Ahmc presentation june 2014 for healthcare private investment conference

 AHMC is a private US company headquartered in Washington D.C. recognized as the
leading international hospital development and management company offering clients
“individualized turn-key services and total hospital solutions.”
 AHMC’s 16 year track record includes successful collaboration in more than 50 hospital
projects, on 5 continents and 24 countries around the world.
 AHMC’s management model is based upon the very best characteristics of American
management practices and Joint Commission International (JCI) Standards.
 AHMC’s successful model has been adapted to the needs of clients around the world in
order to deliver enhanced operational capabilities, quality, and profitability.
 AHMC’s business philosophy and experience enable it to deliver global resources locally in
order to provide state-of-the-art quality medical services
 AHMC’s affiliated healthcare facilities are Five Star, Class “A” academic medical centers that
are committed to quality, service and long-term financial success.
 Unique to AHMC is its experience in the management and development of world-class
healthcare facilities that include private hospitals, Private-Public hospital Partnerships
(PPP), and academic teaching hospitals.
AHMC OVERVIEW

GLOBAL NETWORK:
 Hospitals and Projects: 33
 Operational facilities: 15
 Licensed Beds: 2,900
 Physicians: 3,000
 Staff/Employees: 4,500
 Avg. Patient satisfaction: 97%
UNIQUE EXPERIENCE:
 Private-Public Hospital Partnerships
 New hospital commissioning
 Academic and teaching hospital
AHMC OPERATIONS OVERVIEW

AHMC HOSPITAL FEATURES
 Operated at Joint Commission International standards
 Adoption of world class clinical guidelines
 Commitment to continuous quality improvement and enhanced care
 State-of-the-art medical technology and healthcare services
 Commitment to continuing medical education and employee development
through constant education and technology transfer
 Transparent administration and business practices for to earn investors’ trust and
in order to enhance ROI
 Access to AHMC’s prestigious Strategic Alliances and related resources

AHMC HOSPITAL CHARACTERISTICS
Award winning design and according to JCI Standards

Modern and focused on patient safety/quality and efficiency

Patient and family centered environments

AHMC SCOPE OF SERVICES
PHASE 1-FS/BP Development
TIMEFRAME: 2 – 3 MONTHS
 Conduct Feasibility Study
 Develop Business Plan
 Develop the Financial
Projections
 Analysis of the site and
architectural design
 Preliminary staffing plan
 Market analysis
PHASE 2- PROJECT
MANAGEMENT CONSULTING
TIMEFRAME: 18-24 MONTHS
 Work with architect and
construction manager
 Operating procedures
development
 Equipment planning
 HIT Selection and
implementation
 Development of bylaws for
the board and medical staff
 Establish governance
structure
PHASE 3- PRE-OPERATIONS &
COMMISSIONING
TIMEFRAME: 6 - 9 MONTHS
 Staffing core operating team
 General staffing and
recruitment
 Physician recruitment
 Implement operating
policies and procedures
 Implement process design
and protocol
 Equipment procurement
and installation
 Establish financial controls
and measures
 Hospital commissioning
PHASE 4- OPERATIONS
TIMEFRAME: 10-15 YEARS
 Turnkey executive
management and control of
daily business operations
 Implement international
mode of clinical procedures
and medical care
 Implement quality
improvement and patient
safety framework
 Implement AHMC best
practice financial and
operations management
 Recruitment, training and
retention of physicians,
nurses and hospital staff
 Selection/implementation
of HIT System
AHMC Onsite Full-TimeAHMC Consulting and Support

PHASE I: FEASIBILITY STUDY AND BUSINESS PLAN
TIMEFRAME: 2 MONTHS
SCOPE OF WORK
 Conduct a Feasibility Study to validate hospital project
 Develop the associated Business Plan and related Financial Projections
 Conduct site and review architectural design
 Conduct market analysis
DELIVERABLES
 Feasibility Study serves to validate the proposed hospital project's operational and financial
feasibility from a strategic perspective.
 Business Plan gleams information from the feasibility study to develop the proposed hospital’s
framework and a preliminary operational plan. Also serves as a prospectus grade document.
 Hospital size, scope/breadth of hospital services
 Address needed investments related to building, equipment, HIT and working capital needs
 Outline space allocations
 Preliminary employee and medical staffing plan
 Assess and project operational costs and external service suppliers
 Develop future strategic objectives and marketing strategies
 5 year financial projections including opening financial statements of operation, balance sheet, and
cash flow statement.

