Coloplast A/s Class B · OMXCOP:COLO_B
Coloplast A/s Class B — Investor Day (September 2009)
34 slides from Coloplast A/s Class B's investor day presentation, Sep 29, 2009
Slide 1: How Healthcare is Paid in the US
Coloplast Capital Market Day 2009 How Healthcare is Paid in the US Coloplast p Capital p Market Day y 2009 Russ Miller, Director of Reimbursement 29 September 2009 How Healthcare is Paid in the US Page 1
Slide 2: The U.S. Health Insurance Environment and its Applicability to Coloplast Products
Coloplast Capital Market Day 2009 The U.S. Health Insurance Environment and its Applicability to Coloplast Products Providers Patients Coloplast Corp. Government Private Payers Payers Suppliers Employers p y 29 September 2009 How Healthcare is Paid in the US Page 2
Slide 3: How Healthcare is paid in the U.S.
Coloplast Capital Market Day 2009 How Healthcare is paid in the U.S. Employers Insurance Claims Payers Reimbursement Providers Reimbursement surance Claims Product Sales s Payment Patient R Ins P Product Sales Suppliers Payment Coloplast Corp. 29 September 2009 How Healthcare is Paid in the US Page
Slide 4: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and P Payment) t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29 S
Slide 5: Health Insurance by Payer Segment
Coloplast Capital Market Day 2009 Health Insurance by Payer Segment Lives (millions) Medicare 40.2 Employment-based insurance (Private Payers) 174.8 Directly purchased/Individual market (Private Payers) 26.8 Medicaid 38.1 Military healthcare coverage 11.2 Uninsured 46.6 Total Coverage Arrangements 3
Slide 6: Payer Mix for Product Categories
Coloplast Capital Market Day 2009 Payer Mix for Product Categories Medicare Medicaid Private Self Payers Pay Surgical Urology ▪ Men 68% 30% 2% ▪ Women 40% 60% Continence Care 63% 37% Ostomy Care 70% 30% Wound Care 40% 25% 25% 10% 29 September 2009 How Healthcare is Paid in the US Page 6
Slide 7: The Medicare Program
Coloplast Capital Market Day 2009 The Medicare Program: For people age 65+ or with certain disabilities. Types of Medicare Insurance: Part A – Inpatient Hospital Care, Skilled Nursing Facilities, Home Health Care Part B – Physician Services, Outpatient Hospital, Medical Supplies, Ambulatory Surgery
Slide 8: The World of Private Payers
Coloplast Capital Market Day 2009 The World of Private Payers Private sector companies p who administer health p plans that utilize governmental or private sector dollars ¾ Approximately 1500 – 1700 private health insurance companies 29 September 2009 How Healthcare is Paid in the US Page 8
Slide 9: Private Payers in the U.S.
Coloplast Capital Market Day 2009 Private Payers in the U.S. Private health insurance companies p operate p as: ¾ Health Insurance Companies (for individuals or groups) ¾Third Party Administrators (for employers or unions) ¾ Government Contractors (for the Medicare program) 29 September 2009 How Hea
Slide 10: Medicaid
Coloplast Capital Market Day 2009 Medicaid A state state-administered administered insurance program for low-income low income persons: ¾ Who are aged, blind, disabled or low-income families with dependent children ¾ Who receive public assistance ¾ Other low income disabled groups with high medical
Slide 11: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and P Payment) t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29 S
Slide 12: Product Categories by Provider/Supplier Type
Coloplast Capital Market Day 2009 Product Categories by Provider/Supplier Type SU CC OC WC SC Hospital Inpatient Parrt A g Facilities Skilled Nursing Home Health Agencies Physician Practices p Hospital Outpatient p / Clinic Ambulatory Surgery Centers Medical Supplies (home use) N/A - Primary - Secon
Slide 13: Providers and Suppliers
Coloplast Capital Market Day 2009 Providers and Suppliers A healthcare system of multidisciplinary providers owned or affiliated under common Integrated Delivery management. May include several hospitals, physician groups, rehabilitation centers, home Network health agencies, long-term care faciliti
Slide 14: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and d Payment) P t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29
Slide 15: The Building Blocks of Reimbursement
Coloplast Capital Market Day 2009 15 The Building Blocks of Reimbursement • Coverage: Defines the clinical conditions of a service or technology. • Coding: The nomenclature used to classify medical services, supplies and g diagnostic categories. g Required q for filing g insurance claims with p paye
Slide 16: The Building Blocks of Reimbursement
Coloplast Capital Market Day 2009 The Building Blocks of Reimbursement M di Medicare Pi Private Payers P Coverage Policies National / Local Made by each entity Coding Systems Universal Payment Systems S Defined f system for f Often adopt Medicare Of each site-of-service site-of-service structure / p
Slide 17: Coding – The Language of Reimbursement
Coloplast Capital Market Day 2009 Coding – The Language of Reimbursement CPT ® Coding (Current Procedural Terminology) – used for reporting procedures and services performed by physicians. HCPCS Coding (Level II) – identification of devices, drugs, and supplies. ICD-9-CM Procedure Coding – identific
