (Pathology Associates Medical Laboratories) – a medical reference laboratory serving physicians, hospitals and allied health professionals. Ranked among the top clinical reference laboratories in the nation and considered an industry leader in joint venture partnerships, PAML is dedicated to personalized service, rapid turnaround time and innovative information management systems.

We recently spoke with Dr. Francisco R. Velázquez, President and Chief Executive Officer at PAML, to further understand the history of the company and his methodology to become a driving force in the healthcare solutions industry.

From West to East – A History of Going Nationwide Founded in 1957 in the town of Spokane, Washington, PAML was initially focused on serving the Pacific Northwest region. From Montana to Idaho, the company soon discovered that its reach could extend much farther. Over the years, w w w. p a m l . c o m

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BreathTek® UBT for H. pylori

You Suspected H. pylori.

BreathTek UBT Confirmed.

To be sure of your diagnosis AND confirm treatment success, choose BreathTek UBT • Antibiotic resistance is approaching 25%, increasing the need for eradication confirmation1-3 • ACG* calls the UBT method “the most reliable nonendoscopic test…“ to confirm H. pylori eradication4 • BreathTek UBT offers excellent sensitivity (96%) and specificity (96%) to confirm eradication in adult patients5 • False negative test results may be caused by: − Ingestion of proton pump inhibitors (PPIs) within 2 weeks prior to performing the BreathTek UBT. If a negative result is obtained from a patient ingesting a PPI within 2 weeks prior to the BreathTek UBT, it may be a false-negative result and the test should be repeated 2 weeks after discontinuing the PPI treatment. A positive result for a patient on a PPI could be considered positive and be acted upon − Ingestion of antimicrobials or bismuth preparations within 2 weeks prior to performing the BreathTek UBT − Premature POST-DOSE breath collection time for a patient with a marginally positive BreathTek UBT result − Post-treatment assessment with the BreathTek UBT less than 4 weeks after completion of treatment for the eradication of H. pylori • False positive test results may be caused by urease associated with other gastric spiral organisms observed in humans, such as Helicobacter heilmannii or achlorhydria.

H. pylori can’t hide from BreathTek UBT… Approved as an aid in the initial diagnosis and post-treatment monitoring of H. pylori infection in adults and children ages 3 to 17 years Please see BRIEF SUMMARY on adjacent page.

Click here to learn more or visit BreathTek.com. *ACG, American College of Gastroenterology.

April 2015

05US15EBP0019

Brief Summary about BreathTek UBT Intended Use The BreathTek® UBT for H. pylori Kit (BreathTek UBT Kit) is intended for use in the qualitative detection of urease associated with H. pylori in the human stomach and is indicated as an aid in the initial diagnosis and post-treatment monitoring of H. pylori infection in adult patients and pediatric patients 3 to 17 years old. The test may be used for monitoring treatment if used at least 4 weeks following completion of therapy. For these purposes, the system utilizes an Infrared Spectrophotometer for the measurement of the ratio of 13CO2 to 12CO2 in breath samples, in clinical laboratories or point-of-care settings. The Pediatric Urea Hydrolysis Rate Calculation Application (pUHR-CA), provided as a web-based calculation program, is required to obtain pediatric test results.

The BreathTek UBT Kit is for administration by a health care professional, as ordered by a licensed health care practitioner.

Warnings and Precautions • For in vitro diagnostic use only. The Pranactin®-Citric solution is taken orally as part of the diagnostic procedure and contains Phenylalanine (one of the protein components of Aspartame), 84 mg per dosage unit, and should be used with caution in diabetic patients. (For reference, 12 ounces of typical diet cola soft drinks contain approximately 80 mg of Phenylalanine.)

• A negative result does not rule out the possibility of H. pylori infection. False negative results do occur with this procedure.

If clinical signs are suggestive of H. pylori infection, retest with a new sample or an alternate method.