PHASE II: PROJECT MANAGEMENT CONSULTING
SCOPE OF WORK
 Work in collaboration with architect and construction manager
 Develop hospital operating procedures
 Equipment planning
 HIT Selection and implementation
 Develop bylaws for the board and medical staff
 Establish governance structure
DELIVERABLES
 Detail Room Program: AHMC works with architects to assure each room is appropriately equipped
with medical gases, electrical needs and other necessities for both clinical and diagnostic areas.
 Equipment Plan: AHMC will develop the list of clinical equipment, supplies and furniture necessary to
open the hospital to be approved by the Board of Directors.
 HIT Plan: AHMC will develop the implementation plan for selected HIT system, as well as, evaluate
the leasing and/or purchase of hardware and software relevant to the project.
 Bylaws for the Hospital Board and Medical Staff: Hospital Governance will conform to Accreditation
standards as well as develop a system that can be audited to ensure transparency in all transactions.
 General Hospital Organization (“Hierarchy of Control): To be approved by the Board of Directors.
ARCHITECTURAL DESIGN AND RELATED EXPENSES
AHMC is not an architectural firm, however we work with renowned architects experienced in the design
of world-class international standards hospitals worldwide. At the discretion of the owners, architects can
be integrated as part of our team. Related fees and costs are billed separately from AHMC.

PHASE III: PREOPERATIONS AND COMMISSIONING
SCOPE OF WORK
 Placement of CEO and staffing of the core operating team
 Recruitment of physicians and general staff
 Implement operating policies and procedures
 Equipment planning, procurement, installation and training
 Implementation the Health Information Technology (HIT)
 Develop and implement methods of procurement
 Establish financial controls and measures
 Hospital commissioning
DELIVERABLES
 Operating Plan and Procedures
 Employee Policies and Procedures
 Job Descriptions, Employee handbooks, and Salary/Benefit Structures
 Medical Equipment Planning, Procurement, Installation and Training Plan
HOSPITAL COMMISSIONING- (LAST 2 MONTHS OF PHASE III)
AHMC team will conduct “practice runs” in order to insure all equipment is functioning
appropriately and that all staff understand how to move patients through the system efficiently and
effectively prior to hospital opening.

PHASE IV: ADMINISTRATION AND OPERATIONS
TIMEFRAME: 7-15 YEARS
SCOPE OF WORK
 Turnkey executive management
 Management and control of daily business operations
 Recruitment, training and retention of physicians, nurses and hospital staff
 Implement international mode of clinical procedures and medical care
 Implement quality improvement and patient safety framework
 Implement AHMC’s best practice financial and operations management service
DELIVERABLES
 Clinical Practice and Medical Care Model
 Framework for Quality and Patient Safety Programs
 Financial and Operation Management Services Plan
 Hospital performance benchmark data and KPI’s
 Marketing and Branding Implementation Plan
 Monthly Reports: formal monthly reports prepared for Hospital Board and investors.
Reports include comparison against budget, variance analysis and benchmarks.

