You are on page 1of 122

Ministry of Health Vision Realization Office

Oncology and Mental Health Care Strategy

Transformation Strategy for Oncology and Mental Care


in KSA

A.T. Kearney Technical Proposal - MOH-VRO.28.2018


May 23, 2018
Executive Summary

A.T. Kearney is the best partner to support the development of


a National Strategy for Oncology and Mental Health
Executive summary
What MOH What A.T. Kearney How A.T. Kearney is
seeks proposes different
• KSA is going trough a health system • To develop the national strategies, we • We understand the Saudi
transformation to improve access to propose a 4 step approach supported healthcare context and the
care, elevate the quality of by a fully committed team over 4 transformation vision – Solid
services and ensure sustainability months understanding of the model of care
• As part of the Health transformation, – Understanding the aspiration implementation, current challenges
the MoH is rolling out a new model – Assess current state and future models and objectives for clinical services
of care to enable integrated care – Articulate and detail the strategy • Our approach will be validated by
• In this context, the MoH is seeking – Implementation and evaluation plan on-site visits and international best
support to develop a National practices for pathway design
• Our approach covers from prevention
strategy for Oncology and Mental and diagnose enablement to • Our approach is future proof,
Health to improve clinical services survivorship and beyond based on the art of the possible and
from primary care to highly validated by global case studies
specialized service provision • Throughout the engagement we will
leverage previous work and • We will engage all key stakeholders
• From an initial assessment, specific identified gaps as well as the valuable to ensure collaboration and buy-
challenges have been identified in perspective of patients, clinicians in from day one
the provision of these clinical and senior stakeholders to • Our global experts have done this
services: under-diagnose, suboptimal understand the demand, gaps and – In UK, Italy, Canada, GCC, and
access to treatment, gaps in unmet needs beyond. Our proposed SMEs bring
specialized services, suboptimal the best insights from clinical
geographic coverage, insufficient and • To deliver this, we have assembled a
team of experts including partners, services around the world
highly concentrated skilled workforce,
SMEs and other experienced • We guarantee ownership and
as well as high variability in the
consultants who have deep knowledge feasibility by jointly testing our
supply of medications among others
of health systems across the globe recommendations
Source: A.T. Kearney A.T. Kearney XX/ID 2
‫تعد شركة ايه تي كيرني أفضل شريك لدعم جهود إعداد االستراتيجية الوطنية لعالج مرض‬
‫السرطان والصحة الذهنية‬
‫الموجز التنفيذي‬
‫ما الذي يميز ايه تي كيرني‬ ‫ما تقترحه شركة ايه تي كيرني‬ ‫أهداف وزارة الصحة‬

‫• معرفتنا وإطالعنا عللى نظام الرعاية‬ ‫• نقترح تطبيق خطة عمل من ‪4‬خطوات إلعداد‬ ‫• تشهد المملكة في الوقت الحالي جهود مكثفة‬
‫الصحية في المملكة ورؤيتها في تحويله‬ ‫االستراتيجيات الوطنية‪ ،‬يدعمه فريق متخصص‬ ‫لتحويل نظام الصحة بهدف تحسين قابلية‬
‫وتطويره –عالوة على خبراتنا الواسعة في‬ ‫ومتفرغ لمدة ‪4‬أشهر‪:‬‬ ‫الوصول إلى خدمات الرعاية ورفع مستوى‬
‫تطبيق نماذج الرعاية الصحية ووعينا التام‬ ‫– استيعاب التوقعات والطموحات‬ ‫جودة الخدمات وضمان استدامتها‬
‫بالتحديات القائمة وأهداف الخدمات السريرية‬ ‫– تقييم الوضع الحالي والنماذج المستقبلية‬ ‫ي‬ ‫ف‬ ‫الصحة‬ ‫وزارة‬ ‫• وفي سياق تلك الجهود‪ ،‬تقوم‬
‫• سيتم التحقق من منهجنا من خالل الزيارات‬ ‫الوقت الحالي بتطبيق نموذج الرعاية الجديد‬
‫تدريجيا بهدف توفير خدمات الرعاية المتكاملة – وضع تفاصيل االستراتيجية‬
‫الميدانية والممارسات الدولية المثلى حرصاً‬
‫على التطبيق األمثل للمنهج‬ ‫– خطة التنفيذ والتقييم‬ ‫• ولذلك‪ ،‬تستهدف وزارة الصحة الحصول على‬
‫• منهجنا يتطلع للمستقبل ويستند إلى قدرات‬ ‫• تغطي خطة العمل كافة المراحل بدءاً من‬ ‫المساندة في إعداد استراتيجية وطنية لعالج‬
‫االستشراف التي تدعمها الدراسات الدولية‬ ‫الوقاية والتشخيص وصولً إلى مرحلة ما بعد‬ ‫مرض السرطان والصحة الذهنية سعياً نحو‬
‫المعتمدة‬ ‫العالج‬ ‫تحسين الخدمات السريرية والوصول بها من‬
‫• وخالل مراحل تنفيذ المشروع‪ ،‬سوف نستفيد من‬ ‫مرحلة الخدمات األساسية إلى خدمات‬
‫• سوف نشرك كافة الجهات ذات الصلة حرصاً‬ ‫متخصصة‪.‬‬
‫على التعاون البناء وتقبل النتائج سريعاً‬ ‫الجهود السابقة والفجوات التي تم تحديدها‬
‫باإلضافة إلى فهم توقعات المرضى واألطباء‬ ‫بعض‬ ‫تحديد‬ ‫تم‬ ‫‪،‬‬‫المبدئي‬ ‫التقييم‬ ‫إلى‬ ‫• وبالنظر‬
‫• لقد نفذ خبراؤنا مشاريع مماثلة ‪-‬في المملكة‬ ‫التحديات في توفير تلك الخدمات السريرية مثل ‪ :‬والجهات ذات الصلة بهدف حصر المتطلبات‬
‫المتحدة وإيطاليا وكندا والخليج وغيرها ‪.‬‬ ‫واالحتياجات والفجوات التي يجب تلبيتها‬ ‫عدم دقة التشخيص‪ ،‬عدم القدرة على الوصول‬
‫وخبراتنا تشمل أفضل التجارب الطبية من‬ ‫إلى العالج بالشكل األمثل‪ ،‬وجود فجوات في‬
‫مختلف أنحاء العالم‪.‬‬ ‫• ولذلك‪ ،‬قمنا بتحديد فريق من الخبراء يشمل‬
‫شركاء وخبراء متخصصين واستشاريين آخرين‬ ‫الخدمات المتخصصة‪ ،‬ضعف التغطية‬
‫• نضمن مسؤوليتنا في كافة مراحل المشروع‬ ‫ممن لديهم معرفة وخبرات واسعة في نظم‬ ‫ال‬ ‫المج‬ ‫الجغرافية‪ ،‬عدم كفاية العاملين في هذا‬
‫وقابلية تنفيذه من خالل االختبار المشترك‬ ‫الرعاية الصحية من مختلف أنحاء العالم‪.‬‬ ‫وارتكازهم في موقع واحد‪ ،‬عالوة على التنوع‬
‫لمقترحاتنا‬ ‫الشديد في توفير األدوية وغيرها‪...‬‬
‫‪A.T. Kearney XX/ID‬‬ ‫‪3‬‬
Agenda
• Overview
• Our understanding of the context
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 4


Overview

The healthcare sector is transforming with a vision of a better


future to enhance quality, access and efficiency in care delivery
Vision 2030 overview Non-exhaustive

SAUDI ARABIA: the heart of the Arab and Islamic worlds,


the investment powerhouse, and the hub connecting three continents
Themes VIBRANT THRIVING AMBITIOUS
(selection) 1 SOCIETY 2 ECONOMY 3 NATION
• Promoting culture and entertainment • Establishing special zones • Engaging everyone
• Living healthy, being healthy • Rehabilitating economic cities • Embracing transparency
• Developing our cities • Boosting our small businesses • Protecting our vital resources
• Achieving environmental sustainability • Launching our promising sectors • Being responsible for our lives
• Empowering our society • Building unique regional logistic hub • Committing to efficient spending
• Taking pride in our national identity • Maximizing our investment capabilities • Organizing ourselves with agility

“We intend to provide our health care through public corporations both to
enhance its quality and to prepare for the benefits of privatization in the
longer term. We will work towards developing private medical insurance to
improve access to medical services and reduce waiting times for
appointments with specialists and consultants”.

Source: KSA Vision 2030, A.T. Kearney A.T. Kearney XX/ID 5


Overview

As part of this transformation, a new model of care is being


implemented for holistic care delivery in an integrated way

The six systems of care put the patient at the


center to ensure a transition to a healthier society
What is the new Model of Care?

• It is the establishment of an integrated


system that starts from activating
the citizen's role before entering the
health system
• The system provides the necessary
knowledge to the citizen and enables
Chronic Care

him to take control of his health

Planned Care
Physical wellbeing Mental wellbeing
What are the benefits of the new
Model of Care?
Social wellbeing

• Keep people well, and reach the ill, to


be well again
• Create a sustainable system, and
contribute to a healthier society

Source: KSA Vision 2030, A.T. Kearney A.T. Kearney XX/ID 6


Overview

In the new system, Integrated Clusters are expected to deliver


the new Model of Care strategy to ensure patient centred care

The corporatized system enables the delivery of care

National Holding Company

Five Corporates

Chronic Care

Planned Care
Physical Mental
Integrated Clusters wellbeing wellbeing
Social wellbeing

Highly Specialized
Hospital

Hospital

Primary care center

• Drives changes on the ground to the provision of


• Enables local care delivery of service to focus on the healthcare services
patient • Focus on placing the patient as the center of all
• Develops optimal channels for patients to reach healthcare activities
required care settings • Creates integrated systems of care that activates
citizens’ role in own health
Source: KSA Vision 2030, A.T. Kearney A.T. Kearney XX/ID 7
Overview

In this cluster centred context, specialized services should


consider both a national and a cluster level direction

National / Provision of specialized services criteria: Cluster


Regional • Prevalence / Scale of demand
• Cost impact
Specialized
Specialized
• Resource utilization Services
services

• Conditions with low prevalence, covering • Prevention


Scope of

acute and emergent stages only • Treatment of prevalent conditions


care

• Conditions that require specialized • Screening and post-acute services for rare
equipment and special skills. conditions
Geographic

• Services targeted at the cluster population


scope

• National services
• Services provided within the cluster
• Coverage for one or more regions
boundaries

• Community services
Layers of

• Specialty care, tertiary and quaternary


• Pre-treatment and post-treatment services
care

• Specialized Critical Care Centres within


Secondary care facilities • Primary and general secondary care
services

As the direction is defined, it is important to maintain the continuum of care


across national, regional and cluster services
A.T. Kearney XX/ID 8
Source: A.T. Kearney
Overview

This proposal aims to describe our recommended approach to


deliver Specialized care services for two conditions

• KSA is facing challenges in the delivery of specialized care, areas of opportunity have been identified
in the role of primary care to improve diagnose, the quality of services and the breadth and availability
The situation of services
and ask
• The Ministry of Health has requested support to develop national strategies for Oncology and Mental
Health services to improve access and quality of care across the Kingdom

The developed strategy for Specialized Care should address:


– Lack of appropriate primary care support
Mental Health – Low uptake of screening programs
– Misdiagnosis and lack of or poor follow-up/accountability
– Inefficient referral processes
– Unclear patient pathways
Oncology – Unavailability/lack of awareness of national clinic guidelines
– Medication shortage

Source: A.T. Kearney A.T. Kearney XX/ID 9


Overview

In this context, the MoH is seeking consulting support to design


strategies to improve the delivery of Specialized care
Project objective and scope of work

Project Objective Scope of Work (from RFP)

1 Vision development for each clinical service at


national level

Support the development of 2 Current state assessment and gap analysis

National Strategies for


3 Detailed strategies to achieve the vision nationally
Specialized Care in Oncology
and Mental Health services
4 100-day, 12-month, and 3 years planning
across KSA
5 Evaluation and continuous improvement

Source: RFP A.T. Kearney XX/ID 10


Overview

The future mental health and oncology strategies should


answer five key questions
Mental Health and Oncology Strategies – Key Strategic Questions

TO WHOM the services should be offered?


1
(Which population segments targeted, etc..)
1

2 2 WHAT services should be provided?


(state responsibilities vs informal care, service mix, etc.)

Mental
health WHO should provide The Services?
3 3 (role of different ministries, direct provision vs commissioning, use of
and private sector, role of Clusters, governance, etc.)
oncology

4 4 WHERE should the services be delivered?


(geographic coverage, service model, etc..)
5

5 HOW should the services be funded?


(direct government funding, out of pocket, etc..)

Source: A.T. Kearney A.T. Kearney XX/ID 11


Overview

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
1 2 3 4
Assess Current Develop
Understand the Articulate and Detail
State and Future Implementation and
Aspiration Strategy
Model Options Evaluation Plan

1.1 2.1 3.1 4.1 Develop the


Baseline The Care
Take Stock Of The Articulate The Strategic Implementation
Provision And Demand,
Existing Strategies For Vision And Objectives Roadmap
And Evaluate Future 100 days
The Sector For The Future State
Need roadmap
1.2 3.2
2.2
Understand Key Develop The Sector 1 year road map
Derive Lessons Learnt
Stakeholders View And Strategy and Key
for Best Practices and
Perspective Of The Activities To Reach The 3 years Roadmap
Tailor to KSA Context
Sector Future State Future State
1.3 2.3 3.3 4.2
Develop The Review
Understand Patients Identify and Assess Define the Future
Cycle Plan And
Perspective And Needs Future Model Options Governance Structure
Evaluation Framework

Source: A.T. Kearney A.T. Kearney XX/ID 12


Overview

Introducing your A.T. Kearney team

An experienced project team1

Ira Jerry Ayesha Uliana


Jonathan
Gaberman Cacciotti Kanji Shchepelina
Anscombe
Partner Partner Manager Manager
Partner

Summary of experience Summary of experience Summary of experience Summary of experience Summary of experience
• Head of EMEA • Over 20 years of industry • Over 20 years of • More than 8 years of • Over 9 years of industry
Healthcare Provider, and and consulting experience management consulting consulting and industry and consulting and
Head of Change Mgt with focus healthcare experience in biopharma experience industry experience
sector and healthcare strategy
Areas of expertise Areas of expertise Areas of expertise Areas of expertise Areas of expertise
• Leading or co-leading our • Design of improvements • Has broad experience • Worked with regional • Researched the GCC
support to the MoH in a for clinical and operational across disease hospital system to pharmaceutical and
GCC country to develop a processes for the NHS categories, with particular evaluate its cancer medical devices market,
new healthcare financing • Development and depth in oncology and services epidemiology and
model and to redesign the implement of commercial immunology. • Proposed structure, healthcare systems with
policy for the UK focus specialized care
provider base • Has worked in clinical, organisation and
Department of Health regulatory, and technology requirements • Carried out 50 + market
• Formerly led our support • Worked on information for developing regional research projects,
for many years to the UK commercial strategy in
strategy issues for Health most major geographies cancer centre after including multiple studies
National Heath Service and the Department of reviewing of cancer with focus on care
• Led major transformations pathways and patient
• Spported large complex Health Strategy
of portfolio management centres across the region
journeys of cancer,
transformations in public • Helped to redesign the and R&D decision-making • Created a cancer depression and autism
and private sectors in supply chain of the NHS, processes over the last pathway in collaboration
health, defence, postal, and help set the DH’s decade with a healthcare provider • Supported MoC Dammam
and other sectors approach and its key partners Pilot

