Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
#nordicsolutions
                                 to global challenges
Nordic-Canada Health              funded by:

Solutions Initiative 2018-2019

Photo: OuluHealth
Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Initiative background
         ●   The Nordic Solutions to Global Challenges is a joint initiative by the Prime
             Ministers of the five Nordic countries to identify and promote Nordic sustainable
             solutions and strengths for global challenges
         ●   There was extensive mapping and analysis on Nordic strengths within health
             technology
         ●   The strengths identified were sustainable hospitals, smart digital solutions,
             assisted living technologies & personalized care (Menon report)
         ●   Executed “go-to-market” programs in the region by some of the partners

                                           Demonstrate stronger combined knowledge and
        The initiative’s goal              experience
        is to strengthen the
        Nordic message by                  Create a more complete solution and value
        bringing together                  proposition to Canadian stakeholders
        the five countries to:             Combine efforts to gain access to decision makers
                                           and market opportunities

                         The Initiative will be supported by Nordic Innovation,
                      the Nordic Embassies and Nordic Trade Promotion Offices
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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

        Key Opportunities      ●   Hospitals
                               ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process
                                                                       to global challenges

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Why Canada?

             #1
             In the G7 for FEWEST DAYS
             to establish a new business   #1
             (World Bank Group, 2017)
                                           In the G7 for living conditions and
                                           QUALITY OF LIFE
                                           (OECD, 2017)

             #1
             In the G7 for LOWEST
             total effective taxes
             (PWC, 2017)
                                           #1
                                           MOST REPUTABLE
                                           among G7 countries
                                           (Reputation Institute’s Country Reptrak, 2018)

             #1
             Most HIGHLY EDUCATED
             workforce in the OECD
             (OECD, 2017)

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Introduction to Canada
    A stable economy with 36 million people, across 10 provinces & 3 territories

                                                           •   Six times zones - Canada is the 2nd
                                                               geographically largest country in the world
                                                           •   86% of Canada’s population is in four
                                                               provinces (Ontario, Quebec, Alberta, British
                                                               Columbia)
                                                           •   Provinces have more decision-making
                                                               abilities than federal government, leading to
                                                               differences in doing business in each
                                                               province
                                                           •   17% of population is over 65 years old in
                                                               2018, expected to grow to 23% by 2030

     Canada’s population 2016, millions
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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Healthcare in Canada - Spending
    Publicly funded: Canada’s health spending is about C$242 billion with a 70/30 public and
    private split
                                               •    Contributes funding to the provinces and territories on a per capita basis as
            Federal Government                      well as to aboriginal, Inuit and veteran affairs
               5% spending                     •    Health Canada manages product regulations, standards and research
                                                    including some specific groups (medical devices. pharmaceuticals, natural
                                                    products, health research, food, consumer products)

    Provincial or Territorial Government   •       Managed by Ministry of Health and Long Term Care (Ontario) and administered
               65% spending                        own health insurance programs, ex: Ontario Health Insurance Plan (OHIP)
                                           •       Responsible for funding and delivery of hospital, community, long-term care,
                                                   mental and public health services

                                           •       There area 14 Local Health Integration Networks (LHINs) in Ontario
        Regional Health Authorities        •       Covers hospital and physician services, medically necessary diagnostics,
                                                   inpatient prescription, long term care and home and community care

             Out of pocket: 15%            •       Additional private insurance, held by about 2/3 Canadians, covers ex: vision
                                                   and dental care, prescription drugs, rehabilitation, home care
           Private insurance: 12%
                                           •       There is no cost-sharing for publicly insured physician, diagnostic, and
                  Other: 3%                        hospital services

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Allocation of funds for health services in Ontario
                                              Ministry of Health & Long Term Care

                 Regional Health Authorities                          OHIP           Public Health
              (14 Local Health Integration Networks)

                                                               Physicians’ payment
          Hospitals                Long term care
                                                                   for services

       Community care             Mental health &
       access centres            addiction services

         Community               Community health
       support services             services
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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
50% of Canada’s 2017 healthcare spending includes
    only hospital, drug and physician costs