Country Client /Project Beds
Contracted
Services
Contract
Start Date
Contract
End Date
Current Status
Honduras La Lima 180 Phase 4 2003 2008 Completed and Current investor
Ecuador Hospital Del Rio 90 Phase 2-4 2003 2010 Completed and Current Investor
Honduras Honduras Medical Center 49 Phase 3 -4 2002 2007 Completed and Current investor
Saudi Arabia Mohammed Khan Hospital 70 Phase 4 2014 Present Management/Operations
Saudi Arabia Bakhsh Hospital 120 Phase 4 2014 Present Management/Operations
India Sama Healthcare 31 Phase 4 2012 Present Management/Operations
Antigua & Barbuda Mount Saint John's Medical Center 185 Phase 3-4 2007 Present Management/Operations
Colombia Pastuer Labs NA (Lab/DX) Allaince 2004 Present Management/Operations
Panama Hospital Nacional 120 Phase 4 2000 Present Management/Operations
India Re- Hospital 120 Phase 3 - 4 2014 Present Pre-Operations
Saudi Arabia Al-Jazeera Medical Hospital 120 Phase 3 & 4 2014 Present Pre-Operations
Saudi Arabia AlQadi Specialty Hospital 140 Phase 1-4 2012 Present Pre-operations
Libya VIP Hospital 60 Phase 1, 3-4 2010 Present Pre-Operations
AHMC HOSPITAL NETWORK

Country Client /Project Beds
Contracted
Services
Contract
Start Date
Contract
End Date
Current Status
Libya Swani Road 200 Phase 1-4 2010 Present Construction
Russia Russian American Hospital 100 Phase 1-4 2010 Present Construction
Peru Clinica Delgado 120 Phase 2-4 2009 Present Construction
Peru Torre Trecca NA (OP) Phase 2-4 2009 Present Construction
Libya Swani Road 200 Phase 1-4 2010 Present Construction
Russia Russian American Hospital 100 Phase 1-4 2010 Present Construction
Peru Clinica Delgado 120 Phase 2-4 2009 Present Construction
Peru Torre Trecca NA (OP) Phase 2-4 2009 Present Construction
Georgia American Hospital Tiblisi 120 Phase 1-5 2013 Present Financing
Libya Libyan American Hospital 120 Phase 1-4 2013 Present Financing
Nigeria Lagos American Specialty Hospital 50 Phase 1 2013 Present Financing
Nigeria Crystal Thorpe Lagos 150 Phase 1 2012 Present Financing
Nigeria Chystal Thorpe Abuja 120 Phase 2 2012 Present Financing
Nigeria Chystal Thorpe Yola 100 Phase 3 2012 Present Financing
Egypt Egyptian American Medical Center 182 Phase 1-4 2011 Present Financing
Jordan MIS Surgical Centre NA (OP) Phase 1-4 2011 Present Financing
Mexico Cancun Medical Center 100 Phase 1 2011 Present Financing
Morocco Moroccan American Hospital 182 Phase 1 2011 Present Financing

Al-Jazeera Medical Hospital
Riyadh, Kingdom of Saudi Arabia
 Recruiting Physicians and Staff
 Cath lab projected online by mid-2014
 Implementation of P&Ps and quality
program
 Develop marketing strategy
Beds: 120
Type: General Hospital
Status: Operations

Bakhsh Hospital
Jeddah, Kingdom of Saudi Arabia
 Recruiting Physicians, staff, and executive
team
 Strategic and Operational Development
framework
Beds: 120
Status: Operations

Dr. Mohammed Khan Hospital
Hafr-al-Batin, Kingdom of Saudi Arabia
 Recruiting of physicians and staff
 Strategic and operational planning
framework
Beds: 70
Status: Operations

AlQadi Specialty Hospital
Najran, Kingdom of Saudi Arabia
 Construction in final stages
 Staffing imminent
 Equipment procurement underway
 Financing
Beds: 140
Type: Specialty Hospital
Status: Pre-Operations

Memorial Souad Kafafi Medical Center
6th of October, Egypt
 Moved into Extension with new ED,
OR & Cath Lab
 CCU, NICU, ICU, OB
 Remodeling of Old Building
 Transition to Fee for Service Model
Beds: 140
Status: Operations
(Completed April 2014)