Health Practice Health Practice Health Practice Project Manager Project Manager
EMEA EMEA North America (Option 1) (Option 2)

1. Depending on project start date and availability


Source: A.T. Kearney A.T. Kearney XX/ID 13
Overview

Project team will also gain insight and support by our external
experts network, with specific focus on relevant segments
A.T. Kearney external SME network - Selected profiles1
Phil Hope Olga Laskina William Hyslop
Mental Health expert Mental Health expert Oncology expert

• Held the position of Minister of State for Care • For School Health in Russia, developed and • More than 40 years of experience in
healthcare serving in leading positions
Services in the Department of Health tested a correction program for children with
• Supported in the development of National learning disabilities • Led the development of the MD Anderson
Mental Health Strategy in UK, National Autism • Developed a screening program and education Cancer Network as a leading cancer
Strategy, National Dementia Strategy as well as program for teachers to screen mentally academic affiliate network in UK
National Care Service White Paper distressed students • Served as CEO of three general acute care
• Development of the National Care Service • For an NGO, developed and implemented an hospitals
White Paper, the National Dementia Strategy, education program for families bringing up
the National Mental Health Strategy, and the children with autism • Several engagement related to
transformation and setting national healthcare
National Autism Strategy. • For State penitentiary system, developed a
strategy at the country level
• Delivered several lectures or seminars for the program facilitating adaptation of ex-convicts to
Global Health Innovation . live in the society

Laurie Glimcher Steve Kafka Andrew Stainthorpe


Oncology expert Oncology expert Oncology expert

• Appointed as CEO of Dana Farber Cancer • 15 years of experience of business and strategy
Institute / Harvard Cancer Center • 20+ years of healthcare consultation across
experience in pharmaceutical and biotechnology Europe and UK
• Focuses on research related to finding methods industry with focus on targeted therapies in
to combatting cancers from within the human oncology • Supported in development of several national
immune system and international studies related to
• Led a transformation in cancer care where each specialized care, telemedicine, urology,
• Worked on identifying innovative ways of patient’s cancer can be treated at the level of its emergency, medicine and primary care
treating cancer to increase the patient expected molecular blueprint delivery
age • Led the establishment of a molecular • Assessed Patient Access Schemes for
• Supported several initiatives related to information company which support a specialized care including oncology
improving patient outcome transformation in cancer by providing a unique
cancer treatment based on a deep • Ran the interventional procedures program
• Awarded with several awards for her and set up commissioning through evaluation
discoveries in achievement in oncology understanding of the genomic changes
and observational data unit initiatives
1. Depending on project start date and availability A.T. Kearney XX/ID 14
Source: A.T. Kearney
Overview

We are the right partner to help the MoH, in designing the


strategy for oncology and mental health
A.T. Kearney and SMEs value-add

Deep specialized Deep Global and local Differentiated and


care expertise understanding of right team on the accelerated delivery
MoH and system ground approach
partners

From specialized care Collaborative, co- Global A.T. Kearney Respond to


methods & standards, to creating partner aiming team alongside organizational urgency
strong experience in explicitly to develop specialized with immediate support
oncology and mental MoH capabilities with experienced partners and depth of change
health; leading work in deep insight across thinking
transforming the Transformation
specialized care globally Programs
Source: A.T. Kearney A.T. Kearney XX/ID 15
Agenda
• Overview
• Our understanding of the context
– Mental Health
– Oncology
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 16


Our understanding of the context – Mental Health

Mental Health spectrum includes a range of debilitating conditions


affecting almost half of the population in the developed world
Mental Disorder Classification1 High prevalence Life-long struggle
Organic, including symptomatic, mental disorders

Schizophrenia, schizotypal and delusional disorders ~40-50% of the population ~75% of Mental
of the USA and EU suffer Disorders onsets before
from at least 1 Mental
Mood [affective] disorders
Disorder in their lifetime the age of 24

Neurotic, stress-related and somatoform disorders

Behavioural syndromes associated with physiological


disturbances and physical factors
Under-treatment Frequent self-harm
Disorders of adult personality and behaviour
~90% of suicides are
Mental retardation related to mental disorders
~only 41% of affected
population is treated ~ 18% of the deaths of
Disorders of psychological development
young adults is caused by
Behavioral and emotional disorders with onset usually suicides
occurring in childhood and adolescence

Universal access to treatment remains challenging, resulting in unnecessary


suffering and avoidable deaths across the countries
1.ICD-10 classification 17
Source: WHO, Harvard Health, APA A.T. Kearney XX/ID
Our understanding of the context – Mental Health

Life with a mental disorder does not need to be a life of isolation


and misery
Jean Claude Van Damme – Bipolar Disorder
Like many other undiagnosed bipolar sufferers, Van Damme started abusing intoxicating
substances, and found himself in a rehab. At that point in life, he had been divorced twice,
and his third marriage was on the rocks. In rehab, he was diagnosed with bipolar disorder.
Van Damme received adequate treatment and managed to conquer his drug dependency
and recover his family life

John Nash – Paranoid Schizophrenia


American mathematician, Nobel Prize in Economic Sciences. Nash’s schizophrenia initially
manifested itself as paranoia, he believed all men wearing red ties were part of communist
conspiracy against him. In 1959 he was first admitted to a psychiatric hospital. In the next
10 years he had several remissions and acute episodes. He was returning to his work and
family between the episodes. He remained in full remission on pharmacotherapy from
1970 till his death in 2015 at the age of 86.

Dan Aycroyd – Tourette Syndrome, Autism


Canadian comedian and screen writer, 1 Oscar nomination. At age 12, Dan was diagnosed
with Tourette’s. His symptoms were eased in therapy by age 14. At the age of 28 he was
diagnosed with Asperger’s.
Dan believes his particular interests have helped him in his acting career. In his own
words, he was obsessed with ghosts and police, and was carrying a fake police badge
everywhere. This came in handy in his work on Ghost Busters character
Source: A.T. Kearney A.T. Kearney XX/ID 18
Our understanding of the context – Mental Health

Mental Health in KSA went from “statu nascendi” to a relatively


advanced stage…
Development of KSA Mental Health system
Nascent phase Rapid development
• 1st Psychiatric • KSA Mental
hospital was Health Law:
opened in Taif • KSA Mental
(250 beds) – Definition of
and Social Mental
• Tribal rituals Health Atlas is Health
(beaing and published
• 2d Psychiatric – Qualifacation
cautery) to hospital built – Policy
treat Mental of HCP’s
in Medina (36
Ilness in rural beds) • PHC networs WHO – Legislation – Facility
areas is established recommends to standards
• Psychiatric – Budegeting
link PHC
• Illiteracy residency in network wth – Services – Involuntary
impeding KSU has 3 Mental Health admissions
diagnostics trainees – Strategy

1952 1960 1989 1997 2000 2007 2014 2018

• Systematic • MoH
post-grad announced
training in plans to create
psychiatry psy wards in 45
established government
hospitals
A.T. Kearney XX/ID
Source: Centre for Science, Knowledge and Belief in Society, Newman University, Birmingham, International Journal of Psychiatry in Medicine, Open Journal of Psychiatry 19
Our understanding of the context – Mental Health

…achieving sizable progress in human resources and


infrastructure of mental health services
Mental Disease pathway in KSA
Screening & Primary Acute / Post-acute
Pathway
diagnosis treatment urgent care care

• Screening and • Current care is • Acute and urgent • Post-acute services


patient identification predominantly care is provided are provided in
programs have been provided through through specialty specialty care
initiated in PHC specialty care care facilities facilities in out-
Current facilities patient clinics
state – ~75% of • Involuntary
psychiatric patients • Primary care admission is legally
are referred from facilities started limited to SMI1, in
PHC, remaining developing services the situation of self-
25% form general targeting common harm / public harm
hospitals mental health threat
conditions
• The country has a large network of PHC’s
• KSA 986 psychiatrists, 680 within MOH
(2325)
• 3590 psychiatry and neurology beds are
Accomplis • Many of PHC’s have mental health
available across the country
hments capabilities
• Secondary and tertiary facilities are serving
• School Health is piloting mental health
~0.5 mn patients with mental disorders
interventions
1. Severe Mental Illness
Source: Social Psychiatry & Psychiatric Epidemiology 2004, International Journal of Psychiatry in Medicine, MOH Statistic Yearbook 1437 A.T. Kearney XX/ID 20
Our understanding of the context – Mental Health

Areas of development remain around access to treatment,


service portfolio and medications
Key gaps in the current state

1 4 80 to 85% of
Under-
Segregation treatment
diagnostics 50 to 90% of Primary Care delivered in
and symptomatic of somatic
specialty care
suboptimal patients are and mental
Schools & facilities, where
access to missed Secondary treatment
University physical treatment
treatment care
is not available

2 Lack of 5
Metal Health holistic Large segments
Gaps in
services are approach to with no access to
Lack of specialty
currently not integrate specialty care
School services and
available at patients into (children, women,
Mental Health geographical
schools (there is society geriatric patients
coverage
a Pilot running) etc..)

3 6 Primary care
Lack of Community
Community & Specialty care Restrictions physicians have
understandin resources such
NGOs very restricted
g and as support in
rights to
support groups are psychotropic prescription;
within largely not medication supplies are also
communities available Pharmacotherapy restricted

Source: A.T. Kearney, interviews, Mental Health Phase 2 Report A.T. Kearney XX/ID 21
Our understanding of the context – Mental Health

Best in class countries have introduced 5 key improvement


areas to their mental care pathways
Key trends in EU, USA, Canada

• Deinstitutionalization: main burden of screening and treatment is


shifting from isolating Psychiatric hospitals to Community Care
(mainly Primary) facilities, promoting inclusion into the society
1
• Introduction and growing importance of alternative Community Care
2 providers, primarily School Mental Health and Support Groups

• Growing importance of innovation and technology in Mental


Key trends 3 Disorder treatment

4 • Growing ratio of patients on pharmacotherapy

5
• Increasing number of private providers and NGO’s providing Mental
Health relief services

Source: A.T. Kearney A.T. Kearney XX/ID 22


Our understanding of the context – Mental Health

Globally, care is centered on minimizing the effect of the disease


and ensuring long-term inclusion of the sufferer into the society
Mental Disorder Treatment– multi-channel providers network
The patient is at the center of care… … with strong involvement of
community care
Mental Disorder Primary diagnosis, pharmaco-
Sufferer 1 therapy, psychotherapy, health check
Community: Specialized Care according to risk factors
Primary Care Identification of sufferers,
2
1 5 development of correction programs,
destigmatization
GP / Family
Psychiatrist
Specialized 3 Social support, group therapy
physician Primary Care hospital
Treatment of underlying
4 neurological conditions / co-
Community:
School Health
Secondary Care morbidities
2 4 Provide urgent / acute care for
5 severe mental illness, including
involuntary treatment
Neurologist
School
Psychologist
Schools 3 / other
Hospital

Community: Reduced impact on cognitions,


Home Care / Support Groups emotions and behavior
Control of somatic comorbidities
Lower costs

Source: A.T. Kearney A.T. Kearney XX/ID 23


Our understanding of the context – Mental Health

Primary care plays a crucial role in increasing access to long-


term mental disorder management
1 Mental Health in Primary Care

1 Screening / diagnosis 2 Treatment 3 Comorbidity care

• Common Mental disorder • Initiate pharmacotherapy for • Provide physical health


screening according to risk common mental disorders, check according to the
factors: e.g. anxiety / depression disease pathway. E.g.
recommended annual
- Chronic patients (up to • Continue pharmacotherapy comorbidity checks for
50% depression rate) for patients with SMI, initiated patients with bipolar disorder,
in specialty care (e.g. UK:
- Post-natal screening of continue Lithium therapy for
women (up to 20% patients with bipolar disorder) – BMI, physical activity
prevalence of post-birth
depression) • Initiate and provide – Cardiovascular status
psychotherapy for common
- High-risk families (history mental disorders (e.g. group – Metabolic status
of mental disorders etc..) CBT for patients with mild
depression without chronic – Liver function
• Identification of people with disease problems)
behavioural / emotional / – Renal and thyroid function,
cognitive symptoms and calcium level for patients on
referral to specialty / long-term lithium therapy
secondary care for diagnosis

Source: NICE, APA A.T. Kearney XX/ID 24


Our understanding of the context – Mental Health

Primary care physicians in Melbourne are actively initiating


pharmacotherapy
1 Treatment of mental disorders in primary care, Melbourne Example: Australia

GP records, Melbourne, 2009-2014 Share of diagnosed patients on


psychotropic medication
7892
77,466 patient 2747 got RX of
diagnosed with
consultations psychotropic
mental disorder
with GP meds (3.5%)
(10%)

55% 55%
47% 49%
Records of 41% 42%
50 GP’s

2009 2010 2011 2012 2013 2014

Source: Trends in GP prescribing of psychotropic medication, BMC Psychiatry psychotropic medications A.T. Kearney XX/ID 25
Our understanding of the context – Mental Health

Only ~ 70% of diagnosed USA students are treated only within


School Mental Health system
2 School mental health structure Example: USA

• In 75% of cases onset of • Mental Health programs are


mental disorders happens Screening Mental Health rolled out in 80% of the
before the age of 24 in schools USA Schools
• 90% of first behavioral • On average 20% of
signs of mental disorders students ask for support
happen during the school
years • 90% of students referred to
SMH follow up, while only
• Duration and nature of 13% of those referred to
activities makes schools an psychiatrists do
ideal platform for screening

• School education informs • Mentally distressed


students about mental students may be unable to
disorders, prevalence and cope with regular education
nature of common programs
conditions
• Customized programs
• School correction programs within regular or corrective
help mentally distressed classes reduces cognitive
students to learn to impact of mental disorders
communicate with others
Programs fitting
better Destigmatization special needs • Treatment shows positive
correlation with skills

Source: National Association of School Psychologists, American Psychiatric Association, Washington Post A.T. Kearney XX/ID 26
Our understanding of the context – Mental Health

Learning is enhanced by technology to solve some of the


compelling problems associated with mental disorders
2 Technology-enabled solution for auditory processing Example: USA
improvement in patients with ASD1

• Autistic children have difficulties in Fast ForWord Efficacy2


Auditory
auditory processing, as a result,
processing • Students with autism spectrum disorder (ASF)
reading and learning is impaired
significantly improved their language skills after
the use of Fast ForWord software (CELF-3 test)

Average
• Improves processing skills, by 85
combining game and learning Before After
Fast 80
• It is adaptive, meaning students move
ForWord
from slow and easy speech patterns to 75
Software normal speed at their own pace
• Engaging and fun for autistic children 70

Average
Below
65

• Accurate and less exhausting listening


Impact • Natural and less disrupted reading 0
decoding Language skills

1. Autism Spectrum Disorder


2. Results from 128 students measured on a CELF-3 language test
Source: Gemm learning, Scientific Learning, A.T. Kearney A.T. Kearney XX/ID 27
Our understanding of the context – Mental Health

Many countries have developed SMI1 care pathways based on


community care, acute cases managed in specialized facilities
3 Deinstitutionalization of Mental Disorders Example: UK Child Schizophrenia Pathway

Child with
START psychotic
symptoms
Primary

yes yes yes Hospitalize


Clear Hospitali Child in
Develop Child in in are-
diagnosis zation remissio
care plan crisis? appropriate
? needed? n?
facility
Secondary
no no no yes

Offer Offer Offer


Plan to
treatment treatment treatment
monitor for
based on based on based on
3 years
care plan care plan care plan
Home / Community

