McKinsey

1
McKinsey Company our perspectives on achieving
impact in health system reform
January 2009
2
CONTENT
Situation today
Achieving impact in health systems reform
McKinseys health systems practice
Examples of our work
Appendix
3
HEALTHCARE REFORM IS A TOP ISSUE GLOBALLY
16
Improving healthcare is a top public priority in
every country . . .
. . . but where to start?
Health systems are complex . . .

• Difficult to determine what to do
• Quick wins are hard to identify
• Success is hard to measure

Percent per country ranking health as the top
personal concern
Poland
Russia
China
Bulgaria
Rapid change is difficult . . .

• Many stakeholders, most with different interests
• Hard to rapidly increase skills

Germany
India
Italy
Japan
Sweden

• Based on growth over the past 40 years,
  projections show health costs could hit 50 of
  GDP in more than half of the OECD countries by
  2100

Funding is limited and costs are already high
Spain
France
Canada
U.S.
Britain
Open-ended responses "What is the most
important problem facing you and your family
today?" (multiple answers accepted) Source Kais
er Family Foundation and the Pew Global Attitudes
Project released a report in Dec 2007
4
HEALTH CARE SYSTEMS LEADERS ARE UNDER PRESSURE TO
TACKLE MULTIPLE CHALLENGES
Responding to rising costs

• Improving value for spending
• Ensuring rational adoption of new drugs, devices,
  and technologies
• Creating value conscious consumers and cost
  competitive providers

Providing access
Delivering high quality
How to best balance cost, quality, and access
in a manner that is both sustainable and
consistent with social values and political
goals?

• Defining "right" level of care and coverage
• Defining role of private and public sectors
• Ensuring equity across the system

• Managing rising numbers of chronic disease
  patients
• Reducing variations in clinical practice
• Adopting evidence-based care

5
AGING AND DISEASE MIX ARE DRIVING RISING COSTS
GLOBALLY
Note All WHO countries with private medical
expenditures above USD 5 bn Includes
communicable, maternal, perinatal, and
nutritional conditions Source WHO Core Health
Indicators, ICP Global Results, EIU, McKinsey
analysis
6
AS IS INNOVATION IN TECHNOLOGY
1
2
3
4
All your X-rays a mouse click away
and your new arm will be ready on Friday
First marathon in 135 with Stryker knee
50 of diseases will be predictable at birth
7
. . . WHICH COULD RESULT IN HEALTHCARE SPEND
CONSUMING DISPROPORTIONATE AMOUNTS OF GDP IF
SYSTEMS GO UNCHANGED
OECD-historic rate GDP 2.0
Half OECD-historic rate GDP 1.0
Source Forecast model assuming real GDP growth
of 2.0, health care spending growing at 0.95/1.9
percentage points above OECD Policy
Implications of the New Economy 2000 - 2050
(2001) Global Insight WMM 2000 - 2037
8
CONTENT
Situation today
Achieving impact in health systems reform
McKinseys health systems practice
Examples of our work
Appendix
9
OUR BASIC BELIEF IS THAT HEALTH SYSTEMS REFORM IS
A LONG JOURNEY THAT REQUIRE VISIONARY LEADERS

• There is no best system, adapting reform to local
  context matters
• Major transformation typically requires 25 years
  of sustained effort
• Support from the top is crucial to shape the
  direction, it is imperative to understand the
  full story
• Success is driven by
• Clarity of direction and what success will look
  like relevant to existing context
• Clarity on behaviours which need changing, and
  how that will happen
• The momentum generated by a few of successful
  quick-win projects with substantial quantifiable
  impact
• Capability building at all levels of the system,
  supported by significant leadership inspiration
  and energy

Health systems reform is a journey Visionary
leaders will experience highs and lows but if
thoughtful of the overall direction, will improve
the health of the population in a tangible and
measurable way, improve access and manage costs
10
ACHIEVING IMPACT REQUIRES ATTENTION TO A SET OF
CORE PRINCIPLES
Successful health system transformation
Focus change on the target end state
Take a holistic view of the health system
Develop leadership at every level
Follow the patients journey
Use a multi-stakeholder partnership to drive
change
1
2
5
4
3

• All relevant aspects of government
• Social and private sector actors

• National public health outcomes
• International goals (e.g., MDGs)

• Patient journeys through the health system
• Key clinical pathways

• Top level Ministry leadership
• Mid level system leadership
• Clinical leadership

• Governments
• Donors and bi/multi-laterals
• Private sector
• Social sector and NGOs

