RegionStockholmHealth Impact BondNovember 2020
Our vision is an
attractive, sustainable
and growing Stockholm
region with freedom for
its residents to shape
their lives and make
active decisions.
Trends, challenges and costs
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▪ Increasing costs for health care due to:
▪ Elderly population
▪ Increased costs for medicines
▪ Inefficient business models
▪ Most money is spent on the treatment of sick patients when more money is needed to be spent on prevention.
Global trends in health care
5%2,5bn
of yearly health care budget
SEK2017
Cost of diabetes for Region Stockholm
Solution: we have to flip the pyramid!
Integrated primary care
Self management
Hospital
Primary care
Self
mgmt
3
Hospital
Region Stockholm Prevention Methodology
4
▪ Scalable and digital prevention that could be offered to all prediabetics in the county
▪ Investment case modelling
▪ Structuring & issuing an instrument for outcome-based financing – a Health Impact Bond (HIB)
5
▪ Scalable and digital prevention that could be offered to all prediabetics in the county
▪ Investment case modelling
▪ Structuring & issuing an instrument for outcome-based financing – a Health Impact Bond (HIB)
Region Stockholm Prevention Methodology
2. Health coaching3. Marketplace Health
Services
1. Screening
I have
insight!
I have knowledge
and understand!
I have a plan
and resources!
I have the
right support!
Alcohol
habits
Sleep
Stress
Physical activity
Nutrition
Smoking
habits
This is how the type 2 diabetes prevention programme works
6
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▪ Scalable and digital prevention that could be offered to all prediabetics in the county
▪ Investment case modelling
▪ Structuring & issuing an instrument for outcome-based financing – a Health Impact Bond (HIB)
Region Stockholm Prevention Methodology
Cost of overconsumption of diabetes related healthcare for patients with type 2 diabetes in Region Stockholm
0,0
5000,0
10000,0
15000,0
20000,0
25000,0
30000,0
35000,0
40000,0
-728 -546 -364 -182 0 182 364 546 728 910 1092 1274 1456 1638 1820 2002 2184 2366
Female
Male
152 000
240 000SEK
9
Number of days before and after the first diagnosis
10
▪ Scalable and digital prevention that could be offered to all prediabetics in the county
▪ Investment case modelling
▪ Structuring & issuing an instrument for outcome-based financing – a Health Impact Bond (HIB)
Region Stockholm Prevention Methodology
Shorts fact about the Health Impact Bond
▪ Amount: SEK 30m
▪ Maturity: 5yr
▪ Investor: Skandia
▪ Intermediator: SEB
▪ Interest: based on the outcome of a diabetes
type 2 prevention
▪ Use of proceeds: the proceeds from the bond
will be used to finance a prevention
programme for up to 925 prediabetic
individuals in Stockholm County
▪ Documentation: the documentation is based
on standard stand-alone SEK bond
documentation
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Financial Structure of the Health Impact Bond
-5,00%
-4,00%
-3,00%
-2,00%
-1,00%
0,00%
1,00%
2,00%
3,00%
Success rate
Yield floor (the minimum accumulated return over the
5-year period is -20%)
Yield cap (the maximum accumulated return over the
5-year period is 10%)
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Advantages of the Health Impact Bond
▪ A new type of bond specifically adapted for institutional investors.
▪ Can be a model for similar initiatives, making it easier to enable investments of large amounts of capital in other diabetes projects or within other health areas.
▪ Risk-sharing with external investors, who receive a return based on the outcome of the prevention.
▪ A unique funding model that enables large-scale prevention.
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Health Impact Bond: target group, inclusion & evaluation
▪ People interested in participating will be asked to answer the scientifically proven questionnaire of FINDRISK online to evaluate risk level
▪ For those with a high risk level, a blood sample will be drawn in order to establish prediabetic stage (HbA1c 42-47)
▪ Every year participants will be measured on the following values: a) Weightb) Waist circumferencec) HbA1c (blood sugar)
▪ 50-60 years▪ Special effort to
ensure sufficient participation from men
▪ Aim to include 925 pre—diabeticindividuals
Target group EvaluationInclusion criteria
Impact success: As long as the participants´HbA1c value are within normal range
i.e below 42, the participant’s risk is to be regarded as in line with the non-diabetic population and the saving to be regarded as 50% (initial risk level) of the total over consumption cost of diabetes related care.
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