Hospital Nacional
Panama City, Panama
 Kidney Transplant Program
 Da Vinci Robotic Surgery
 Radiation Oncology Center
 Expansion ICU, Surgery and ED
Beds: 100
Status: Operations

Mount Saint John’s Medical Center
St. John’s, Antigua & Barbuda
 New Executive Team & Board
 Updating Strategic Plan
 GPO Pilot Program
 Teaching Accreditation
 Cancer Centre of Eastern Caribbean
Beds: 185
Status: Operations

Hospitals Under Development (continued)
VIP Hospital
Tripoli, Libya
60 Beds
Status: Construction (Pending)
Swani Road
Tripoli, Libya
200 Beds
Status: Pre-Operations (Pending)
Tripoli American Hospital
Tripoli, Libya
120 Beds
Status: Design and Capitalization

Moroccan American Medical Center
Casablanca, Morocco
110 beds
Egyptian American Medical Center
Cairo, Egypt
180 beds
Minimally Invasive Surgery Center
Amman, Jordan

Lagos American Medical Center
Lagos, Nigeria
50 Beds
Crystal Thorpe (3 hospitals)
Yola, Abuja and Lagos, Nigeria
100, 120 and 150 Beds
R&H Specialty Hospital
Accra, Ghana
100 Beds

Russian American Medical Center
Tver, Russia
120 beds
American Hospital Tbilisi
Tbilisi, Republic of Georgia
120 beds

Clínica Delgado
Lima, Peru
120 Beds
Status: Phase 2 Construction
Torre Trecca
Lima, Peru
Ambulatory and Urgent Care Center
Hospital Solaris
Guayaquil, Ecuador
100 Beds

Completed and Current Investor
Honduras Medical Center
Tegucigalpa, Honduras
Status: Commissioned, Operated
and own equity in Hospital
La Lima Medical Center
Tegucigalpa, Honduras
Status: Renovated, Operated,
and own equity in Hospital
Hospital Del Rio
Cuenca, Ecuador
Status: Business Plan, Commissioned,
Operated and own equity in Hospital

6/6/2014 FAMILY HOSPITAL GROUP 29
INVESTING IN HEALTHCARE
 Hospitals are complex
businesses
 Business of “people”
 High technical skills
required
 Long-term perspective and
dedication required
 Significant ROI is possible

HEALTH MARKET TRENDS
 Scarcity of Capital
 Human
 Financial
 Increased Complexity
 Capital Markets and
Investor Expectations
 Quality & the Patient
Experience
 Cost Pressures

HEALTH MARKET TRENDS
 Transitions:
 Financial Markets
 Reimbursement
 Aging Hospitals
 Younger Populations
 New Technology
 Increased Complexity

BUSINESS MODELS
Classic:
 Public
 Public Private Partnerships
 Private:
 Foundation
 Family Owned
 Doctor Owned
 Investor Owned
Alternative:
 Hospital within a Hospital
 Doctor – Investor Hybrid
 Joint Ventures
 Collaboration with
Insurance Companies
 Tenant Hospitals
 Concession of Services

CHARACTERISTICS OF SUCCESS
 Focused Business Plan – Clear investment objectives
 Clearly identified and sustainable local market
 Socio-economic levels of patients are top “informed” 40%
 Class “A” tertiary care with quality and economic volumes
 Class “B” volume and service focused 1 and 2 level care
 Aligned, well-trained and multi-specialty medical staffs
 Operated to International Standards (ISO9000/HQS/JCAHO)
 Emphasis on “value” technology as a clinical and business tool
 Clinical benchmarking and measuring of outcomes
 Ability to understand the relationship and implications between clinical
care and financial performance

CHARACTERISTICS OF FAILURE
 Over reliance on the government for patients & revenue
 Alienating the physicians or insurance companies
 Poor quality and patient experience
 Lack of clear strategic plan and/or poor implementation
 Ineffective leadership and lack of accountability
 Wrong or incompatible investor expectations
 Focusing on the socio-economic levels of patients in the top 5% to 10% or
the bottom 50%
 Too many hospitals/beds in market, lack of differentiation
 Too much technology or too little technology
 Lack of resources: financial and human capital
 If you build it, they will come

CRITICAL INVESTMENT QUESTIONS
 Why are you investing?
 What is the expected
ROI?
 What are the incentives?
 Understand how all
investors will make
money
 Who is in charge and
who is accountable?