Engage the system from within
Millennium Development Goals
11
HEALTH SYSTEM REFORM REQUIRES CHANGING AN ENTIRE
SYSTEM, NOT JUST THE MINISTRY OF HEALTH
1
Alternative/ traditional medicine
Ministry of Finance (health system financing)
Social Sector (NGOs, community service
organizations, think tanks)
Ministry of Labour (health care work force
domestic and international)

• Health systems play a role in a countrys human
  and economic development
• While reform may require change at the micro
  level, it will also require change at the macro
  level including many other aspects of government

Parastatal companies (access to
telecommunications, power, water for health
facilities)
Ministry of Education (health care degree
programs, bursaries and secondary school sciences)
Private Sector (health care and large employers)
Regional and local governments (sanitation,
hospitals, schools and infrastructure)
Ministry of Works and Transport (facility
construction, renovation and repair, and roads)
12
REFORM SHOULD FOCUS ON THE TARGET END STATE WITH
REGULAR TRACK OF PROGRESS
170
2
GCC EXAMPLE
Progress against target
Target
Main activities
Objective
Days of waiting time for Gastroentology
1

• Reduce waiting time of new patient referrals for
  10 hospital specialties to 30 days or under

Outpatient department Waiting times

• Optimized triaging by nurse
• Opening HC in the evening
• Pre-booking telephone appointments
• Patient segmentation

266
15
11
11
Oct 05
Jan 06
May 07
June 07
Average opening times over a week, gynecology
services

• Begin operations by 745 AM for all departments

Improve operation theater utilization

• Identification of bottlenecks, such as cold OTs
• Installment of timers to heat OTs in the morning
• Reorganization of shifts

2
806
933
832
March 06
Dec 06
May 07

• Strengthen and enforce quality standards in
  private and public health care
• Strengthen the role of the Office of Licensure
  and Registration as regulator of health
  institutions, professionals and the
  pharmaceutical industry

Establishment of national authority for
regulation of health profession and services

• Nomination and training of CEO and key staff
• Regulation of health institutions, professionals
  and the pharmaceutical industry
• Development, of national minimum standards for
  health institutions and enforcement criteria
• Establishment of criteria for registration,
  licensing and re-licensing of health professionals

3
13
3
A CLINICAL PATHWAYS APPROACH IDENTIFIES
IMPROVEMENT AREAS ACROSS THE PATIENTS LIFE SPAN
UK EXAMPLE
Proposed key changes required to deliver
world-class care based on best practice

• Women should be offered choice of home birth,
  midwife-led or obs-led care
• Obstetrics units with at least 96 hrs/week
  consultant cover
• Every obstetrics unit should have a co-located
  midwifery unit
• 11 midwife-led care should be provided in labor
  within existing resources
• Antenatal and some postnatal care should be
  provided in local dedicated hubs

• More should be invested in proven health
  improvement programs
• The NHS should play a greater role in improving
  the health of its employees
• All health professionals should be incented to
  improve health at each interaction
• Need for more partnership working to help people
  stay healthy

• Integration of community and secondary care
  services
• Pro-active primary care to reduce emergency
  admissions
• Develop London-wide best practice Care Pathways
  for different LTCs (e.g., DM, COPD, HTN, Asthma)
• Routine diagnostics provided in a community
  setting

• Improve access through local 24/7 urgent care
  centers with doctors on-site
• A single point of contact (by telephone) for
  urgent care
• Centralization and networks for Major trauma, MI,
  and Stroke
• Dispatch and retrieval protocols for LAS need to
  be aligned with centralization

• More specialized inpatient care should be
  centralized into major acute hospital
• Shift less complex surgery, diagnostics, and
  outpatients out of major acute hospitals
• Better use of the day case setting for many
  procedures
• Improve community-based services (e.g., community
  nursing)

• Commission end-of-life service providers to
  co-ordinate end-of-life care
• People have an end-of-life care plan, including
  preferences on place of death
• All organizations should meet good practice
  (e.g., gold standards framework)
• Greater investment to support people to die at
  home

14
STRONG INDIVIDUAL AND COLLECTIVE LEADERSHIP IS
REQUIRED TO IMPLEMENT AND SUSTAIN CHANGE
PRIORITIES
4
Leadership development can effect significant
lasting change
Necessary shifts in traditional leadership
development approaches
To
From