Slide 18: Coding drives Payment
Coloplast Capital Market Day 2009 Coding drives Payment XX = payment ‘driver’ driver x = required, required but not a payment driver C di Coding Site-of- CPT ICD-9 ** HCPCS ICD-9 Service Procedure Payment Diagnosis Medical Fee Supplies X XX Schedule ** Critical for meeting payer coverage requirement
Slide 19: Coding drives Payment
Coloplast Capital Market Day 2009 C di d Coding drives i P Paymentt XX = payment ‘driver’ x = required, but not a payment driver Coding Site-of- CPT ICD-9 ** HCPCS ICD-9 Payment Service Diagnosis Procedure Hospital H it l Outpatient XX X X APC Group (PPS) Hospital Inpatient XX XX MS-DRG (PPS) Physic
Slide 20: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and P Payment) t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29 S
Slide 21: Medicare Prospective Payment Systems
Coloplast Capital Market Day 2009 Medicare Prospective Payment Systems ¾ Hospital Inpatient and Outpatient Example: Virtue Male Sling System Inpatient (choose 1) Outpatient MS-DRG 662 $15,690 APC 385 $6 447 $6,447 MS-DRG 663 $7,752 MS-DRG 664 $5,762 Benchmark • > 24 hour stay (patient in bed). • < 2
Slide 22: Private Payer Reimbursement is critical for Hospital Profitability
Coloplast Capital Market Day 2009 Private Payer y Reimbursement is critical for Hospital p Profitability 132% 140% Community Hospital Payment-to-Cost Ratios by Source, 1980-2006 in 2007 130% 120% 110% 100% 90% Private Payers 80% Medicare Medicaid 70% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
Slide 23: Medicare Fee Schedules
Coloplast Capital Market Day 2009 Medicare Fee Schedules ¾ Physician y and Ambulatoryy Surgery g y Center Example: Virtue Male Sling System Physician Fee Ambulatory Surgery Center CPT $905 CPT $4,811 53440 53440 • Formula-driven Payment • Factored from the Hospital • Relative Value Units (RVUs) Outp
Slide 24: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and P Payment) t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29 S
Slide 25: Insurance Reimbursement
Coloplast Capital Market Day 2009 Insurance Reimbursement Two Important p Variables ¾ A Reimbursement Rate that allows for Supplier Margin ¾ A Utilization Rate that reflects Accepted Clinical Practice Defined by Coverage Policies Medicare Product Rate Utilization One-Piece Ostomy Pouch $4 99 $4.99
Slide 26: Agenda
Coloplast Capital Market Day 2009 Agenda • Payers • Providers and Suppliers • Insurance Transactions (Coverage, Coding and P Payment) t) • Insurance Reimbursement for the Surgical Urology Patient • Reimbursement for the Ostomy, Wound or Continence Patient • Reimbursement for Med Tech Innovation 29 S
Slide 27: Reimbursement definition and why it matters
Coloplast Capital Market Day 2009 re'im·burse'ment n. – a.)) repayment p y for expenses p incurred,, b.) payments given to healthcare providers for services rendered or supplies provided, base on benefits covered under an insurance plan. …but more importantly… It’s a critical factor for: ¾Determinin
Slide 28: From a Foundation of Clinical Effectiveness
Coloplast Capital Market Day 2009 From a Foundation of Clinical Effectiveness Patient Access and Utilization Coverage Coding Customer Payment P t Acceptance Evolving in Importance Health Clinical Economic Effectiveness Outcomes 29 September 2009 How Healthcare is Paid in the US Page 28
Slide 29: How Medicare determines coverage
Coloplast Capital Market Day 2009 How Medicare determines coverage ““No payment may be made under [Medicare] ffor any expenses incurred for f items or services [that] are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed bod
Slide 30: How Private Payers determine coverage
Coloplast Capital Market Day 2009 How Private Payers determine coverage ¾ Few payers have published clinical criteria criteria. Technology Evaluation Center Criteria 1. The technology must have final approval from the appropriate governmental regulatory bodies 2. The scientific evidence must p permi
Slide 31: New Coding requires Clinical Evidence
Coloplast Capital Market Day 2009 New Coding requires Clinical Evidence Requirements AMA Website – Requirement q for New CPT Coding:g ¾ “…the clinical evidence of the service/procedure is well-established and documented in U.S. peer-reviewed literature.” CMS Requirements - HCPCS Request Process: ¾ R
Slide 32: Successful Execution of Concurrent Pathways
Coloplast Capital Market Day 2009 Successful Execution of Concurrent Pathways Execute Payer Coverage Tactics ce Clearanc 12 mos. 24 mos. 36 mos. C Secure Coding Secure Payment Class 29 September 2009 How Healthcare is Paid in the US Page 32
Slide 33: Reimbursement / Health Economic Assessment Model
Coloplast Capital Market Day 2009 Reimbursement / Health Economic Assessment Model Integrate A Analyze A. A l th Pathway the P th &E Environment i t in AIM Process F Monitor & Revise F. B2. Determine “Fit” B1. Analyze Execution of the Competing Therapies Proposed Therapy D. Strategic g Plan C. Gap A
Slide 34: Coloplast Capital Market Day 2009
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