Deinstitutionalization proved to improve outcomes and reduce costs by


moving care to community facilities and returning patients to labor market
1. Severe Mental Illness
Source: NICE A.T. Kearney XX/ID 28
Our understanding of the context – Mental Health

Community care covers 3 important functions: destigmatization,


information and guidance, support groups
3 Community care beyond home care

NGO’s engaging with opinion leaders to


spread awareness and diminish social
stigmatization of mentally distressed people.
E.g. Mariah Carry talking about her life with
bipolar disorder
Charity organization and initiative
group offering group therapy in
community setting
Destigmatiz
ation
E.g. MIND – one of the leading UK
mental health charities providing Support groups may be
pathway guidance independent or affiliated
with larger organizations.
ReThink offers telemedicine services They often meet at
community locations, e.g.
Information schools, community
Support
and free centres, hospitals etc..
Groups
advice

Source: Mind.org, Rethink.org,, A.T. Kearney A.T. Kearney XX/ID 29


Our understanding of the context – Mental Health

Comorbidity of mental and physical disorders is calling for


integration of mental health and general medicine
4 Mentally distressed patients requiring physical care

Chronic / end of life


patients developing Patients with chronic
depression symptoms pain syndrome
developing depression
symptoms
Patients with mental Patients
disorders with organic requiring mental and
origin physical treatment

Patients hospitalized
Patients with somatic with SMI, having severe
complications of mental physical comorbidities
disorders

Mental Health service is present in the portfolio of general hospitals;


introduction of general medicine in tertiary mental health is yet to be achieved

Source: A.T. Kearney A.T. Kearney XX/ID 30


Our understanding of the context – Mental Health

Specialized care caters to more serious cases in all patient


segments
5 Specialized mental care

Specialized Mental Care


• Covers SMI, with focus on long-
Geriatric Geriatric stay and complex conditions
population: population:
Male Female • Should cover tertiary needs of all
disease groups

Adult population: Adult population: • Should provide specialized age


appropriate treatment
Age

Male Female
• Footprint and referral process
should promote universal access
Pediatric Pediatric
population: population: • Facilities should cover all
segments including forensic and
Male Female prison healthcare

Gender

Source: A.T. Kearney, APA, WHO A.T. Kearney XX/ID 31


Our understanding of the context – Mental Health

As part of the transformation program, MOH is seeking support


to develop a new mental care strategy

Initial assessment of improvement …additional insight is needed in several


opportunities has been conducted.. areas

• What is the target scope for


specialty care?
• What is the optimal footprint?

Specialty • Which community institutions are


care best suited to provide the care?
• How to involve them?

• How to organize seamless


Community patient journey?
care • How to ensure universal
access to care?

Integrated
support

Source: Mental Health Master Report A.T. Kearney XX/ID 32


Our understanding of the context – Mental Health

We identified a set of key questions which we need to address


during the design of Mental Health National Strategy
Key questions

• What should be the scope and objectives of the Mental Health System in KSA?
Scope of services • What is the list of key gaps that need to be prioritized and bridged in the next 12
months? 3 years?

• Which facilities / service layers need to deliver this scope?


• What should be the delivery model (Regional vs Cluster)?
Providers
• How to facilitate the participation of community organizations, particularly in the
areas of education for children with special needs and support groups?

• How to improve screening rates and ensure universal access to care?


• How to de-stigmatize mental care?
Approach
• How to mitigate the impact of the disorders on cognitions, emotions and behavior?
• Which digital tools would help to achieve the KSA objectives in Mental Health?

• How does these services should be funded?


Funding
• How does cost of referred patients should be managed across a clustered system

Source: RFP A.T. Kearney XX/ID 33


Agenda
• Overview
• Our understanding of the context
– Mental Health
– Oncology
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 34


Our understanding of the context – Oncology

Cancer causes deaths more than several extreme diseases


combined, making it a high burden disease for health systems
Cancer disease overview

Cancer can be treated using


Cancer is a group of diseases surgery, radiation,
Definition characterized by the growth and Treatment
chemotherapy, hormone
spread of abnormal cells therapy and targeted therapy

Cancer can be caused by Cancer causes more deaths


inherited genetic mutations, than Aids, tuberculosis, and
Direct cause Impact malaria combined  One is
hormones, and immune
conditions seven death

By 2030, global burden will reach


Tobacco, organisms, unhealthy
External 21.7 Mn new cancer cases and 13
diet and other external factors can Spread
factors Mn cancer deaths due to population
cause cancer as well
growth and age

Cancer is among the leading causes of death worldwide. The burden of the
disease is high and awareness important to inform local cancer strategies

Source: A.T. Kearney A.T. Kearney XX/ID 35


Our understanding of the context – Oncology

KSA has invested in several areas to deliver services to more


than 15,807 patients both locally and internationally…
Current State
Distribution of services in KSA Key statistics about oncology
2014 in KSA

1000 Beds

15,807 patients

120+ oncology specialist

Further analysis is required 1800 patients sent abroad


Major gaps in services available
Other cancer centres
Gaps in services available
Chemo units
Deficits in beds numbers/ radiotherapy machines
Major cancer centres
Most comprehensive provision of care

Source: MoH Oncology report, PWC A.T. Kearney XX/ID 36


Our understanding of the context – Oncology

…MoH hospitals cover a wide range services with different level


of satisfaction
MoH Cancer service providers Not exhaustive

Paediatric
Radiation
oncology

oncology

oncology

oncology

Palliative

medicine
Haemat-
Surgical
Medical

Nuclear
Provider

ology

BMT

care
King Fahad Medical City
Riyadh ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓

KFSH&RC ✓✓✓ Key observations


Riyadh ✓ ✓ ✓ ✓ ✓ ✓ ✓

• Most of providers
King Saud Medical City offers cancer services
Riyadh ✓ ✓ ✓  ✓ ✓✓✓ ✓ 
to patients
King Faisal Specialist Hospital, • Many providers offer
Jeddah ✓ ✓ ✓  ✓ ✓✓✓ ✓ 
only chemotherapy
King Abdullah Medical City • In Southern region,
Makkah ✓ ✓ ✓   ✓✓✓ ✓  cancer patients are
admitted as part of
Al Noor Specialist Hospital
Makkah ✓        other departments

King Fahad Specialist hospital,


Dammam ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓

King fahad Hospital


Medinah ✓ ✓ ✓   ✓ ✓ 
Source: A.T. Kearney A.T. Kearney XX/ID 37
Our understanding of the context – Oncology

Based on initial assessment, challenges have been identified


which need to be addressed in accordance to vision 2030 goals
Healthcare service challenges in KSA

System
gaps
Unavailability
of specialized
care Cost & burden
of disease

A
Several issues are currently faced in the system including pre-treatment services, service distribution,
skilled workforce and supply of medications

B
Several specialized services are not currently available with KSA with improvements
required on others

C
Disease cost is increasing with expectation of an increase in the
prevalence: SAR 400k is spent per patient sent abroad

Source: A.T. Kearney A.T. Kearney XX/ID 38


Our understanding of the context – Oncology

In addition, several gaps have also been identified in the


system that need to be addressed…
A Gaps in the system

Access to primary care support


Screening programmes
Pre-treatment Early diagnosis and follow ups
phase Referral processes
Patient pathways
Awareness and national guidelines

Availability of required oncology consultants, specialists and services

Supply and prices of medicines

Availability of medical equipment

Distribution of oncology providers/ beds across KSA

Source: MoH Oncology report, PWC A.T. Kearney XX/ID 39


Our understanding of the context – Oncology

…as well as, variability and unavailability of services specially


related to screening and diagnosis Available Unavailable service

B Current KSA cancer services against patient journey Illustrative

Recovery
Primary Detection & Triage &
Treatment /Remission /End
prevention screening Diagnosis
of life
Immunisations Genetic screening for
Palliative care / Clinics
against HBV, HPV hereditary cancer
Smoking prevention & Breast cancer Haematology
Clinical examination Monitoring
cessation screening oncology
Obesity & healthy Cervical cancer
Medical imaging Paediatric oncology Survivorship
eating advice screening
Services

Biopsy, Fine Needle Psychological and


Colorectal screening Radiotherapy
Aspiration religious support
Specialized cancer Chemotherapy &
PET scan
screening medical oncology
Molecular diagnosis Cancer surgery
Colonoscopy, Bone marrow
gastroscopy, etc. transplant
Access to primary Limited access to
Deficiencies/ gaps

care services Limited access to Medical shortage supportive services


specialized equipment Lack of awareness of Enablement of
Screening uptake to improve accuracy national clinic Service footprint secondary care
Lack of enablement to and speed of guidelines (concentrated in 3
early diagnosis diagnosis cities) Home care
Inefficient referral process
Unclear referral process
Source: MoH Oncology report, PWC A.T. Kearney XX/ID 40
Our understanding of the context – Oncology

As a result, an increase in the number of cancer patients and


delays in diagnosis and service provision are creating a burden
C Disease burden and cost

Number of new cancer cases in KSA Where is KSA positioned?


2004-2030, number of new cancer cases

+748% 1800 cancer patients were sent aboard in 2016


134,000 costing the government SAR 888 Mn
Projection are based on 2 scenarios
• Incidence rate remains constant
• Incidence rate reaches USA levels
105,357 33% of breast cancer are diagnosed at stage I
in KSA vs 66% in USA
+69%
15,807
9,381 28,643 40% survival rate low compared to other
countries
2004A 2014A 2030F

The number of patients could significantly


increase over the coming years which require Limited clinical research
immediate intervention

Source: MoH Oncology report, PWC A.T. Kearney XX/ID 41


Our understanding of the context – Oncology

Different countries have identified several ways to improve


patients’ outcomes in oncology
Way of improving patients’ outcomes
• An integrated approach goes beyond clinical coordination among health practitioners
Integrated
Approach • True integrated care involves standardized protocols, data availability and information
sharing as well as aligned incentives to enable outcome based care

1 • Survival rates dramatically improve when early diagnose allows the disease to
be confined to the organ of origin
Prevention/ • Cancer prevention and control programs in UK is done through National
Early
2 Diagnose
Cancer Institute
• UK and Australia have a centralized program for screening population based
specific criteria

• Trough treatment innovation, Cancer, once presumed a ‘‘death sentence’’, is


becoming a chronic treatable disease
3 Access to
Treatment
• Recent developments on inhibitor immunotherapies are showing potential
curative scenarios for specific patient segments cures
Innovation • In the U.S. two thirds of cancer patients live at least five years after confirmatory
diagnosis, compared to just over half of patients in 1990
4
Referral models • In advanced health systems, a strong and distributed infrastructure for primary and
for Specialized supportive care is enabled by clear referral pathways that provide access to highly
Care specialized services

1. Saving lives, averting costs. Cancer Research UK. September 2014 A.T. Kearney XX/ID 42
Our understanding of the context – Oncology

Globally, care is centered to support early diagnosis and


reducing the mortality rate of the disease
1 Cancer Treatment– multi-channel providers network

The patient is at the center of care… … with strong involvement of


supportive care
Cancer Sufferer 1 Awareness of the disease with
Community: Research & screening effort
innovation centers
NGOs and support 2 Early diagnostic of patients; defining
groups
1 6 a care plan for treatment
3 Treatment for most common types of
cancer without covering all the needs
4 Access to full spectrum of treatment
Home care
Primary care 5 Home care supported by technological
2 5 tools to provide patients’ services
6 Develop innovative and cost
GP / Family
physician Primary Care 3 4 efficient way to treat the disease
Secondary care Cancer specialized
centers Early detection
Integrated care approach
Effective patient pathway
Source: A.T. Kearney A.T. Kearney XX/ID 43
Our understanding of the context – Oncology

The typical journey of a patient involves a multidisciplinary team


of clinicians from the diagnose to the end stages of the disease
1 Patient journey

Key observations
• Multidisciplinary team
Screening Survivorship (MDT) is key to provide
appropriate treatment
Therapy cycles
decisions and plans
and regimes • Case coordinators1 are
Awareness of Diagnostic & changes Disease progression
Symptoms - Staging
the primary point of
Prevention contact within the MDT
to ensure
Health Hospital – Continuity of care
Treatment choices informatics avoidance – Patient centric approach
Workforce involvement – Reducing access barriers
Case coordinators – Patient education
(MDT)
– Patient adherence to
therapy
Nurse Oncologist Radiologist Nurses, hospices,
Nurse GP Multidisciplinary team
Chemotherapy Surgeon Palliative care

Multiple healthcare providers with no coordinated support increase the likelihood of care
fragmentation, contributing to ineffectiveness, inequality, less adherence and higher costs

1. Case coordinators may be referred to as care coordinators, case managers or patient navigators and are usually healthcare professionals
Source: A.T. Kearney A.T. Kearney XX/ID 44
Our understanding of the context – Oncology

The scope of oncology is broad from a health system perspective,


it involves multiple stakeholders across all treatment stages
1 Treatment stages

Screening and prevention


Screening • Find and identify types of cancer before causing symptoms
and
Prevention Diagnosis methods
Support Diagnosis • Perform tests to identify if symptoms care caused by cancer
group methods
Nuclear methods
• Support in diagnosing and treating cancer at early stages

Turn or council
Home Nuclear • Turn a silent killer into a know disease that can be fought
care methods
Cancer surgery
• Remove the tumour & surrounding tissue during operation
Approach to cancer Medical oncology
patients • Use chemo, hormonal, biological or targeted therapy
Patient Turn or Radiotherapy
follow-up council • Use waves of radiation to teat cancer and tumours

Patient follow-up
• Provide long term support to avoid cancer recurrence

Radioth- Cancer Home care


erapy surgery • Provide stress & side effect management during treatment
Medical
oncology Support group
• Provide moral and emotional support
Source: A.T. Kearney A.T. Kearney XX/ID 45
Our understanding of the context – Oncology

An integrated approach to oncology management should be focused


on improving access, quality and outcomes at a reasonable cost
1 Oncology management approach

• Based on best practices • Delivered by a


and international guidelines comprehensive set of
Care Integrated disciplines involved in
• Inclusive of diagnostic care,
acute treatment, supportive Protocols Care disease treatment
care and palliative care • Driven by coordinated
interactions along the
• Embracing innovative
patient journey
therapies and protocols
• In constant review to • Ensuring timely access to
services, diagnose tools,
integrate up to date clinical
treatment and other support
evidence
areas

• Aligned rewards with care Better access, • Ensuring data availability


protocols and outcome quality and and information systems to
based care outcomes enable clinicians and
providers performance
• Based on a clear set of
metrics to ensure outcomes • Fostering open interactions
and positive performance among providers and easy
access to performance data
• Connecting outcomes with
payer incentives • Enabling outcome and
Aligned performance assessment
Incentives Transparency

Source: A.T. Kearney A.T. Kearney XX/ID 46


Our understanding of the context – Oncology

Prevention is one of the key levers to improve patient outcomes


in oncology
2 Prevention role in improving patients’ outcomes Selected example: NHS

Cancer journey Comprehensive cancer control


Primary Care
Recovery/
survivorship
Prevention Screening Diagnosis Treatment
End of life
care

Psychological & Palliative Care


Early
diagnosis

Screening Treatment
NHS example
• National Cancer Institute in UK have designated cancer
center for cancer prevention and control programs
Palliative
– Early diagnosis and accessible treatment for cancer Prevention
care
are critical
Survivorship
– Effective interventions to prevent cancers exist and are care

very cost-effective (i.e. tobacco control, vaccination, etc.)