      Top 3 areas          % health     2016                              Investments
      of spending          spending     growth              •   Federal government has granted $4.2
                                                                billion for Ontario over the next 10 years
                            28%          +1.9%                  •      $2.3 billion for better home care
    Hospitals                                                   •      $1.9 billion in support of mental
                                                                       health initiatives
                                                            •   Ontario is investing $155 million over 3
                            16%          +4.2%                  years to improve community-based
    Drugs                                                       palliative and end-of-life care
                                                                •      May 2017, medical assistance in
                                                                       dying legislation passed
    Physicians              15%          +3.4%
                                                            •    2018 - Free prescription medication
                                                                 for Ontarians under age 25 (4,400 listed
                                                                 drugs)
       How is it implemented?
       Health care is largely delivered by private individuals and organizations. These services,
       however, are financed by governments through public health insurance plans and direct
       funding to health care facilities                                                                     8

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Patient care pathway                                                                                                    Out of pocket unless
                                                                                                                            covered by private
                                                                                                                            insurance (common)
                                                                        PATIENT                                             Publicly covered
                                                                                                                            healthcare

                 $0 co-payment                Emergency
                                              care only

         Primary Care                                                                                                 Dentist, Optometry
                                                Hospital                                                         Physiotherapy, Chiropractors,
            Doctors
                                                                                                                      Physiotherapy, etc.

      Referrals to                                                  Regional Health Authorities
    specialist and                                                (Local Health Integration Networks)
           testing

           Specialist                                 Home care                        Long term care               Private retirement home

                     •   Primary care physicians function as gatekeepers for access to all other health services in the system
                     •   Many family physicians and specialists work as independent contractors billing the provincial insurance
                         under ‘fee for service’ model with recent slow shift towards alternative payment plans
                     •   Physicians billing has reached C$22.8 billion in 2012-2013. This is growing on a 3.5% annum
                         average. The average income of a Canadian physician is $320,000 CAD (2012)
                     •   Since 2009, there has been an 8% increase in the number of nurses in Canada                                           9

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Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
Summary of insights
    •   Canada is similar to Nordics with its publicly-
        funded, universal healthcare system (Medicare)
    •   Decentralized and provincially/territorially
        managed – 13 different markets
                 • Ontario is the largest province and a
                      key entry point for healthcare in
                      Canada
    •   High spending – need for transformation due to
        aging population and increased cost of health
        care
    •   Fee for service is common
    •   Focus on efficiency with new interest in
        innovation, digital solutions, workflow optimization
        – showing particular interest in Nordics
    •   Over capacity for long term care facilities is
        causing focus on increasing home care
        services
    •   Changing towards a patient-centric care model

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Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

                               ●   Hospitals
        Key Opportunities      ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement in Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process                 to global challenges

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Hospital statistics (Ontario)

                         1M km2
                         Area of Ontario
                                                                                  Full capacity
                                                                                  Half of all hospitals were at full
                                                                                  capacity with some hospitals
                         under 20 to over 1,200 beds                              at 140% capacity (85%
                         Range in the amount of beds/hospital                     considered safe capacity)

                  141                            206,000                        17%
            public hospitals                    total number of     acute hospital beds occupied by
             corporations                       Ontario hospital    patients who should be receiving
            (262 hospital sites)                  employees        care at home, in long-term care or
                                                                            in the community
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Hospital spending

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Hospital sector:
Opportunities & Feedback

      Efficient workflow and better
                                      Optimizing hospital facility
      waiting times

      Medication management           Infection control

      Patient safety                  Lowering readmission rates

      Interconnectivity                Data Security
Hospitals – things to consider

       •   Hospitals are allocated ‘global annual
           budgets’ for providing services
       •    Budgets fluctuate based on population,
           need and efficiency
       •    Priority within reducing costs, improving
           quality and outcomes, and giving patient
           empowerment
       •    Wide spread use of EMR
       •    Older hospitals face difficulty in utilizing
           Wi-fi/bluetooth based technologies due to
           infrastructure
       •    Green builds are proactively
           implementing fully digitized facilities
       •   Many hospitals require pilot projects prior
           to implementation – requires time,
           resources and funding
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Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

                               ●   Hospitals
        Key Opportunities      ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement in Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process                 to global challenges