• False negative test results may be caused by: — Ingestion of proton pump inhibitors (PPIs) within 2 weeks prior to performing the BreathTek UBT. If a negative result is obtained from a patient ingesting a PPI within 2 weeks prior to the BreathTek UBT, it may be a false-negative result and the test should be repeated 2 weeks after discontinuing the PPI treatment. A positive result for a patient on a PPI could be considered positive and be acted upon.

— Ingestion of antimicrobials, or bismuth preparations within 2 weeks prior to performing the BreathTek UBT — Premature POST-DOSE breath collection time for a patient with a marginally positive BreathTek UBT result — Post-treatment assessment with the BreathTek UBT less than 4 weeks after completion of treatment for the eradication of H. pylori.

• False positive test results may be caused by urease associated with other gastric spiral organisms observed in humans such as Helicobacter heilmannii or achlorhydria.

• If particulate matter is visible in the reconstituted Pranactin-Citric solution after thorough mixing, the solution should not be used.

• Patients who are hypersensitive to mannitol, citric acid or Aspartame should avoid taking the drug solution as this drug solution contains these ingredients. Use with caution in patients with difficulty swallowing or who may be at high risk of aspiration due to medical or physical conditions.

• No information is available on use of the Pranactin-Citric solution during pregnancy.

• For pediatric test results, the Urea Hydrolysis Rate (UHR) results must be calculated. The Delta over Baseline (DOB) results are only used to calculate the UHR metrics to determine H. pylori infection in pediatric patients. DOB results cannot be used to determine the infection status of pediatric patients. Use the web-based pUHR-CA (https://BreathTekKids.com) to calculate the UHR. • Safety and effectiveness has not been established in children below the age of 3 years.

Adverse Events During post-approval use of the BreathTek UBT in adults, the following adverse events have been identified: anaphylactic reaction, hypersensitivity, rash, burning sensation in the stomach, tingling in the skin, vomiting and diarrhea. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to establish a causal relationship to drug exposure.

In two clinical studies conducted in 176 (analyzed) pediatric patients ages 3 to 17 years to determine the initial diagnosis and post treatment monitoring of H. pylori, the following adverse events experienced by ≥1% of these patients were: vomiting (5.1%), oropharyngeal pain (4.5% to include throat irritation, sore throat, throat burning), nausea (2.3%), restlessness (2.3%), stomach ache/belly pain (1.1%), and diarrhea (1.1%). Most of the adverse events were experienced by patients within minutes to hours of ingestion of the Pranactin-Citric solution.

In another clinical study comparing the UBiT®-IR300 and POCone® in pediatric patients ages 3 to 17 years, the following adverse events were observed among the 99 subjects enrolled: 2 incidences of headache, and 1 incidence each of cough, dry mouth and acute upper respiratory infection.

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References: 1. Vakil N, Megraud F. Eradication therapy for Helicobacter pylori. Gastroenterology. 2007;133(3):985-1001. 2. Vakil N, Fendrick AM. How to test for Helicobacter pylori in 2005. Cleve Clin J Med. 2005;72(suppl 2):S8-S13. 3. Chu Y-T, Wang Y-H, Wu J-J, Lei H-Y. Invasion and multiplication of Helicobacter pylori in gastric epithelial cells and implications for antibiotic resistance. Infect Immun. 2010;78(10):4157-4165. 4. Chey WD, Wong BCY; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102(8):1808-1825. 5. Package Insert for BreathTek UBT. Otsuka America Pharmaceutical, Inc; 2014.

©2015 Otsuka America Pharmaceutical, Inc.

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PA M L PAML grew to encompass a wider geographical presence, additionally realigning its focus to diagnostics.

“About three years ago, we launched a professional services corporation,” said Dr. Velázquez.

“We developed a portfolio of complementary skills that are useful not only to us as a company but more importantly bring valuable services to those that we work with.”

Referring to PAML as a healthcare solutions company, Dr. Velázquez went on to explain that his primary goal was to do the best work possible, leaving his clients and partners with the solutions and a roadmap to providing better care.