– Strategies to address risk factors, including physical
inactivity, obesity, harmful use of alcohol, air pollution and
exposure through collaboration with local communities

Source: A.T. Kearney A.T. Kearney XX/ID 47


Our understanding of the context – Oncology

However, prevention needs to be supported by early screening


and continuous diagnosis based on specific target groups
2 Screening and Diagnosis roles Selected examples

How is screening and diagnosis performed? Symptoms


onset
• In United Kingdom, a centralized organized
screening program exist
– all eligible individuals are invited and re-invited
using a call-recall system
Pre-invasive Invasive Cancer
• Australia has a centralized screening program for
cancer cancer progression
cancer based on eligibility. Diagnosis is managed
based on the outcome of the screening
• On contrasting situation, in the United states, cancer
screening with exception to breast cancer follows an
opportunistic approach and rely mainly on Screenings Diagnosis
physician recommendation, impacting severely the
total cost burden for the health system
Service provided for a Service provided for
target population people with symptoms

Based on UK example, the benefits from population screening resulting in


early diagnosis outweighs the risks in overdiagnosis

Source: NHS; A.T. Kearney A.T. Kearney XX/ID 48


Our understanding of the context – Oncology

To improve outcomes, interventions must be implemented to


address expected barriers and ensure early diagnose
2 Interventions across the patient journey Selected examples

Access to care services and Diagnosis, staging and


Access to treatment
awareness treatment referral
Description
• Health-seeking behaviour awareness • Initial entry point to the health system • High-quality
• Access to health services • Evaluation by the health-care provider • Affordable
• Symptoms appraisal • Staging examinations • Time efficient
Barriers
• Poor health education • Inaccurate and delayed assessment • Barriers related to the following
• Social pressures • Limited access tools and/or pathologic aspects:
• Limited access to primary care methods and staging assessment – Financial
• Uncoordinated services – Geographic and logistical
• No follow up in the process – Sociocultural
Interventions
• Awareness campaigns to enable and • Improvement of diagnosis • Effective treatment including
empower patients capabilities at first point of contact innovative therapies
• Access to primary care • Diagnostic and pathologic • Value assessment frameworks to
• Primary care to become the centre of capabilities are in place and optimized ensure achievement of desired
patients health • Effective referral pathways outcomes
• Activation of primary care referrals to • Integrated care via multidisciplinary • Drug and supplies sourcing
ensure early diagnose and effective teams & care coordinators optimization
screening • Patient support and counselling
Source: A.T. Kearney A.T. Kearney XX/ID 49
Our understanding of the context – Oncology

Supportive care can range from the traditional pharmaceuticals


approach to more effective integrated services solutions
3 Overview of supportive care solutions Not Exhaustive

Drugs & other products Technologies Services

‘Traditional’
Apps, platforms &
Examples

drugs (e.g. G- Integrated care


CSFs, ESAs) websites

Nutrition & Other services


dietary New delivery
mechanisms (e.g. nutrition)
supplements
• Has traditionally covered new
• New products can be acquired in • More challenging to implement &
administration methods to reduce
Overview

the short-term or developed in with unclear ROI, but can deliver


patient burden & increase safety
the long-term lasting improvement & create
• More recently expanding into digital & partnerships with healthcare systems
• Most traditional approach of
mHealth, which can be product- or -
pharma, recently expanding into • Growing appetite for this in certain
oncology specific, or about palliative
nutrition & supplements countries (e.g. US, Spain)
care in general
• A study on 928 patients showed • Easier access to medication • Improve the quality
Benefit

Neulasta can reduce infection • Enhanced symptoms tracking • Reduce the cost
risk by 94% when treated • Tracking of appointments • Improve health outcomes

Pharmacological only Integrated-solutions


ESA=erythropoietin stimulation agent; G-CSF=granulocyte-colony stimulating growth factor
Source: A.T. Kearney A.T. Kearney XX/ID 50
Our understanding of the context – Oncology

Innovation in Oncology treatment and health data is providing


options that are turning cancer into a chronic condition
3 Case for innovative treatments Selected example: USA

Evolution of cancer treatment Distribution of drug types in oncology pipeline


(2005 – 2015)
• 50 years, approach to cancer treatment was a
brute force; using all purpose compounds to 359 586
4% 1% 1% 3%
attach every kind of tumour
9%
17%
• Today, two thirds of U.S. cancer patients live
at least five years after confirmatory diagnosis,
compared to just over half of patients in 1990
• Targeted agents, immuno-oncology and
87%
precision medicine are the focus areas for 78%
oncology R&D, generating curative treatments
• Cancer, once presumed a ‘‘death sentence’’, is
becoming a chronic treatable disease, the
recent development of inhibitor
immunotherapies are showing possible cures 2005 2015
Radiotherapies Hormonals Cytotoxics Targeted

Innovation in oncology treatments together with early diagnose has generated better
prognosis and longer life expectations in recent years

Source: IMS Health, R&D Focus, IMS Institute for healthcare informatics (May 2016); A.T. Kearney A.T. Kearney XX/ID 51
Our understanding of the context – Oncology

More treatment options and longer extensions to life have


resulted in a growing level of expenditure on cancer medicines
3 Cost of innovation
Expenditure on cancer medicines is increasing due to Global Oncology and Supportive Care Costs
more treatment options and longer use of cancer medicines USD Bn, (2011-2015)

11.5% of total drug costs are for oncology treatment in CAGR


104 107
2017 in US compared to 10.5% in 2011
96 6.6%
90 91
Payer agencies are facing issues 15.0%
due to rising drug costs 5.4%

Scrutiny of value is already intense specially in markets


where reimbursement decision are by single payer system 5.3%

Value based frameworks can help in solving issues due to


increase scrutiny of drug prices
7.4%
Innovative agreements between companies & payers
help to minimize payer risk while providing performance base returns

New value assessment frameworks have been developed 2011 2012 2013 2014 2015
by physicians and policy groups along with targeted population
Rest of the world Pharmerging Japan EUS US

As R&D advances produce longer life extensions, access to innovative treatment through
outcome based reimbursement will become a key capability of any health systems

Source: A.T. Kearney A.T. Kearney XX/ID 52


Our understanding of the context – Oncology

In addition, a redefinition of the treatment paradigm can


improve outcomes but may require improved capabilities
3 Implications of the Redefinition of Cancer treatment

Implications
• Stronger screening capabilities
• The use of predictive biomarkers has allowed sub-
populations within cancer types to be identified • Better access to innovative
Personalized therapies
• Overall, this trend has led to an increase in the
Medicine number of personalized medicines that can specifically • Skilled practitioners
target unique cancer populations • Holistic system to segment
patient populations

• Enhanced screening and diagnostics will provide


patients with the health solutions they need to remain
Long Term healthy or manage their disease • Evidence based resource
Treatments • MoH will need strong screening capabilities to enable allocation
clinicians to accurately diagnose and target specific
and effective therapies

• Targeted agents, biomarkers and immune-oncology • Strong HTA capabilities in the


are the focus areas of R&D Health System
Accelerated • These new therapies are enabling the launch of
Innovation multiple innovative medicines targeted at different • Optimized sourcing capabilities
patient segments for drugs and supportive services

Source: A.T. Kearney A.T. Kearney XX/ID 53


Our understanding of the context – Oncology

Consolidation of specialized services can improve quality of


care and provides a platform for the delivery of best practices
4 Referral model for specialized care

Recommended criteria for referral


Specialized Care
• Cancer diagnosis • Psychosocial distress
• Prognosis • End-of-life care • Specialized and rarer cancer services should be linked to
• Physical symptoms needs cancer research institutions that can improve uptake to
Specialized care Hub/ clinical trials and promote translational research in the
Acute care hospitals cancer field
• Acute oncology teams are likely to play a key role in
service development alongside partner organizations in
both secondary and primary care
Cross cancer centres

Supportive Care
PATIENT • Allows for integration of highly specialized cancer
treatment alongside local delivery while avoiding
unnecessary admissions to hubs
• Provides the required information and advice to support
Hospices and • Enable early detection and management of cancer
End of life support Follow up / complications
Survivorship services
Primary care, Home care

Consolidating specialized services reduces duplication of effort, equipment and dilution


of expertise. Supportive care should be sufficiently localized to ensure accessibility
Source: A.T. Kearney A.T. Kearney XX/ID 54
Our understanding of the context – Oncology

Coordination between centralized and localized care ensures


treatment plans can be delivered close to patient’s home
4 Referral model for specialized care

• Acute oncology services aim to improve patient safety, quality of care, and the coordination of
Specialized Care care for all patients irrespective of the place of care and admission route
(National / Regional • The recommendation to further consolidate services is based on the relationship between
hubs) volumes and outcomes and on the wider ambition to provide high quality acute services

• The relationship between specialized and localized services should be balanced to allow
enough volumes for clinical expertise and sufficient local access for patient support
• Clinicians involved in acute oncology will have a critical role in delivering training and education
to all health-care professionals in the wider system

• These outpatient services will need to incorporate extended hours of work and provide
ambulatory care / outpatient procedures
Supportive Care • These services will need to integrate alongside existing acute care services to maximize
(Cluster led) efficiency opportunities
• Capacity is a significant challenge in other areas of cancer care, such as community
chemotherapy and devolved follow-up for low-risk patients.

Source: A.T. Kearney A.T. Kearney XX/ID 55


Our understanding of the context – Oncology

To improve the current state, KSA has set clear patient goals to
be achieved as part of the transformation program
Defined patient goals

Improve access to Shorter travel time to receive


treatment treatment

Reduce
Centralizing complex surgery
complications
Patient
goals More effective treatment
Decrease length
Waiting time reduction
of stay
Improvement in referral process
Quicker diagnosis
Decrease mortality (e.g., improved access to PET scans)
rates Fewer complications

Goals need to further defined to be linked to clear and tangible and outcomes

Source: MoH Oncology report, PWC A.T. Kearney XX/ID 56


Our understanding of the context – Oncology

As part of the transformation program, MOH is seeking support


to develop a new oncology care strategy
Initial assessment of improvement …additional insight is needed in several
opportunities has been conducted.. areas

• What is the target scope for


specialty care?
• What is the optimal footprint?

Specialty • Which community institutions are


care best suited to provide the care?
• How to involve them?

• How to organize seamless


Community patient journey?
care • How to ensure universal
access to care?

Integrated
support

Source: MoH Oncology report, PWC A.T. Kearney XX/ID 57


Our understanding of the context – Oncology

For KSA, a set of key questions need to be addressed as part


of the design of National Strategy for Oncology
Key questions
• What should be the scope and objectives for Oncology Specialty Services in KSA?
• How to enable primary care services to ensure care continuum and access to
Scope of services specialty care?
• What are the key gaps that need to be prioritized and bridged in the next 12
months? 3 years?

• Which facilities / service layers need to deliver this scope?


• How to define where to provide Specialty Care to optimize capacity and ensure
Providers access? (Regional vs. Cluster)
• How to enable the private and third sector to effectively contribute and improve the
Health system?

• How to improve diagnosis and early stages, ensure access to required care and
improve outcomes?
Approach • How to ensure patients get access to the right therapy / treatments?
• How to ensure access to supportive services complemented with a strong referral
pathway?

• How does these services should be funded?


Funding
• How does cost of referred patients should be managed across a clustered system

Source: RFP A.T. Kearney XX/ID 58


Agenda
• Overview
• Our understanding of the context
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 59


Proposed project approach and methodology

A.T. Kearney distinctive approach is grounded on critical factors


that will enable a successful strategy design
Project success factors
• Solid understanding of the transformation, the model of care
We understand the Saudi implementation and the current challenges and objectives for clinical
healthcare context services

Focus on stakeholder • Our work is focused on engaging all key stakeholders to ensure
engagement collaboration and buy-in from day one

Validated by on-site • Our approach will be validated by on-site visits and international
visits and best practices best practices for pathway design

• Our approach is not constrained by today’s reality, and design is


Future proofed approach based on the art of the possible through proven case studies

• We guarantee ownership and implementability by jointly testing our


Ensure ownership recommendations

• Our global experts have done this – In UK, Italy, Canada, GCC, and
Informed by beyond. Our proposed SMEs bring the best insights from clinical
international experts services around the world

Source: A.T. Kearney A.T. Kearney XX/ID 60


Proposed project approach and methodology

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
1 2 3 4
Assess Current Develop
Understand the Articulate and Detail
State and Future Implementation and
Aspiration Strategy
Model Options Evaluation Plan

1.1 2.1 3.1 4.1 Develop the


Baseline The Care
Take Stock Of The Articulate The Strategic Implementation
Provision And Demand,
Existing Strategies For Vision And Objectives Roadmap
And Evaluate Future 100 days
The Sector For The Future State
Need roadmap
1.2 3.2
2.2
Understand Key Develop The Sector 1 year road map
Derive Lessons Learnt
Stakeholders View And Strategy and Key
for Best Practices and
Perspective Of The Activities To Reach The 3 years Roadmap
Tailor to KSA Context
Sector Future State Future State
1.3 2.3 3.3 4.2
Develop The Review
Understand Patients Identify and Assess Define the Future
Cycle Plan And
Perspective And Needs Future Model Options Governance Structure
Evaluation Framework

Source: A.T. Kearney A.T. Kearney XX/ID 61


Proposed project approach and methodology

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
1
Understand the
Aspiration

Key activities Key deliverables


1.1 • Issue data request and collect any relevant documents, • Key stakeholders and players in
and materials that could provide more details and insights the sectors
Take Stock Of The on the mental health and oncology sectors • List of services and
Existing Strategies For • Review and analyze previous strategies by MoH+ beneficiaries profiles
The Sector • Understand the current set up of services • Mental Health ecosystem
• Derive a perspective on the healthcare ecosystem • Oncology ecosystem
1.2
• Interview key stakeholders in MoH and other relevant
Understand Key hospitals working on mental health and oncology • Key Stakeholders perspective
on disease future state for
Stakeholders View And • Interview key stakeholders in MoH, MLSD, and other Mental Health and Oncology
Perspective Of The relevant entities related to mental health and oncology
• Highlight areas of alignment and divergence • Areas of alignment and
Sector Future State divergence
• Understand the services overlap and complementarity

1.3
• Conduct interviews and / or launch a survey
• Evaluate patients demand drivers, satisfaction level, and • Patient perspective on:
Understand Patients
perspective on the public services for Oncology and Mental – Mental Health
Perspective And Needs Health – Oncology

Source: A.T. Kearney A.T. Kearney XX/ID 62


Proposed project approach and methodology

We will start by analysing the existing strategy and issuing data


requests to support our work and hypothesis
1.1 Current state mapping
Existing documents Data requests
Detailed activities
List of service providers
• Prepare and issue a
data request covering
previous strategies,
processes, current state
of facilities offering Readiness assessment
specialized care
• Analyze previous
analysis from Model of
Care reports List of stakeholders

• Identify list of
stakeholders to be
interviewed per area
Current system key components

Source: A.T. Kearney A.T. Kearney XX/ID 63


Proposed project approach and methodology

To map the current state, we will collect the input from all layers
of care (currently operating in silos) and plot it on the pathways
1.1 Current state mapping Example – Mental Health

Mental Health MoC School Mental Mental Health in


Specialty Care
Report Health Pilot PHC
• Use the assessment and • Collect the list of the • Collect the details on the • Gather the data on Al
suggested direction of Pathways planned for current Primary Mental Amal hospitals:
improvement of the Mental implementation in the Health services and future
Health system as a School environment plans – As-is strategy
starting point – Key pathways and
• Gather the input on – Scope (pathways),
success factors (e.g. guidelines guidelines
resources needed, – Key patient segments
availability in KSA) – List of facilities offering
the services • For psychiatric services in
• Collect the info on the secondary care:
Pilot learnings – Current trainings and #
of HCP’s trained – Map services, referral
• Map implementation plans protocols and facilities
and timelines • Collect Cluster planned
changes in Mental Health – Expansion plans
within Moc Rollout

Map as-is for the sector in general and for pathways of top-10 most devastating mental
disorders (depression, anxiety, bipolar disorder, schizophrenia, dysthymia, eating disorders,
childhood behavioral disorders, ADHD, intellectual disability, substance abuse1)
1. Based on BMI DALY data for KSA, may be adjusted based on validated epidemiology and Client demand
Source: A.T. Kearney A.T. Kearney XX/ID 64
Proposed project approach and methodology

We will engage different stakeholders to capture their


perspective about Mental Health and Oncology
1.2 Engage key stakeholders For discussion
Detailed example
on next slide
• Identify stakeholders
Public Discussion topics
VRO Health
and Mental Health
RHDs Public
providers Vision and future Challenges & areas
state of improvements
• Define objectives
Leadership
and priorities
team Social care sector Medication
Private
Suppliers Availability of
Project Key Stake- …
specialists
Team holders
• Provide insight & Internal
industry / SME SMEs Oncology
Vision and future Challenges & areas
state of improvements
MoH+
Primary care access Home care
• Organize and Delivery
facilitate meetings team Clusters
Boards Innovative treatment ….