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Long term care and retirement home stats

            45%               78,872                700                6.5 million
          public-sector      Beds for long-   licensed retirement         Nursing visits
       health care dollars   stay residents     homes in Ontario
        spent consumed
           by seniors
                                                                        27 million
                              78,872                                hours of personal support
                                 Staff                              and homemaking services
                                                                      to more than 600,000
                                                                         clients per year

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Long term care & retirement homes:
Opportunities & Feedback

       Efficient workflow             Improve environment & experience

       Improve e-connectivity         Increase safety/health

        Help plan & coordinate care   Better manage food services

        Human resources

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Long term care & retirement – things to consider

  •   Many long term care homes want to
      pilot a new technology before
      purchasing – costly and lengthy
  •   Public vs. private long term care
      homes have different decision
      makers and funders
  •   Safety and regulatory approvals can
      be difficult to navigate and may be
      lengthy processes
  •   Procurement rules and process may
      differ between LHINs and long term
      care homes

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Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

                               ●   Hospitals
        Key Opportunities      ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement in Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process                 to global challenges

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Home & community care stats
                                       73% increase
                                       in home care funding in Ontario
                                       (from 2005-2015)

                                       20% more patients
                                       have been receiving care at home
                                       in the past 5 years

                                       13% more patient referrals
                                       from hospitals

                                       Caring for terminally ill patients in an
                                       acute-care hospital is estimated to cost
    Image source: Global News
                                       over 10 times more
                                       than providing at-home care
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Home & community care:
Opportunities & Feedback

                                      Monitor and connect with
       Efficient workflow
                                      patients

                                      Help patients self-manage their
       Improve communication          care

      Physical & emotional security   Reduce social isolation
Home & community care – things to consider

    •   Ontario is made up of 14 different LHINs, each
        with varying budgets and strategies – fragmented
        province, subtle nuances between each LHIN
    •   Third party service providers (e.g. Saint
        Elizabeth) are often technology users and
        buyers, but not always (sometimes it is the
        LHINs)
    •   Many LHINs and third party service providers will
        require pilots in order to purchase new
        technology – costly and lengthy
    •   Safety and regulatory approvals can be difficult
        to navigate and may be lengthy processes
    •   Procurement process may be unclear between
        LHIN and third party service provider

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Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

                               ●   Hospitals
        Key Opportunities      ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement in Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process                 to global challenges

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Approval process in Canada

    Source: MaRS Discovery District
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Procurement in Ontario

     ●   Ontario spent C$12 billion in 2017 on procurement of healthcare
         goods and services
     ●   70% of medtech purchases are done at a hospital
     ●   Highly fragmented process of procurement
     ●   Approvals, reimbursement codes, clinical trials do not guarantee
         adoption
     ●   Must demonstrate cost savings/budget impact
     ●   Hospitals often have their own Value Analysis Committee to
         determine economic benefit of technology
     ●   Over C$100,000 must go through a transparent tender process
         (RFI/RFP/RFQ) - can take 6 mos - 2 years
     ●   Shared Services (SSO) for commodity purchases - but starting to
         procure innovative technology as well
     ●   Bundled payment pilots on some procedures may lead to the
         procurement of novel technologies and across silos
     ●   Procurement by co-design and issuing problem statements
         increasing - more novel solutions being adopted

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Agenda

      Healthcare in Canada     ●   Geographical overview
                               ●   Healthcare spending
                               ●   Allocation of funds
                               ●   Patient journey

                               ●   Hospitals
        Key Opportunities      ●   Long term care & retirement homes
                               ●   Home & community care

         Approval Process      ●   Approval and procurement in Canada

     Nordic-Canada Health      ●   Program background
                               ●   Details of program
        Solutions Initiative   ●   Partners & facilitators             #nordicsolutions
                               ●   Application process                 to global challenges

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Why Canada is great for Nordic companies

     Canadian Med Tech Advantages              Benefits

     •   Government committed to               •   Stable, predictable market growth
         healthcare funding
                                               •   Attractive for commercializing new devices
     •   A top 10 medical device market
                                               •   Ideal for high quality clinical trials
     •   High volume tertiary care hospitals
                                               •   Ability to track and evaluate outcomes
     •   Integrated healthcare delivery
                                               •   Less trial set up times and better product
     •   Highly trained clinicians                 design feedback

     •   Top scientific talent                 •   Access to leading edge science

     •   Health technology assessment          •   Faster, more efficient reimbursement
                                                   strategies for Canadian and global markets

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Why join?