“Our goal is to go in and help you and leave as quickly as we can,” said Dr. Velázquez.

Successful Direction How does a company remain competitive, especially within the

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healthcare industry? According to Dr. Velázquez, the answer is simple: pay attention.

“We pay attention to new developments,” clarified Dr. Velázquez. “And not just in the healthcare industry, but in others as well.”

“It’s important for us to understand what the world around us is doing because ultimately most of the trends that we see in other industries will come to healthcare,” he continued.

PAML also connects with higher level academic institutions to understand where innovation is headed. By spending time with entrepreneurs and those investing venture capital dollars in new technologies, PAML successfully keeps its “finger on the pulse.”

Innovative Solutions PAML is striving to close the gap in

“It’s important for us to understand what the world around us is doing because ultimately most of the trends that we see in other industries will come to healthcare” – Dr. Francisco R. Velázquez, President and Chief Executive Officer w w w. p a m l . c o m

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Now available, an FDA cleared assay that delivers the results physicians need for patients with symptoms of IBD • A new fecal ELISA test kit offering expanded dynamic range of 15.6-500mg/kg1 • High sensitivity helps guide decision-making when selecting patients for endoscopy2

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INOVA Diagnostics, Inc., San Diego, CA 92131 858-586-9900 www.inovadx.com References: 1. QUANTA Lite Calprotectin directional insert.

2. Bunn, S. et al. Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease. J Pediatric Gastroenterology Nutrition 2001;33:14-22.

QUANTA Lite is a trademark of Inova Diagnostics, Inc. © 2015 Inova Diagnostics, Inc. All rights reserved.

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PA M L the continuum of care between the time that individuals are consumers and the time that they are patients.

“Right now, both worlds don’t connect and we’re looking to connect those better,” said Dr. Velázquez.

With more consumers looking for ways to proactively manage their health, many have turned to the internet for help in accessing medical resources to help them make smart decisions. In response to this, late last year PAML unveiled its website for Cinch™, the company’s new consumerbased product line that empowers individuals to reveal their health through easy access to laboratory testing and information.

“Our Cinch product line is a step above what is currently being offered in the market for directto-consumer laboratory testing,” said Shawn Whitcomb, PAML’s Chief Information Officer in a press release. “We are delivering the same superiority in laboratory testing that patients receive from their physician, but with much more convenience and flexibility, and often at a lower cost than a traditional physician visit.”

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Additionally, PAML recently launched another brand titled AION (meaning “life” or “longevity” in Greek) which aims to assist physicians practicing personalized medicine by delivering evidencebased testing utilizing robust diagnostic technology to detect risk factors and biomarkers associated with aging.

Through clinical relevance and uniformity of testing, AION aids physicians in their efforts to monitor patients and manage treatment programs over time. AION also provides nationwide concierge phlebotomy services to healthcare providers that do not have in-house drawing personnel, as well as an online portal delivering enhanced reports.

“We’ve segmented the areas of wellness we serve into traditional and clinical wellness, wellness for consumers, wellness for the ageing population and we’re now entering into corporate wellness for employees,” said Dr. Velázquez.

Why Choose PAML? “In short, we’re a true partner,” said Dr. Velázquez. “Our goal is for you to w w w. p a m l . c o m

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succeed. We’re focused on quality and service in terms of providing for those that work with us.�

As a value-driven organization, PAML looks to enhance the skills and abilities of its clients all while remaining community-centric.

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Mindful of its presence in the community, PAML is constantly looking to locally brand joint ventures for the benefit of its partners and the community as a whole. “Our goal is to do upwards of 90 percent of the volume generated in a

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Company Information INDUSTRY

PAML HEADQUARTERS

Healthcare FOUNDED

1957 EMPLOYEES

1000 REVENUE

$250 M PRODUCTS/ SERVICES

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particular region locally,” explained Dr. Velázquez.

“That way we can increase the efficiency of our local partners, provide them with a revenue stream they didn’t previously have, and maintain the continuity of information for the region of delivered care.”

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