Engagement of stakeholders will performed by conducting small or one to one


meeting to maximize the input of attendees

Source: A.T. Kearney A.T. Kearney XX/ID 65


Proposed project approach and methodology

To further understand improvement opportunities & applicability


of global best practices, we will perform interviews with KOL’s1
1.2 Understand key stakeholders view Example: Common Mental Disorders
Stakeholders
1 Al Amal Hospitals management:
central and regional Interviews agenda elements
2 • Existing improvement
Primary care Mental Health opportunities per pathway
Program Leads
• Implication on the patient
3 outcomes and healthcare costs
School Mental Health Leads
• Evaluation of global best
4 practices
Psychologists and psychiatrists
working in the secondary care
5
Academia (Deans of psychology
/ psychiatry programs)

Interviews should be dedicated to groups of conditions with similar pathways,


e.g. common mental disorders; severe mental illness etc…
1. Key opinion leaders
Source: A.T. Kearney A.T. Kearney XX/ID 66
Proposed project approach and methodology

In addition to that, we will reach out to key patient associations


to collect patients’ perspectives of future state
1.3 Patient focus groups

Objective Session agenda example


Collect patient perspective and needs for the oncology and mental Mental Health
health including services, providers, home care etc. Time Topic Objectives
Oncology
• Present the overall
Time Topic Objectives
transformation program
Participants 8:00 – 9:00
Overall
transformation
• Present the overall
• Show the importance of the
transformation program
• VRO Team Overall patient in the transformation
8:00 – 9:00 transformation program
• Show the importance of the
• A.T. Kearney • Discuss keyingaps
patient
deficiencies
and
the transformation
program in the system
9:00 – 9:30 System gaps
• Clinical Team from the patient perspective
• Discuss key gaps and
deficiencies in the system
• Patient Association 9:00 – 9:30 System gaps from the the
• Understand patient perspective
future needs
of the patients
Perspective • Understand the future needs
Outputs 9:30 – 10:00 about the • Discuss
of thenext steps and
patients
future state assign a champion for the
Perspective patients’ side to support in
• Patient perspective and needs 9:30 – 10:00 about the • strategy
the Discuss next
designsteps and
future state assign a champion for the
• Patient supports and buy-in for the transformation program patients’ side to support in
the strategy design

Patient focus groups may be supported by surveys to reach out to a bigger


number of patients

Source: A.T. Kearney A.T. Kearney XX/ID 67


Proposed project approach and methodology

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
2
Assess Current
State and Future
Model Options
Key activities Key deliverables
2.1
• Conduct high-level estimate of the demand for mental health
and oncology, incl. of type of service & population
Baseline The Care • Forecast demand to understand future need • Demand/ Supply of mental
Provision And Demand,
• Conduct 10 visits to providers to understand the quality and health
And Evaluate Future availability of supply • Demand/ Supply of oncology
Need
• Understand and evaluate current supply and care provision
• Conduct a supply demand gap analysis

2.2
• Benchmark both sectors for provision, governance, target
Derive Lessons Learnt
population, services, private sector & funding • Benchmarks of mental health in
• Evaluate KSA context and cultural particularities comparable countries
for Best Practices and • Understand the ongoing transformation programs and • Benchmarks oncology in
Tailor to KSA Context evaluate the impact of best practices comparable countries
• Summarize the findings and provide perspective on services

2.3 • Potential Future Models for


• Summarize the finding from previous phases to develop a
Identify and Assess Mental Health
list of potential future models for mental health and oncology
Future Model Options • Potential Future Model of
• Identify advantages and drawbacks of the identified model
Oncology
Source: A.T. Kearney A.T. Kearney XX/ID 68
Proposed project approach and methodology

Market visits and field studies offer insights into quantity and
quality of current service supplies
2.1 Supply & Demand Baseline: Market & Field visits Illustrative

Market Visits and Field Study Objectives & Methodology

• Define the gaps of services across


We will perform 10 site visits regions
from selected care providers – Understand the quality of care and
across different regions patient interaction
Objectives
– Assess the availability of services
and quality
• Understand supply and demand
differences between regions

• Visit facilities across the kingdom


• Assess the service across the patient
journey:
– Registering as patient
Methodology
– Requesting a consultation
Other cancer centres
– Requesting a referral
Chemo units – Getting checked by a nurse and a
Major cancer centres doctor

Source: A.T. Kearney A.T. Kearney XX/ID 69


Proposed project approach and methodology

Understanding current and future supply / demand clarifies gaps


that need to be bridged during strategy development
2.1 Supply & Demand Baseline: Gap Analysis Illustrative

Drivers Example Gaps in the market


Demographic National vs. Expat, age
Profile bracket, gender, etc.

Demand Geographical Geographical areas,


Assessment Segmentation neighborhood, etc.

Socio-economic Income level, Purchasing


factors power, etc.

Private vs. Public Private vs. public clinics

Major center, secondary


Supply hospital, primary care
Setting of Care centers, supportive care,
Assessment etc.
Further analysis is required
Major gaps in services available
Gaps in services available
Scope of service Chemotherapy, Deficits in beds numbers/ radiotherapy machines
radiotherapy, hospices,
and availability palliative care. Most comprehensive provision of care

Source: A.T. Kearney A.T. Kearney XX/ID 70


Proposed project approach and methodology

We will also use a quantitative approach to forecast the


demand of the different diseases
2.1 Forecast demand Example – Oncology: Breast cancer

Calculation logic:
Average incidence Average rate of BC
C2 women # Patients needed
rate of breast diagnosis / person
population to be tested
cancer in KSA tested

Calculation:
22.4 per 100,000 1.5 million Saudi by ~1680 patients/year
10% or lower
women 2020 * 50% women ~32 patients/week

Assumptions & Potential Data Sources to Validate


Independent research Different calculations
NHS Parkside Hospital: ‘One can be applied given
papers Stop’ approach can quickly
assess whether a lump is
availability of local
Or VRO Cluster design: data
MOH Statistical benign or malignant,
Yearbook reassuring 90% of patients C2 population catchment
immediately that their lump
Or is benign and no further
International diagnosis intervention is
Organization Estimates required.

Source: A.T. Kearney A.T. Kearney XX/ID 71


Proposed project approach and methodology

We will benchmark the patient journey vs services in leading


countries to identify potential gaps
2.2 Benchmark & lessons learnt: Understand patient journey Example: Depression

Deliverables: patient journey + unmet needs


Major Depression Postpartum Depression Persistent

Screening Diagnosis & treatment Acute / urgent care Post-acute care

Treated within PHC with Pharmacotherapy in


mental care function or in PHC, psychotherapy
OPD of Al Amal hospital in Al Amal OPD

Typically referred from the well- In-patient treatment is offered


baby clinic with complain on lack mainly in Al Amal hospitals
of energy an various somatic
disorders

Gaps: Few PHC’s offer the service, Location far from home, few No support groups /
50 to 90% of cases pharma supply is female wards are available community care close to
are missed interrupted home

Research will need to be focused on few key disorders to maintain focus and
achieve reliable and extrapolatable insight

Source: A.T. Kearney A.T. Kearney XX/ID 72


Proposed project approach and methodology

We will also prioritize the findings completed in previous steps


to set the way for unifying the vision
2.3 Future models: Areas of improvement prioritization

Areas to be addressed Expected outcome


• Prioritize the findings of the previous Prioritized areas of improvement
steps in order to the set the pave for …
1 Collect expected
2
Define criteria 3 Prioritize areas of
the way forward based on focus areas outcomes previous for prioritization improvement
steps
• Improve early
diagnose Impact Prioritization Matrix

• Enable Oncology Resources


to address
specific needs Time
Key questions to be answered
• … Viability
• What is the criteria to define the • ….
complexity of the initiative?


• How can we measure the impact? ..

• What is the expected timeline?


• Are the resources required to achieve
tangible results available? Alignment of stakeholders
• What is the best way to ensure
• Map of key stakeholders with action plan if necessary
stakeholder alignment?
• Evaluate the stakeholder environment to understand
key influencers, their ability to affect change and
importantly their priorities

Source: A.T. Kearney A.T. Kearney XX/ID 73


Proposed project approach and methodology

Future models will be evaluated to determine which ones are


likely to deliver the best results for the entire system
2.3 Future models: Assessment of different options Recommended Model

Potential Future Models


Criteria Model #1 Model #2 Model #3

1. Alignment to
Core 1 2 4
Government Criteria 1 Criteria 2 Criteria 3
Mandate

2.
Implementation 2 2 2
Complexity Critera1 Criteria 2 Criteria 3

3. Cost Impact 1 3 4
on Government Criteria 1 Criteria 2 Criteria 3

4. Role of 2 3 4
Private Sector Criteria 1 Criteria 2 Criteria 3

5. Alignment
with Current 1 2 4
Throughout the process clinical leaders will be Transformation Criteria 1 Criteria 2 Criteria 3
enabled to design, challenge and test solutions to
support the whole health system Total 1 2 3

1. Present value of future cash flows /Initial investment


Source: A.T. Kearney A.T. Kearney XX/ID 74
Proposed project approach and methodology

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
3
Articulate and Detail
Strategy

Key activities Key deliverables


3.1 • Conduct alignment workshops with key stakeholders to
discuss and validate future model options for both mental • Strategic vision and objectives
Articulate The Strategic health and oncology for mental health
Vision And Objectives • Articulate the strategic vision & objectives for mental • Strategic vision and objectives
For The Future State health based on the future vision for oncology
• Articulate the strategic vision & objectives for oncology
based on future state
3.2 • Identify Key activities & initiatives for strategic objectives
List of prioritized initiatives for
Develop The Sector • Highlight the key enablers and requirements to achieve mental health and oncology
Strategy and Key the future vision (e.g., regulatory requirement, IT
Activities To Reach The requirement, innovation requirement, etc.) List of key enablers and
requirements for mental health
Future State • Prioritize initiatives and develop a wave 1 blue print for
and oncology
the respective strategies
3.3
• Develop the governance structure to delivery strategy • Governance structure for mental
• Clarify the role of MoH 2.0 vs. Clusters vs. Private sector health and oncology strategy
Define the Future vs. Other gov. entities taking into account mandate & role including roles and
Governance Structure
• Define roles and responsibilities of the key stakeholders responsibilities of the different
Source: A.T. Kearney • Define interaction model between the different entities entities
A.T. Kearney XX/ID 75
Source: A.T. Kearney
Proposed project approach and methodology

In step 3, we will deliver alignment workshops to define a vision


for mental health and oncology
3.1 Vision Best Practices

A clear, specific, compelling picture or image of what the system will be and what its defining
Vision attributes will be at a specific time in the future… It can include key results yet to be
accomplished and their expected impact

“A “vision” is therefore
Good Practices Typical Components a picture of a
preferred, desirable
future state that
• Aspirational, inspiring, energizing • Future oriented describes what the
statements describing the future state system will be like in
• Likely to lead to a better future some years from now.
• Crystallizing the rationale for It is a dynamic picture
achieving desired state by providing a • Reflects values of the future that
common, coherent strategic direction • Sets standards of excellence answers the question
“what do we really
• Asserting the systems outcomes to • Clarifies purpose and direction want?”
key stakeholders in ways that will
resonate with them • Inspire enthusiasm and commitment
• Concision, descriptiveness and clarity • Reflects the uniqueness
• Referring to a specific time in the • Ambitious
future

Source: A.T. Kearney A.T. Kearney XX/ID 76


Proposed project approach and methodology

We will further detail the vision into strategic objectives which


will be key in defining the strategy
3.1 Articulation of strategic objectives

1 Vision 2 Stakeholder workshops

Directions set by Alignment


Mental Health workshops with key
and Onco Vision stakeholders

6 Patient voice 3 Existing strategies

Strategic
Patient perspectives objectives Targets defined in
and objectives existing strategies

5 Lessons learnt 4 Current state analysis

Outcome of gaps
Benchmark against
assessment vs
leading countries
future state

Source: A.T. Kearney A.T. Kearney XX/ID 77


Proposed project approach and methodology

The strategy definition will shape the delivery of care in KSA


both for Oncology and Mental Health based on current needs
3.2 KSA focus for future strategy in Specialized Care

• Be designed to cover from prevention, screening


and diagnose enablement to survivorship and Mental Health Strategy
The Specialized Care strategy should:

beyond
• Identify the right patient segments to strategy
• Be based on clear guidelines and governance for addresses Paediatric needs, Women specific
cross cluster activities as well as access to highly requirements and Geriatric needs among others
specialized centres
• De-stigmatize care and increase awareness to mental
• Provide an optimal delivery model in terms of health conditions
National services and cluster led services that are
• Enable communities to dignify living conditions of
aligned with the Model of Care strategy
patients
• Enable private and third sector participation to
improve the delivery of Specialized Care
• Deliver a sustainable model to ensure future Oncology Strategy
capability development based on population needs
• Understand the specific needs of children and
• Be based on best practices, standards and clinical empower Paediatric services
guidelines
• Enable primary care to take a more relevant role in
• Determine what IT and digital systems will be preventing, screening and early diagnose
needed
• Develop an Oncology model that ensures equitable
• Be aligned with all other transformational programs access to primary services, supportive care and
(Corporatization, Model of Care, Workforce, specialized care
eHealth, etc.)