KEYS TO SUCCESS
 Demand in market – priced for the market
 Diversified referral base of patients
 Clear focus of the business and strategic plan and
objectives of the hospital
 Service selection – Cannot be all things to all people: Ok
to be a Wal-Mart and ok to be a Saks 5th Avenue, you just
cannot be both
 Realize the uniqueness of the hospital business and the
uniqueness of the customers

THE PHYSICIAN KEY
Working in partnership with
the medical staff:
 Doctors are unique
customers
 Doctors bring patients
 Doctors spend the money
 The Doctor Workshop

THE PATIENT EXPERIENCE
 Differentiating and
understanding quality care
and quality service:
 The patients and families’
expectations
 The patient experience
 The “little things” of service
 Voting with their feet

ALIGNMENT OF INCENTIVES
 Owners / Investors
 Doctors that Bring Patients
 Insurance Companies
 Other Hospitals

MAXIMIZING PROFITS
 Programs – not “Bricks and Sticks”
 Day to Day control of money and information
 Understanding the true and the incremental costs of care
 Productivity and flexibility
 Appropriate and sufficient capitalization – with reality based
financing
 Accountability, transparency and long-term relationships

MAXIMIZING PROFITS
 Best practices and standardization
 Clear strategic plan for insurance and third party
contracting of local domestic patient referrals:
Healthcare is local
 Share the risk – share the rewards
 Doctors
 Insurance companies
 Competing hospitals
 Clinical partners

REDUCING THE RISK
 Not Re-Inventing the
Wheel:
 Learn from Others
 Clinical Partners
 Best Practices
 Invest in Human
Capital:
 Professional
Management
 Technical Training

CASE STUDY
Mount St. John’s Medical Centre is a state-of-the-art hospital facility centrally-located
on the island of Antigua and has been prepared to be the premier hospital of the
Eastern Caribbean region.

OVERVIEW
 185 bed hospital structured as a
Public Private Partnership
ownership model.
 The Hospital is professionally
managed and operated as a
modern, private enterprise by
American Hospital Management
Company that ensures the
effective management of all
business operations
 The hospital provides
comprehensive medical services
to the public and private patients
 Regional demand for quality
healthcare services is growing with
lack of adequate private facilities in
the region
 Private, insurance and for tertiary
level government patients,
reimbursement is under fee for service
 Primary and secondary services for
government sponsored patients are
reimbursed under a capitation
agreement with he Government of
Antigua and Barbuda on a monthly
basis
 Antigua and Barbuda is centrally
located within the Eastern Caribbean
Economic Market and a major
transportation hub

SERVICES
 Medical / Surgical
 Suites
 Private Rooms
 Semi-Private Rooms
 Intensive Care
 Maternity
 Nursery
 Neonatal Intensive Care
 Operating Theaters
 Radiology
 MRI
 CT-Scan
 Fluoroscopy
 Ultrasound
 Full Clinical Laboratory
 Rehabilitation
 Emergency Room
 20 Medical Offices
 Helicopter Landing Pad

SUMMARY
 Significant new opportunities exist
 Know who you are and know your market
 Everyone must understand why they are going into business
and the expectations
 Align your incentives with the doctors
 Focus on quality and the patient experience
 Human capital and resources
 Maintain the optimal mix of technology and financial
resources

Ahmc presentation june 2014 for healthcare private investment conference

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Ahmc presentation june 2014 for healthcare private investment conference