• Today, many health interventions can not be
  implemented or brought to scale because of weak
  system leadership, among other factors
• Strengthening leaders will improve the
  effectiveness of actors within the public health
  system
• A collective leadership team in a coordinated
  fashion, with aligned intent, focused on the most
  crucial challenges in the system will achieve
  step-change improvements in the health of the
  system
• Developing leaders in a complex adaptive system
  such as public health can catalyze positive
  increasing returns and create public health
  systems that evolve organically to higher levels
  of performance

• Shifting aspects of the system while developing
  the people in it

• Developing people in system

Objective

• Public healthcare professionals
• The individual

• Inclusion of the private sector, adjacent systems
  leaders (e.g., education, finance), others
• Collective leadership team as well

Target

• Technical/managerial skills
• Special project for action learning

• Mindsets (meaning, purpose, etc.) as well as
  skills
• Broader set of skills (e.g., interpersonal, etc.)
• Joint initiatives to shift system at leverage
  points

Curriculum

• Injection of best practice from outside
• External faculty
• Offsite program
• Additive
• Episodic

• Engagement from within enable local capacity to
  develop, tailor, embed, extend learning
• Building on/removing barriers to what works
  already

Delivery Mechanism
15
5
REFORM SHOULD BE DRIVEN BY A MULTI-STAKEHOLDER
PARTNERSHIP
Reform will require commitment and resources from
a wide group actors both public and private over
3 to 5 years
Private sector
Donors and bi-/multi-laterals

• Deep functional expertise
• Core competence in specific business areas, e.g.,
  supply chain management, corporate finance,
  social marketing
• Broad-based business and organizational
  experience
• In-depth knowledge across multiple industries and
  organizations
• Specific product offering
• Specific products and services required by the
  health system, e.g., consumables and
  infrastructure

• Financial support
• Ability to finance projects that support
  government efforts as well as to test new
  approaches and initiatives
• Broad health system experience
• Experience across multiple geographies to share
  knowledge and approaches
• Deep knowledge in health
• Depth in knowledge across health system
  financing, human resources, infrastructure,
  operations, and enablers such as IT
• Government influence

16
CONTENT
Situation today
Achieving impact in health systems reform
McKinseys health systems practice
Examples of our work
Appendix
17
AN OVERVIEW OF MCKINSEY COMPANY
Origin
Founded in 1926 in New York by James O. McKinsey
Resources

• Presence in 45 countries around the world with 89
  offices
• 8 300 consultants around the world

Clients
Private sector companies, governments and social
sector organizations
Healthcare

• 2 250 projects since 2002
• Clients include payors, providers, pharmaceutical
  companies as well as medical products
• Our consultants include over 150 medical doctors
  and over 250 with Masters or Ph.D degrees in life
  sciences, medical and healthcare fields

18
McKINSEY HAS ATTRACTED TALENT SPECIFICALLY TO
MEET THE GLOBAL HEALTHCARE SECTOR CLIENT NEEDS
100
The McKinsey Global Healthcare practice has
medical, scientific and extensive business
management skills and knowledge
100
400

• Approximately 150 MDs with patient care or
  research experience (often both) representing
  most major medical specialties including
• Anesthesiology
• Cardiology
• Cardiovascular surgery
• Gastroenterology
• Critical Care and Emergency Medicine

150
Medical Doctors

• Neurosurgery
• Orthopedic surgery
• Pediatrics
• Radiology

• Approximately 200 consultants with Masters or
  doctoral degrees in various life sciences and
  medical fields including
• Genetics A
• Immunology
• Biochemical Engineering
• Biotechnology

Life Science Masters/PhD
200

• Molecular Biology
• Neurobiology
• Biochemistry
• Pharmaceuticals

About 50 consultants with Masters degrees in
Healthcare (e.g., Master of Public Health,
Healthcare Management)
Other Health-related backgrounds
50
Consultants
Source McKinsey Company, 2007
19
HEALTH SYSTEMS IS ONE OF FOUR HEALTH CARE
PRACTICES AT MCKINSEY
McKinsey Healthcare Practice
Focus of this document
Healthcare Provision and Payment
Pharmaceuticals and Medical Products
Health Systems
Global Public Health

• Governments

• Governments, hospitals

• Foundations, multilaterals, NGOs (e.g., Gates
  Foun-dation, Global Fund, GAVI, WHO)

• 20 of top the 20 pharma companies biotech and
  medical devices

Clients

• Africa, India

• Worldwide (mostly developed countries)

• 17 countries around the world including Egypt,
  Middle East, Canada, Cyprus, Namibia, India
  Tanzania, and the UK

• Major hubs in US, U.K., Germany, and Singapore
• Work in more than two dozen countries

Geographies

• Expertise in running developed health systems,
  including commissioning, contracting and
  community care

• Expertise in pharmaceutical and medical products,
  strategies, sales and marketing, RD, operations,
  etc.