Source: A.T. Kearney A.T. Kearney XX/ID 78


Proposed project approach and methodology

Future Mental Health will be based on integrated pathways1,


involve communities and cater to needs of all patent segments
3.2 Future state: Mental Health Example: Depression

1 National guidelines for depression will be


selected, tailored for layers of care and
cascaded to facilities / academia

Screening 2 Screening for children will be provided through


3
2 School Health, screening for other ages will be
Diagnosis implemented in all PHC’s according to risk factors
3 Diagnosis of depression will mainly be a
1
responsibility of Primary care, with consultations
Standardized
in specialty on as needed basis
guidelines and
tailored education 4 Primary treatment of depression, discreet and
Remission and training for all
layers of care 4 anonymous, to be offered in PHC, with support
6 of community organizations
Primary
treatment 5 Hospitalization for acute episodes to be
offered in gender and age-appropriate facilities
in acceptable proximity to home
Acute 5
episode 6 Patients in remission will be supported in the
community settings according to the care plan,
with monitoring for relapses
1. Prioritized pathways for most critical and prevalent conditions
Source: A.T. Kearney A.T. Kearney XX/ID 79
Proposed project approach and methodology

We will further design the future governance structure to ensure


clear accountability and increase collaboration among players
3.3 Future Governance
Structure
Roles & Responsibilities
Regulatory
Roles & Entities
Entity
responsibilities Input and MoH 2.0
Coordination
Regulatory Set the overall regulation and Advisory Approval
entities law to be followed in the
industry
Care Delivery the services to the Care Delivery
Delivery patients Clusters
Payor Covers all the expenses and Payor /
cost incurred for the healthcare Monitoring / Advisory Financing
Financing National Healthcare Budget
delivery based on specific Oversight
MoH 2.0/ Shared Services
Holdco Support Purchase
guidelines and policies Program
Private sector
Monitoring Monitor and audit the
and third party
compliance with the laws and
regulations defined
Licensing Provide licenses to
healthcare providers in order Patients
to operate

Benchmarks will be used to design the governance and define the roles and
responsibilities of the different stakeholders

Source: A.T. Kearney A.T. Kearney XX/ID 80


Proposed project approach and methodology

Mental Health and Oncology streams will be run in parallel


following a solid approach
Project Approach – Mental Health and Oncology
4
Develop the
implementation roll-
out
Key activities Key deliverables
4.1 • Sequence the identified initiatives for mental health and
oncology • 100-day plan, 1 year plan, and
Develop the • Develop a 100 days plan for mental health and oncology two years plan for oncology and
Implementation mental health
• Develop a 1 year plan for mental health and oncology
Roadmap • Initiatives charters for oncology
• Develop a 2 year plan for mental health and oncology and mental health
• Develop charters for the key identified initiatives
4.2
• Develop the evaluation framework for mental health and • Evaluation framework for mental
Develop The Review
oncology health and oncology
Cycle Plan And
• Develop an implementation review plan for mental health • Review cycle and plan for
Evaluation Framework
and oncology mental health and oncology

Source: A.T. Kearney A.T. Kearney XX/ID 81


Proposed project approach and methodology

Implementation plan will be developed based on a rigorous


prioritization framework and follow a detailed roadmap
4.1 Implementation Roadmap

Segmentation and sequencing of initiatives Implementation Roadmaps

Define the factors need to be considered when


Step-by-step plans for 100-day, 1 year, 3 year
prioritizing initiatives, and map initiatives into
implementations
each prioritized matric

Source: A.T. Kearney A.T. Kearney XX/ID 82


Proposed project approach and methodology

Evaluation & review plan will be defined at the beginning of the


implementation to ensure consistent and high quality work
4.2 Review and Evaluation

Evaluation Framework Implementation Review Plan

Define the format, frequency, content and


Evaluation objectives help in controlling KPIs
personnel involved in the review cycle that align
frequency and evaluation outcomes
with the overall objective of the project

Source: A.T. Kearney A.T. Kearney XX/ID 83


Agenda
• Overview
• Our understanding of the context
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 84


Project timeline

We suggest a structured project plan enabling the phased


approach with strong interlinks of workshops and assessments
Proposed project plan
Activity Week 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16
1 Understand the aspiration
1.1 Take stock of existing strategies (data request & analysis)
1.2 Understand stakeholders perspective and future state
(Perform interviews)
1.3 Understand Patient perspective and needs
(Focus groups / survey)
2 Assess Current State and Future Options
2.1 Baseline care provision, demand and evaluate future needs
(perform site visits)
2.2 Derive lessons learnt from best practices and tailor to KSA
2.3 Identify and assess future model options
3 Articulate and Detail Strategy
3.1 Articulate strategic vision and future state objectives Strategic vision and Future state session
3.2 Develop sector strategy and key activities to reach future state Sector strategy session
3.3 Define future Governance structure Governance validation

4 Develop Implementation plans and


Evaluation framework
4.1 Develop implementation roadmap
4.2 Develop review cycle plan and evaluation framework

Project Project update Project update Project update Project


Key dates kick off delivery

Source: A.T. Kearney A.T. Kearney XX/ID 85


Project timeline

Our delivery approach is based on the following assumptions

Delivery assumptions

■ We have planned a collaborative work with the VRO team, both to create the opportunity for applied learning to deepen
their capability development and to help go deep on the assessment and design of the new strategies. We assume there
will be a core team of Saudi Nationals fully dedicated to the delivery of this engagement, and that people selected for the
roles will bring enthusiasm for the transformation, deep knowledge of and commitment to the MoH system, specially about
the implementation of a new Model of Care

■ While we commit to provide our support in accordance with best industry practice, the success of the project will ultimately
be the result of the joint efforts of the talented people of MoH along with the A.T. Kearney team. The MoH’s ability to create
a widespread momentum and organisational commitment is key to successfully develop and implement the new strategies
for Specialized Care in Oncology and Mental Health

■ Successful delivery of the project within the timelines assumes timely decision making and approvals on the agreed model
and strategies from the VRO leadership, especially the outcomes of the workshops highlighted in the timeline. Attendance
to workshops and leadership sessions is critical for the success of the project

■ Interviews with main stakeholders should take place early in the process to provide initial hypothesis on the strategic
opportunities. Working sessions with clinicians should also be planned well in advance as their availability can be
problematic

■ It is also assumed that the teams will work on a positive environment that enables constructive challenge through expert
opinion and external references as well as internal analysis of the current situation, ambitions and expected outcomes

Source: A.T. Kearney A.T. Kearney XX/ID 86


Agenda
• Overview
• Our understanding of the context
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 87


Leadership commitment & project team

We will jointly work with MoH VRO team to ensure that the
design of national strategy for mental health and oncology
Proposed project organization with significant senior involvement For Discussion

Project Leadership Project Leadership


• Review / approve recommendations
• Help address organizational barriers MoH - VRO A.T. Kearney A.T. Kearney Experts
• Support stakeholder alignment
• Assure project / process quality
• TBD • Ira Gaberman • Phil Hope
• Jonathan Anscombe • Olga Laskina
• Jerry Cacciotti • William Hyslop
• Laurie Glimcher
Project Management • Steve Kafka
Project management
• Plan and oversee project • Andrew Stainthorpe
• Report progress and issues MoH - VRO A.T. Kearney
• Coordinate involvement of subject
matter experts and key client • 1 project manager full • 1 Senior Manager full Project Experts
contacts time time • Assure project deliverables quality
• Manage internal and external • Support in overall delivery of the
communications project
• Facilitate workshops with key
Mental Health Oncology stakeholders if needed
Execution team
• Collate materials and conduct
interviews Execution team Execution team
• Prepare workshop materials
• Conduct analysis and develop MoH - VRO A.T. Kearney MoH - VRO A.T. Kearney
recommendations
• Complete project deliverables • 1,5 full • 2 • 1,5 full • 2
time consultants time consultants
resource full time resource full time

Note: A.T. Kearney delivery team staffing will be finalized on confirmation of project start date
Source: A.T. Kearney A.T. Kearney XX/ID 88
Leadership commitment & project team

We recommend a project governance which allows for senior


guidance and quick decision making
Proposed governance model

Stakeholders Role Meetings schedule

• Provide overall direction for the project


MoH • Once every two
• Provide inputs on project outcomes
Executive Team months
• Authorize any project change requests

• Ratify scope, objectives, deliverables & success metrics


Steering committee / • Support project resource requirements
• Monthly
Project leadership • Ensure project quality
• Make Stage Gate decisions
• Manage project progress, deliverables and risks
Project Management • Conduct analysis, meetings and workshops • Weekly/ as
and Team • Complete project deliverables needed
• Escalate issues as required

• Provide insights and industry / subject matter expertise


A.T. Kearney SMEs
• Participate in quality reviews, bringing constructive challenge • On-demand
and Partners • Participate in workshops as needed

Source: A.T. Kearney A.T. Kearney XX/ID 89


Leadership commitment & project team

Introducing your A.T. Kearney senior support

Project Team1

Ira Jerry Ayesha Uliana


Jonathan
Gaberman Cacciotti Kanji Shchepelina
Anscombe
Partner Partner Manager Manager
Partner

Summary of experience Summary of experience Summary of experience Summary of experience Summary of experience
• Head of EMEA • Over 20 years of industry • Over 20 years of • More than 8 years of • Over 9 years of industry
Healthcare Provider, and and consulting experience management consulting consulting and industry and consulting and
Head of Change Mgt with focus healthcare experience in biopharma experience industry experience
sector and healthcare strategy
Areas of expertise Areas of expertise Areas of expertise Areas of expertise Areas of expertise
• Leading or co-leading our • Design of improvements • Has broad experience • Worked with regional • Researched the GCC
support to the MoH in a for clinical and operational across disease hospital system to pharmaceutical and
GCC country to develop a processes for the NHS categories, with particular evaluate its cancer medical devices market,
new healthcare financing • Development and depth in oncology and services epidemiology and
model and to redesign the implement of commercial immunology. • Proposed structure, healthcare systems with
policy for the UK focus specialized care
provider base • Has worked in clinical, organisation and
Department of Health regulatory, and technology requirements • Carried out 50 + market
• Formerly led our support • Worked on information for developing regional research projects,
for many years to the UK commercial strategy in
strategy issues for Health most major geographies cancer centre after including multiple studies
National Heath Service and the Department of reviewing of cancer with focus on care
• Led major transformations pathways and patient
• Supported large complex Health Strategy
of portfolio management centres across the region
journeys of cancer,
transformations in public • Helped to redesign the and R&D decision-making • Created a cancer depression and autism
and private sectors in supply chain of the NHS, processes over the last pathway in collaboration
health, defence, postal, and help set the DH’s decade with a healthcare provider • Supported MoC Dammam
and other sectors approach and its key partners Pilot

Health Practice Health Practice Health Practice Project Manager Project Manager
EMEA EMEA North America (Option 1) (Option 2)

1. Depending on project start date and availability


Source: A.T. Kearney A.T. Kearney XX/ID 90
Leadership commitment & project team

Project team will also gain insight and support by our external
experts network, with specific focus on relevant segments
A.T. Kearney external SME network - Selected profiles1
Phil Hope Olga Laskina William Hyslop
Mental Health expert Mental Health expert Oncology expert

• Held the position of Minister of State for Care • For School Health in Russia, developed and • More than 40 years of experience in
healthcare serving in leading positions
Services in the Department of Health tested a correction program for children with
• Supported in the development of National learning disabilities • Led the development of the MD Anderson
Mental Health Strategy in UK, National Autism • Developed a screening program and education Cancer Network as a leading cancer
Strategy, National Dementia Strategy as well as program for teachers to screen mentally academic affiliate network in UK
National Care Service White Paper distressed students • Served as CEO of three general acute care
• Development of the National Care Service • For an NGO, developed and implemented an hospitals
White Paper, the National Dementia Strategy, education program for families bringing up
the National Mental Health Strategy, and the children with autism • Several engagement related to
transformation and setting national healthcare
National Autism Strategy. • For State penitentiary system, developed a
strategy at the country level
• Delivered several lectures or seminars for the program facilitating adaptation of ex-convicts to
Global Health Innovation . live in the society

Laurie Glimcher Steve Kafka Andrew Stainthorpe


Oncology expert Oncology expert Oncology expert

• Appointed as CEO of Dana Farber Cancer • 15 years of experience of business and strategy
Institute / Harvard Cancer Center • 20+ years of healthcare consultation across
experience in pharmaceutical and biotechnology Europe and UK
• Focuses on research related to finding methods industry with focus on targeted therapies in
to combatting cancers from within the human oncology • Supported in development of several national
immune system and international studies related to
• Led a transformation in cancer care where each specialized care, telemedicine, urology,
• Worked on identifying innovative ways of patient’s cancer can be treated at the level of its emergency, medicine and primary care
treating cancer to increase the patient expected molecular blueprint delivery
age • Led the establishment of a molecular • Assessed Patient Access Schemes for
• Supported several initiatives related to information company which support a specialized care including oncology
improving patient outcome transformation in cancer by providing a unique
cancer treatment based on a deep • Ran the interventional procedures program
• Awarded with several awards for her and set up commissioning through evaluation
discoveries in achievement in oncology understanding of the genomic changes
and observational data unit initiatives
1. Depending on project start date and availability A.T. Kearney XX/ID 91
Source: A.T. Kearney
Agenda
• Overview
• Our understanding of the context
• Proposed project approach and methodology
• Project Timeline
• Leadership commitment, project team and subject matter experts
• Why A.T. Kearney

A.T. Kearney XX/ID 92


Why A.T. Kearney

A.T. Kearney is uniquely positioned to support MoH VRO in the


development of the strategy for specialized care
A.T. Kearney differentiators
• A.T. Kearney is a leading global management consulting
Global firm with a firm since 1926 globally, and in the GCC for over 40 years
1 strong presence in
• Our Middle East consulting team includes over 200 consultant
KSA
with more than 70 Arabic speakers
Experience with • Successfully supported the pilot preparation and
development and implementation of the Chronic Care pathway in east region
2 implementation of
• Ability to leverage experience by leveraging best practices,
Model of Care
pathways lessons learned and intellectual capital

Proven experience • Deep understanding of the health transformation and the


with multiple KSA KSA landscape, supported by our team’s position supporting
3 government the health reform from different perspectives (MoC pathways,
references rollout plan, CCIs and Corporatization)

Experienced team • MoH will benefit from a senior and highly experienced
with intimate A.T. Kearney team supported by a global expert network
4 knowledge of MoH • Our team has intimate knowledge of all MoH relevant
key stakeholders stakeholders

• A.T. Kearney is known for delivering real impact early in the


5 We make it happen! project and supporting clients until the “Work is done”
• Our collaborative working style sets us apart

Source: A.T. Kearney A.T. Kearney XX/ID 93


Why A.T. Kearney

1
A.T. Kearney is a leading global management consulting firm

A.T. Kearney is a leading global management consulting firm with


offices in more than 40 countries. Since 1926, we have been
trusted advisors to the world's foremost organizations.
A.T. Kearney is a partner-owned firm, committed to helping
clients achieve immediate impact and growing advantage
on their most mission-critical issues.