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Our Nordic-Canada Health Solutions Initiative offers
                               full year program for accelerated market entry
                                                                2018                                                2019                                     2020

                                                  Determining Eligibility:                     Visit 1 to Canada:                                  End of Official Program:

                                                                                 * April 1-3
    Held in Nordic cities and online Nov. 19-23

                                                  •   Canadian market 101                      •   Canadian health system advanced training        •   Companies are in a position
                                                      education session                        •   Breakout detailed education sessions and            to independently test or pilot
                                                      (free for all interested                     site visits within specific sub-sectors (i.e.       with Canadian organization;
                                                                                                   digital health, devices, etc.)
                                                      companies)                                                                                       establish partnership/
                                                                                               •   Advanced pitch session with local experts
                                                                                                                                                       distribution agreement, etc.
                                                  •   Q&A session with                         •   Presentations from and networking with
                                                      Canadian expert                              Nordic companies already established in
                                                                                                   Canada
                                                  •   Application process for
                                                      program participation
                                                                                               Follow-up meeting (online or in person):
                                                                                 Spring

                                                      deadline Dec. 21
                                                                                               •   Go-to-market strategy review and pitch
                                                                                                   revisions with Canadian experts
                                                                                                                                                                        * all dates
                                                                                                                                                                        subject to
                                                                                               Visit 2 to Canada:
                                                                                 Fall 2019

                                                                                                                                                                        change
                                                                                               •   Small group or 1:1 tailored meetings with
                                                                                                   relevant stakeholders
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Company application deadlines to join initiative

    Task                                            NOV     DEC    JAN    FEB    MAR    APR    MAY    JUN   JUL   AUG      SEP   OCT   NOV

    One day Introduction to Healthcare in
                                                    19-
    Canada workshop with Canadian experts           23
    ( held in Nordic cities and online)

    Deadline to submit application for
                                                            21
    participation
    Selection of 20 companies to join                              14-
    program and signed agreement                                   18
                                                                          Week
    Nordic Initiative Kickoff call with all                                of
    participants                                                           11

    First tour to Canada                                                                1-5

    Second tour to Canada                                                                                                              TBD

    Company costs include: 50,000 NOK to participate in Nordic Initiative and any company travel involved in the program

    To apply to join the Nordic-Canada Health Solutions Initiative please register at: https://goo.gl/forms/5kbW9r463k5SHE593

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Facilitators of our Nordic initiative in Canada

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Odd Arild Lehne, Norway Health Tech
    +47 958 33 144
    oal@norwayhealthtech.com
    www.norwayhealthtech.com

    Kerry Allerton, Ministry of Foreign Affairs of Denmark
    Senior Advisor, Healthcare & Life Sciences
    M. +1 647 631 6947
    kerall@um.dk
    http://um.dk/en/

    Agata Leszkiewicz, Business Sweden
    Project Manager
    T. +1 416 640 7477, M. +1 647 638 1474
    agata.leszkiewicz@business-sweden.se
    www.business-sweden.se

    Lori Woloshyn, Innovation Norway Toronto
    Market Manager
    T. +1 416 920 0434 x124, M. +1 416 271 7327
    lori.woloshyn@innovationnorway.no
    www.innovationnorway.no

    Johanna Tarvainen-Lee, Business Finland
    Sr. Consultant
    M. +1 416 400 1792
    johanna@merenbridge.com
    www.businessfinland.com
                                                             #nordicsolutions
    Andri Marteinsson, Promote Iceland                       to global challenges

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Additional Slides - Innovation in Ontario

               First province to have
               Chief Innovation
               Officer in Healthcare -
               OCHIS

               Dual report - Health
               Minister and Innovation

               Mandate: put $50 B
               health systems to drive
               wealth creation

     http://ontario.ca/healthinnovation

     OCHIS
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