A.T. Kearney XX/ID 94


Why A.T. Kearney

1
A.T. Kearney is a leading global management consulting firm
with a strong global and Middle East footprint
A.T. Kearney overview
Clients We work with more than two-thirds of the
Fortune Global 500, the world’s largest
companies by revenues, as well as with the most
influential governmental and non-profit
organizations. Europe
Locations A.T. Kearney has 62 offices located in major • Amsterdam • Istanbul • Oslo
• Berlin • Kiev • Paris
business centers in more than 40 countries. • Brussels • Lisbon • Prague
• Bucharest • Ljubljana • Rome
Team We are 3,500 people strong worldwide who • Budapest • London • Stockholm
have broad industry experience and come from • Copenhagen • Madrid • Stuttgart
• Düsseldorf • Milan • Vienna
leading business schools. • Frankfurt • Moscow • Warsaw
• Helsinki • Munich • Zurich

Middle East & Africa


• Abu Dhabi
• Beirut
• Doha
Americas • Dubai
• Johannesburg
• Atlanta • New York Asia Pacific
• Manama
• Calgary • San Francisco • Riyadh • Bangkok • New Delhi
• Cambridge • São Paulo
• Beijing • Seoul
• Chicago • Southfield • Hong Kong • Shanghai
• Dallas • Toronto • Jakarta • Singapore
• Detroit • Washington, • Kuala Lumpur • Sydney
• Houston DC • Melbourne • Tokyo
• Mexico City • Mumbai

Source: A.T. Kearney A.T. Kearney XX/ID 95


Why A.T. Kearney

1
In the Middle East, we have a strong presence, with six
established offices and over 200 consultants
A.T. Kearney presence in KSA and the Middle East
• Since 1926 globally and in the GCC for over 40 years
Turkey
• We hire locally and our Middle East consulting team
includes over 200 consultant with more than 70
Arabic speakers
Lebanon Kuwait
• Six established offices
– Riyadh, Dubai, Abu Dhabi, Manama, Doha, and
Bahrain Beirut
Saudi Arabia Qatar
- Riyadh • A.T. Kearney is strongly committed to the GCC and
Egypt U.A.E has completed 250+ projects
• Direct access to A.T. Kearney’s global network of
industry and functional experts, resources and
Oman methodologies
• Internationally experienced consultants

Formal Office
Operations

We leverage specific expertise of consultants from our global offices and work
in most countries in the region, including GCC countries, Lebanon, Jordan,
Iraq and Egypt
Source: A.T. Kearney A.T. Kearney XX/ID 96
Why A.T. Kearney

1
In the KSA, we have a strong presence, with the following
detailed personal information
A.T. Kearney information in KSA
Information
Legal name A.T. Kearney Saudi Limited - ‫شركة ايه تي كيرني السعودية المحدودة‬
Type of Company / Establishment Limited Foreign

Address Al Khaiyria Building, South Tower, 7th Floor FS07A, King Fahad Road, Olaya,
P.O 25495 Riyadh 11466 KSA
Phone Tel. +966 (0) 11 290 5200, Fax.+966 (0) 11 206 1258
Staff at Tenderer Company / Robert Willen – Partner - Managing Director, Middle East
Establishment (Names & Positions) Mohamed Berrada – Partner (main contact)
Employees at main KSA office 10
Employees globally 3500
Work Permits (License) No 102031119005 issued at SAGIA
Date of issue 15/01/1430 Validity 10 years
Commercial Registration No 1010302463 issued at Ministry of Commerce and Industry dated: 03/03/1432

What we do Next slides


Organization structures Next slides
Years of experience Since 1926 globally and in the GCC for over 40 years
References and similar projects Next slides

Source: A.T. Kearney A.T. Kearney XX/ID 97


Why A.T. Kearney

1
Our expertise spans a wide range of industries and services

What we do
Service Practices

Transformation
Organization &
Policy Council

Sustainability

Supply Chain
Operations &

Production &
management

Management
Marketing &

Technology
Information

Operations
Innovation
Strategy &
Business

and R&D

Sourcing
Strategic

Improv.
Growth
Global

Sales
Financial Institutions

Government &
Economic Development
Industry Practices

Travel, Transportation
and Infrastructure

Communications, Media
& Technology

M&A, Private Equity,


Merger Integration

Pharma and Health

Energy, Petrochemicals,
and Process

Consumer Goods &


Retail
Source: A.T. Kearney A.T. Kearney XX/ID 98
Why A.T. Kearney

1
Our global organization is segmented by region…

Organization chart – Global Board of Directors


(ATK Holdings Ltd)

Managing Officer and


Chairman of the Board
J. Aurik

Global Business
Chief Financial Chief Talent Chief Marketing
General Counsel Policy Council
Officer Officer Officer
R. Zeller P. Laudicina / E.
C. Laurens P. Morgan G. Singer
Peterson

Americas EUROPE, MIDDLE EAST and AFRICA Asia Pacific Practices


EMEA Region Asia Pacific Region
Brazil L. Rossi S. Doshi
S. Machado
Australia/
Africa Benelux DACH2 M. Eastern Europe Greater China Global Practices
Columbia New Zealand
W. Plazier J. Van Der Oord Sonnenschein B. Zibret T. Luedi
M. Fanjul M. Beitle L. Gurski

France Iberia Italy India Japan


Mexico S. Declercq E. Prieto M. Adreassi V. Kishaul M. Kishida Procurement
R. Haneine and Analytic
Solutions1
Southeast
Middle East Nordic UK South Korea3 J. Blascovich
US / Canada Asia
Bob Willen L. Eismark M. Page W. Lee
D. Mahler S. Chua

1. Global organization with European and Asian operations


2. DACH includes Germany, Austria, Switzerland
3. Operates as an affiliated licensee of A.T. Kearney
Source: A.T. Kearney A.T. Kearney XX/ID 99
Why A.T. Kearney

1
…and our Middle East organization is segmented by practice

Organization chart – Middle East


Managing Director
Bob Willen

Finance Administration

HR IT

Government & Travel,


Communications,
Economic Energy and Process Transportation and
Media & Technology Service Practices
Development Industries Practice Infrastructure
Practice
Practice Practice

Strategy, Marketing
and Sales

Procurement &
Analytics Solutions
(PAS)

Operations

Source: A.T. Kearney A.T. Kearney XX/ID 100


Why A.T. Kearney

2
We supported in piloting the HTN and SCD pathways in the
Eastern cluster as well as the MoC roll-out
HTN & SCD pilot experience in Eastern… …and MoC roll-out
20+ Interviews & 10+ A.T. Kearney is supporting
Pilot toolkit
workshops the roll-out planning of the
Model of Care

• Organized interviews with key • Developed a detailed Pilot


stakeholders toolkit (for both pathways) to
• Collected points of view on as- support knowledge transfer and
is and future state scale-up
20+ Sites visit and 100+ Health Care
readiness assessments Professionals trained

• Conducted sites visits and • Launched a robust training


readiness assessment of program involving local HCPs
healthcare providers (from consultants to nurses) to
– Focus on IT capabilities ensure Pilot success
Source: A.T. Kearney A.T. Kearney XX/ID 101
Why A.T. Kearney

3
We have a wide range of experience that can be leveraged
during our work for MoH
Our Relevant experience Selection of cases – Details in appendix

Pathway design
transformation

Mental Health
Model of care

management

Oncology /
Healthcare
Qualifications Country

Disease
1
For a mid-size EU provider of community and mental health services, we
performed a market assessment ✓ ✓ ✓ ✓
We supported in analysing the depression patient journey, identifying gaps
2 and providing recommendations ✓ ✓ ✓ ✓
3 For a leading medical player, we assessed the markets of 5 brain diseases ✓ ✓ ✓ ✓
4
We analyzed the patient journey for cancer treatment and proposed a new
approach ✓ ✓ ✓ ✓
5 For a Department of Health, we supported in designing the Cancer
Commission Toolkit as part of their reform strategy ✓ ✓ ✓ ✓ ✓
6
We helped identify partnering opportunities with the NHS to help improve
funding to cancer services ✓ ✓ ✓ ✓ ✓
We have defined the Clinical Regulatory Strategy for two lead compounds in
7 Oncology ✓ ✓ ✓
8 We developed a strategy for brain health for a leading healthcare player ✓ ✓ ✓ ✓ A.T. Kearney XX/ID 102
Source: A.T. Kearney
Why A.T. Kearney

1 For a mid-size EU provider of community and mental health


services, we performed a market assessment
Selected case study
Mental health market assessment (1/3)

Approach
Market analysis
and competition • Rapid market analysis aiming to provide key
market insights (but not intended to be
comprehensive)
a. Market analysis:
demand side
• High level market segmentation defined to
What are our market structure analysis
segments, their size
and growth? • Using existing fact base, interviews with
key stakeholders, and additional external
b. Market analysis: research where needed
supply side
How competitive is • Market analysis co-developed by trust team
each segment?
with external consulting support1

Source: A.T. Kearney A.T. Kearney XX/ID 103


Why A.T. Kearney

1 Understanding local market, in terms of size, growth and key


segments, is a prerequisite for setting informed strategies
Selected case study
Mental health market assessment (2/3)

Purpose Approach
• Understand our market segments • Core market geography grouped into
distinct segments, aligned to how
• Gain a common understanding of
patients access services and how
local market size and growth
commissioners purchase and
− Size is a key indicator of market manage services
potential/attractiveness
• Fact-based estimates were used
− Growth indicates future size and when needed
determines market dynamics
• Growth estimated based on forward
projections and assumptions relating
to changes in underlying drivers (i.e.
patient needs and commissioner
funding)

Source: A.T. Kearney A.T. Kearney XX/ID 104


Why A.T. Kearney

1 Ten core market segments were identified by the project


team, guided by feedback from network directors
Selected case study
Mental health market assessment (3/3)
Higher Income Segments1 Lower Income Segments1
Adults with inpatient mental
Healthy adults
health needs
Adults with community mental Adults with learning
health needs disabilities
Adults in secure environments Children and adolescents with
mental health needs
Older adults with dementia Children with specialist health
needs
Healthy children
Adults with long-term
conditions
98% of current CLIENT clinical income is captured in these priority market
segments
1. Higher income segments are those accounting for >10% of total CLIENT income; lower income comprise all other segments
2. Mapping of current services to segments, can be found in the Appendix
Source: Clinical Services Contracted Income, as of September 30, 2013 A.T. Kearney XX/ID 105
Why A.T. Kearney

2 We supported in analysing the depression patient journey,


identifying gaps and providing recommendations (1/3)
Selected case study
Depression Patient Journey Overview
Origination & Diagnosis Treatment

1st Episode Recurrent Episodes Complex & Severe


Onset
May recognise Side-effects Side-effects Disability / welfare
Patient Show symptoms symptoms & talk to Go to HCP
someone Adherence issues Adherence issues Home / social care

Treatment
Patient in remission
cessation

Notice change in Talk to


Family / Friends Continuing care
behaviour patient

Work / School / Notice change in Talk to


University behaviour patient

ADD adjustment ADD use Continue ADD use


Notice change in Continuing monitoring &
GP / HCP Diagnosis
behaviour assessment
Psychosocial interventions Periodic assessment

Psychologist /
Psychosocial interventions Psychosocial interventions Continuing treatment
Therapist

Psychiatrist /
• Combine ADDs Management &
Specialist Mental Specialist / enhanced care
• Augment therapy continuing care
Health Services

Patient Associations
Aid recognition & self-diagnosis Raise awareness of options & “own” patient groups Continuing care
/ Social Care

Payers Develop / approve / enforce clinical guidelines and reimbursement / pricing decisions

Process Flow Patient in Remission Critical moments in PJ


Source: A.T. Kearney A.T. Kearney XX/ID 106
Why A.T. Kearney

2 We supported in analysing the depression patient journey,


identifying gaps and providing recommendations (2/3)
Selected case study
Depression Unmet Needs Mapped
Origination & Diagnosis Treatment

1st Episode Recurrent Episodes Complex & Severe


Onset Side-effects Side-effects
May recognise Problems adhering to drugs Problems adhering to drugs Disability / welfare
Patient Show symptoms symptoms & talk to Go to HCP
Lack of treatments for patients
someone LowAdherence
efficacy ofissues
ADDs Adherence issues
Low efficacy of ADDs Home / social care
that want to self-treat
Weight change of patients poorly Treatment Weight change of patients poorly
Patient in remission addressed addressed
cessation

Patients relapsing from remission (drug / non-drug remission)


Notice change in Talk to
Family / Friends Continuing care
behaviour patient

Work / School / Notice change in Talk to


University behaviour patient

ADDto
Difficult adjustment ADDto
predict response use Continue ADD use
Notice change in Inconsistent diagnosis of early Continuing monitoring &
GP / HCP ADD treatment leading to long
behaviour depression symptoms Diagnosis assessment
adjustment periodinterventions
Psychosocial Periodic assessment

Psychologist /
Psychosocial interventions Psychosocial interventions Continuing treatment
Therapist

Psychiatrist / Difficult to predict response to


ADD • Combine
treatmentADDs
leading to long Management &
Specialist Mental Specialist / enhanced care
• Augment
adjustment therapy
period continuing care
Health Services

Patient Associations
Aid recognition & self-diagnosis Raise awareness of options & “own” patient groups Continuing care
/ Social Care

Payers Develop / approve / enforce clinical guidelines and reimbursement / pricing decisions

Process Flow Patient in Remission Feed ‘Treat’ Diagnostic Tool / Service


Source: A.T. Kearney A.T. Kearney XX/ID 107
Why A.T. Kearney

2 We supported in analysing the depression patient journey,


identifying gaps and providing recommendations (3/3)
Selected case study
Depression Business Ideas Mapped
Origination & Diagnosis Treatment

1st Episode Recurrent Episodes Complex & Severe


Onset Side-effects Side-effects adherence Disability / welfare
May recognise Improving adherence Improving
Patient Show symptoms symptoms Treating
& talk to self-
Go to HCP
someone diagnosed Adherence
Improvingissues
adherence Adherence issues
Improving adherence Home / social care
patients Enhance ADDs Enhance ADDs
Treatment
Patient in remission
cessation Depression weight loss
Depression weight loss

Notice change in Talk toNutritional solutions to extend remission periods


Family / Friends Continuing care
behaviour patient

Work / School / Notice change in Talk to


University behaviour patient

ADD adjustment ADD use Continue ADD use


Notice change in Continuing monitoring &
GP / HCP Diagnosis
behaviour assessment
Psychosocial interventions Periodic assessment

Psychologist /
Psychosocial interventions Psychosocial interventions Continuing treatment
Therapist

Psychiatrist /
• Combine ADDs Management &
Specialist Mental Specialist / enhanced care
• Augment therapy continuing care
Health Services

Patient Associations
Aid recognition & self-diagnosis Raise awareness of options & “own” patient groups Continuing care
/ Social Care

Payers Develop / approve / enforce clinical guidelines and reimbursement / pricing decisions

Process Flow Patient in Remission Feed ‘Treat’ Diagnostic Tool / Service


Source: A.T. Kearney A.T. Kearney XX/ID 108
Why A.T. Kearney

3 For a leading medical player, we assessed the markets of 5


brain diseases (1/3) Selected case study
Patient journey, standard of care and unmet
Disease introduction & epidemiology
needs

Available solutions Future solutions

How will the sales and price of Rx develop?


Client will have to compete with generic, reimbursed Rx drugs, which start at $350 a year

Rx competition1

Patients buying (m.) Sales (b. $) Price ($ for full year of usage2)
10 10
9 Pipeline: Antibodies 13.730
8 8
7 Pipeline: Small molecules 1.805
6 6
5
ACHE inhibitors 1.145
4 4
3
2 2 NMDA antagonist 1.436
1
0 0 Generic ACHE inhibitors 359
2012 2021 2012 2021

Reimbursement Healthcare costs on AD per patient ($k4)


• All of the AD brands are reimbursed in the US, but non- Community, mild 27
generic ACHE inhibitors may require considerable co-buys Community, moderate 42
• They are also reimbursed across Europe, with some slight
Community, severe 60
regional differences3
Residential care 52

1. Based on US, Japan, Germany, France, UK, Spain, Germany


2. Average price during available years on the market between 2012-2021
3. E.g. France ACHE inh. only for mild-mod; NMDA ant. Only for mod-severe; Germany: no matter what severity; Italy only ACHE for mild-mod., etc.
4. Annual costs based on UK market
Source: Datamonitor, Alzheimer’s Society A.T. Kearney 82/31438/5ert4rQllQQ6Gky67k 27

Source: A.T. Kearney A.T. Kearney XX/ID 109


Why A.T. Kearney

3 For a leading medical player, we assessed the markets of 5


brain diseases (2/3)
Selected case study
Disease introduction

• Alzheimer’s: A progressive disease with changes in intellectual and Healthy Brain with
brain Alzheimer’s
social skills interfering with day-to-day life, caused by death/
degeneration of nerve and nerve cells
• Mild Cognitive Impairment: A stage between forgetfulness due to age
and dementia, with minimal changes to daily activities, caused by a
lesser degree of the types of brain changes in AD

How is it diagnosed? How is it treated?


There is no specific test to confirm AD/MCI. • AD is treated with drugs, which are not disease-
Doctors will define the most likely cause based on: modifying but only have a limited, temporary
• Information provided by patient/family effect
• Physical exam to test neurological health • For AD, ACHE inhibitors1 and NMDA
• Mental status testing to assess memory Blood antagonists2 increase cell-to-cell commu-
tests and brain imaging to rule out other nication among remaining nerve cells
diseases • For MCI, there is no standard of care. AD drugs
are sometimes prescribed in the US
1. Donepezil, Galantamine, Rivastigmine
2. Memantine
Source: A.T. Kearney A.T. Kearney XX/ID 110
Why A.T. Kearney

3 For a leading medical player, we assessed the markets of 5


brain diseases (3/3)
Selected case study
Disease attractiveness

Size, growth & spend Unmet needs Market players


Prevalence1: • Disease modifying drugs Rx:
• MCI 12-26 m. • Better, simple diagnostic tools to • Limited impact
• Mild AD 3 m. confirm AD/MCI • Some negative side effects
• Moderate AD 2,5 m. • Increased awareness to diagnose • Generic, reimbursed drugs starting
earlier at $350/yr.
• Severe AD 1,5 m.
• Total 19-33 m • New Rx potentially only in 2019

Annual growth: 2% Nutritional Solution:


• “Treat” (cognition) and “feed”
Diagnostic rates: (malnutrition) solutions by Nutricia,
• MCI 10% Nutritional needs Abbott and Client2
• AD 57% • Solutions against malnutrition, as AD • Treat & feed “in 1” in Abbott’s Ensure
patients forget to eat, lose appetite Acti M2, lacking clinical data (data
Treatment rates: for PS ingredient)
and see their taste changing
• MCI 51% (preference for sweet food) • Souvenaid: limited clinical data, high
• AD 76% out-of-pocket price (not reimbursed)
Rx market sales: $4,1b

1. Based on US, Japan, Germany, France, UK, Spain, Germany


2. Incl. Company B and Company C
Note: A.T. Kearney A.T. Kearney XX/ID 111
Why A.T. Kearney

4 We analyzed the patient journey for cancer treatment and


proposed a new approach
Cancer patient journey

Situation Approach Impact and advantage


• A leading healthcare provider Macro project steps • Clear understanding of patient
established a new cancer team, but • Collect and analyze various reports and data needs & concerns shared
lacked a common understanding of throughout the organization
the overall patient journey and Approach and activities
• Collect and analyze various reports and data • Key themes and visions that will be
associated needs of patients
related to cancer treatment, especially patient the foundation of strategy
• A.T. Kearney was engaged to help needs & concerns discussed and agreed in
Client develop a common workshops
understanding of how cancer • Hypothesize the cancer patient journey and map
key bottlenecks for better treatment, coupled with • Cancer patient “portrait” that gives
patients “live with cancer” along
underlying patient needs & concerns richness to internal discussions
their journey, with a view to not only
about patient needs and
understanding key opportunities for • Using the newly developed patient journey, behaviours; it also led to a common
Client but also re-orienting the facilitate discussions to discuss and agree on key
language system that accelerated
organization around the same priorities for the future activities
cross-functional communications
vision and priorities
and collaborations
• Next phase support to deep-dive
into specific cancer types under
discussion

Source: A.T. Kearney A.T. Kearney XX/ID 112


Why A.T. Kearney

5 For a Department of Health, we supported in designing the


Cancer Commission Toolkit as part of their reform strategy
Cancer reform strategy

Situation Approach Impact and advantage


• The Cancer Reform Strategy identified • A stakeholder consultation covering • An intuitive, user-friendly and easy-to-use toolkit was
better information and stronger 100+ practitioners and healthcare made available 10 months after start of the project.
commissioning as two of the key professionals provided a high level
• The tool has been made available to all Cancer Networks
drivers to achieve the goal of view of the requirements for a Cancer
and PCTs for them to use
developing cancer services to be Commissioning Toolkit
amongst the best in the world. • The Cancer Commissioning Toolkit is the "one-stop-shop"
• Detailed analysis on all the available
for commissioning of cancer services. Both providers and
• Cancer is perceived by commissioners national databases was conducted to
commissioners can use the tool to check service
as technically difficult to commission, in understand how to best collate the
performance and benchmark services across tumour sites
addition cancer patients use many different types of information in a
and localities
diverse health services. meaningful way for commissioners and
in accordance with the Cancer Reform • Feedback from users have been extremely positive and
• The development of provider Cancer
Strategy the National Cancer Director endorsed the use of the
Networks has improved service
toolkit in the Cancer Reform Strategy
delivery and created specialist centres, • A prototype toolkit was developed and
a similar approach in the tested in 6 different geographies. After
commissioning side has not happened, a few iterations the toolkit was signed
creating an information dissymmetry off and a 3rd party software provider
between providers and commissioners was engaged to develop a web version
of the tool
• There is a significant number of
national databases containing different
types of information about cancer in
local geographies, but these are not
linked or even widely used

Source: A.T. Kearney A.T. Kearney 12/12/2013 XX/ID 113


/ 593738-0
A.T. Kearney
Why A.T. Kearney

6 We helped identify partnering opportunities with the NHS to


help improve funding to cancer services
Funding strategy

Situation Approach Impact and advantage


• Having established a significant programme • A.T. Kearney where retained for an intense 4 • The A.T. Kearney team, together with the
to tackle capacity issues within Cancer week period to work with the client team to client teams, identified 15+ potential
Networks, the client wanted support to: deliver and a agree a "funding" strategy interventions and evaluated the benefit to a
range of stakeholders (including patients) for
• Exploring the "flow" of funding for cancer • The project was delivered in two
each
treatment in the NHS workstreams.
• This analysis informed a restructuring of the
• Identify and prioritise options the client had to • Using publicly available data, a model was
clients strategic development teams to focus
help improve funding and more efficient use built to breakdown the top-line programme
on specific interventions to help "free up"
of resources budget for cancer services into its consistent
funds or make more effective use of the
services, such as radiotherapy and
funds available, resulting in more effective
chemotherapy, and then into cost lines such
partnerships with NHS organizations such as
as staff, drugs, administration etc
Cancer Networks, PCTs as well as central
• Sensitivity analyses where used to test government
reliability
• The second stream of work, investigated the
various options for influencing these funding
flows from government to clinician
• Workshops with key individuals were held to
identify these options
• Using the model an "order of magnitude"
estimate of the outcome of each option was
given, and together with other inputs, was
used to prioritize the options

Source: A.T. Kearney A.T. Kearney 12/12/2013 XX/ID 114


/ 593801-0
A.T. Kearney
Why A.T. Kearney

7 We have defined the Clinical Regulatory Strategy for two


lead compounds in Oncology
Legal framework

Situation Approach Impact and advantage


• The client has the opportunity of • Attractiveness assessment of possible • Assessment of oncology space and identification of seven
developing a distinctive positioning in indications in oncology, to ensure wide oncology indications (and sub-segments)
oncology, by addressing Cancer Stem development scope
• Advisory Board in place and preparation of Clinical trials
Cells
• Epidemiology assessment plans
• Client was faced with four key
• Competitive landscape • Negotiation strategy with Academia to procure the
challenges
necessary IP
• Analysis of unmet medical needs
• How to design clinical trials in order to
• Shortlist of possible companies interested in in-licensing /
prove the applicability of the results • Facilitation of clinical and regulatory
co-development
across a wide range of commercially strategy definition and set-up of a
attractive indications? scientific Advisory Board
• How to structure clinical trials in order • Structured negotiation strategy (Batna
to accelerate the achievement of methodology) with Academia to acquire
credible results, in a short timeframe needed IP
and without overinvesting?
• Portfolio and pipeline assessment of
• How to negotiate the best possible deal companies possibly interested to in-
with the academic institution co-owner licensing client's candidates
of the indication IP co-owner?
• How to identify the best possible
partner for co-development after Proof
of Concept?

Source: A.T. Kearney A.T. Kearney 12/12/2013 XX/ID 115


/ 523045-0
A.T. Kearney
Why A.T. Kearney

8 We developed a strategy for brain health for a leading


healthcare player

Situation Approach Impact and Advantage


• Client is a leading healthcare player • Structured the program around three • Aligned vision for client success in
areas of focus: the brain health area
• The company has grown through
• Market attractiveness
acquisitions and is now seeking to • Identified 5 priority therapeutic
create focus in the business by • Patient needs analysis segments for strategic focus
developing platform strategies in • R&D and Innovation landscape
different conditions to drive the R&D • Reviewed and re-prioritized existing
strategy, licensing activities and • Conducted a global review and portfolio of R&D projects to align
commercialization priorities segmentation of the mental and with the strategy and identified 2
brain health markets to identify critical new technologies for
• The company works in a matrix priority areas of focus based on investment
structure and therefore building market attractiveness (growth,
commitment across the organization value, policy environment) and • Agreed a portfolio of 12 strategic
to the strategy was a critical success ability to win (client capabilities and initiatives covering
factor reach). Profiled competitors commercialization, new product
development and acquisition to
• Reviewed priority patient pathways support the strategic roadmap
based on expert interviews and
focus groups, identifying treatment • Strategy endorsed and signed off by
paradigm and unmet needs the global board, with quarterly
reviews to assess progress
• Mapped emerging technologies,
state of evidence and players
• Developed a short and mid-term
strategy roadmap to maximize
prospects of the business
Source: A.T. Kearney A.T. Kearney XX/ID 116
Why A.T. Kearney

4
We will mobilize a team of senior and highly experienced
A.T. Kearney consultants with intimate knowledge of MoH
A.T. Kearney team & SMEs1

Team Summary of Experience Team Summary of Experience


Phil • 20+ years of experience in industry and
Ira • Head of Healthcare Provider Hope consulting for healthcare
Gaberman Team Mental health • Development of the Mental Health
• Head of Leadership & Change Mgt Strategy
Partner
Olga • 20+ years of experience in Mental
Leadership

Laskina Health
Jonathan • Over 20 years of industry and Mental Health • Development of several screening
Anscombe consulting experience with focus programs
Partner on the healthcare sector William
• More than 40 years of experience in

Global Experts
Hyslop
healthcare serving in leading positions
Oncology
Jerry Cacciotti • Over 20 years of management
consulting experience in Laurie
Partner biopharma and healthcare strategy Glimcher • 20+ years of experience in oncology
Oncologyert now serving as CEO of Harvard Cancer
center

Ayesha Kanji • More than 8 years of consulting


Steve • 15 years of experience of business and
Management

and industry experience with focus


Manager on oncology Kafka strategy experience in pharmaceutical
Project

Oncology and biotechnology industry with focus


on targeted therapies in oncology
Uliana Andrew • 20+ years of healthcare experience with
• Over 9 years of industry and
Shchepelina Stainthorpe focused on specialized care
consulting and industry experience • Development of research and training
Manager Oncology
for specialized care
1. Depending on project start date and availability
Source: A.T. Kearney A.T. Kearney XX/ID 117
Why A.T. Kearney

4
We have built an intimate knowledge of MoH and MoH key
stakeholders through four engagements in the past 2 years
A.T. Kearney knowledge of MoH

Project Description Year

Insurance and Purchasing of For a GCC Ministry of Health designed the 2017
A Healthcare Services strategy, structure and implementation plan for
the payer-provider split

Corporatization of the Healthcare Implementation of a complex transformation to 2017


system Corporatize the Healthcare system and
B improve delivery of care

Chronic Model Pilot Detailing and piloting of the new approach to 2017
treating Chronic patients
C

Roll out plan for the Model of Care Develop the national rollout plan for the piloted 2018
Model of Care pathways, including a national
D strategy, a plan to adjust pilot implementation
based on each region/cluster particularities
and the estimated budget required

Source: A.T. Kearney A.T. Kearney XX/ID 118


Why A.T. Kearney

5
We will engage project team members from MoH VRO with a
collaborative and co-creating working style
A.T. Kearney collaborative style of work
Cooperation and continuity Client’s involvement Know-how sharing & Coaching
MoH &
project
leadership

A.T. Kearney
Co- MoH VRO
creation A.T. Kearney

• We work with our clients – not on • We work “side-by-side” with our • A.T. Kearney consultants will be
our clients, to deliver immediate clients to drive change straight sharing their know-how with
impact and growing advantage from day one MoH VRO managers
• Develop new ways of interacting • Strong internal buy-in and drive • Strong interaction during
with clients adapting the to change project
approach to specific needs

Collaborative approach is part of our DNA … engaging our clients, motivating


them to want to change, and working with them to make change happen

Source: A.T. Kearney A.T. Kearney XX/ID 119


Why A.T. Kearney

5
A.T. Kearney is known for delivering real impact early in the
project and supporting clients until the “Work is done”
A.T. Kearney way of working
A.T. Kearney Positioning vs. Competition Our Approach and Philosophy
+
“Pure Strategy Our
consulting firms” A.T. Kearney Promise Immediate Impact, Growing Advantage
(e.g. McKinsey) “Strategy and
concepts into
tangible results”
Strategy

“Implementation How we
oriented consulting deliver
firms” (e.g. Booz&Co)
Forward-
Collaborative Authentic
“Big Four” thinking
(e.g. KPMG)
• Strategic reasoning • Pragmatic approach
“Technical • Content leadership • Results orientated
consulting firms”
(e.g. Detecon)
• Collaborative and • International benchmarks
pragmatic working style • Industry experienced
• Adapting to the local people
- Implementation + culture • Hands-on support

A.T. Kearney's end-to-end focus supported by a collaborative working style,


truly allows us to turn strategy into results

Source: A.T. Kearney A.T. Kearney XX/ID 120


Why A.T. Kearney

To contact any of our previous clients, please refer to Mohamed


Berrada to arrange for that

Mohamed Berrada
Mohamed.Berrada@atkearney.com
A.T Kearney Saudi Limited
King Faisal Foundation Building
South Tower, 7th Floor, Office FS07A
King Fahad Highway, Olaya District
Riyadh, Saudi Arabia

+966 (11) 290 5238 Office


+971 56 503 0714 Mobile

A.T. Kearney XX/ID 121


A.T. Kearney is a leading global management consulting firm with offices in 40 countries. Since 1926,
we have been trusted advisors to the world's foremost organizations. A.T. Kearney is a partner-owned firm,
committed to helping clients achieve immediate impact and growing advantage on their most mission-critical
issues. For more information, visit www.atkearney.com.

Americas Atlanta Boston Chicago Detroit Mexico City San Francisco Toronto
Bogotá Calgary Dallas Houston New York São Paulo Washington, D.C.

Asia Pacific Bangkok Hong Kong Melbourne Perth Singapore


Beijing Jakarta Mumbai Seoul Sydney
Brisbane Kuala Lumpur New Delhi Shanghai Tokyo

Europe Amsterdam Copenhagen Ljubljana Moscow Prague Warsaw


Berlin Düsseldorf London Munich Rome Zurich
Brussels Istanbul Madrid Oslo Stockholm
Bucharest Lisbon Milan Paris Vienna

Middle East Abu Dhabi Dubai Riyadh


and Africa Doha Johannesburg

A.T. Kearney XX/ID 122