• Expertise in design of MDG programmes,
  HIV/AIDS, vaccines, evaluation and strategies for
  alliances

• Expertise in designing health systems, including
  assessing performance, setting strategic
  priorities, policy and regulation

Focus
Millennium development goals
20
OUR HEALTH SYSTEMS WORK IS TAILORED TO ADDRESS
TYPICAL ISSUES

• We assist governments to perform a diagnostic to
  assess their health system and map bottlenecks
  and priorities for health system reform
• We help governments draw up a vision for their
  health system identify key reform elements

• We help governments shape the role of the
  regulator and assist in building independent
  health regulators with a clear role and
  accountability, eg. quality regulator,
  reimbursement regulator

• We work with ministers of finance and health to
  optimize the way healthcare funds are collected,
  administered and spent in line with the countrys
  priorities, e.g. to address shortages

• We assist governments in assessing and
  transforming medical needs of whole regions or
  population segments into tangible infrastructure,
  e.g. physician allocation, emergency care

• We support key stakeholders to build capabilities
  throughout the healthcare pyramid, e.g. doctor
  education and continuous training, accreditation

• We work with governments in defining the IT
  architecture that meets their needs for better
  efficiency and information collection/transparency

• We support governments to design chronic disease
  programs improving outcomes in stroke, cancer,
  diabetes, cardiovascular diseases as well as
  obesity

• We support the set up and design of public
  private consortiums, building a Mobile enabled'
  infrastructure that address the lack of
  healthcare resources in remote or rural areas

21
MCKINSEY HAS HAD THE OPPORTUNITY TO WORK ON
HEALTH SYSTEMS PROJECTS ACROSS THE WORLD
National review, capital accounting, compulsory
medical audit, competition as stimulus, sexual
transmitted diseases, focus on publishing
outcomes data, national screening programs e.g.
cancers, waiting, vaccination programs, HR
multidisciplinary teams
Provincial health policy, demand supply
management, quality control
Focus on qua-lity accrued, transfer of MOH to NHA
Health system reform
Health system diagnostic
Health system blueprint, provider selection
Health insurance strategies, integrated care
Regional system design
National insurance, hospital/clinic coverage and
operations, quality regulator
Ministry restructuring, new health insurance
scheme
System reform
Task shifting, standardizing salaries of HC
workers
Drug approval
Patient safety in health reform, Medicare for
elderly, managed care, mammography utilization
Malaria prevention, physician education
Policy framework and implementation roadmap
User charges, emergency care, rural care
Sustainable local care
Decentralization of health services/ regions and
perform-ance based system
Movement to national health insurance
Regulation of the private sector
Implement perform-ance management program across
system
Data driven and definition of ess-ential package
System diagnosis, initiative and leader selection
22
A NETWORK OF PARTNERS WITH STRONG LOCAL AND
GLOBAL EXPERTISE
Americas
EMEA
Asia
Elisabeth Hansson Sweden
Axel Baur Germany
Deepak Khandelwal Canada
Bruce Simpson Canada
Paul van Arkel Russia
Claudia Süssmuth-Dyckerhoff China
David Chinn Israel
Jean Drouin GPH/HSI Leader
Nicolaus Henke EMEA HPP Practice Leader
Ben Richardson UK
Ludwig Kanzler Japan
Takashi Takenoshita Japan
Paul Mango US
Bob Kocher US
Viktor Hediger GCC/ HSIG Practice Leader
Amine Omar Tazi-Riffi North Africa
Maria Marquez Iberia
Rui Diniz Iberia
Tilman Ehrbeck India
Paolo De Santis Medeter-ranian
Thomas London France
Chinta Bhagat Singapore
Yael Heynold Australia/New Zealand
Carlos Murietta Latin America
Cristian Baeza Latin America
Shrey Viranna, Sub Saharan Africa
23
McKINSEY REGULARLY PUBLISHES ON A RANGE OF
HEALTHCARE TOPICS, EXTERNALLY

• Addressing Japans Healthcare Cost Challenge
• A healthier healthcare system for the United
  Kingdom
• Innovation in Healthcare an interview with the
  CEO of Cleveland Clinic
• A better hospital Experience
• Mapping the market for medical travel
• Dissecting global trends an example from Italy
• Universal principles for healthcare reform

• Health Europe/Health International publications
  on the healthcare industry
• Management matters
• How service line management can improve hospital
  performance
• The health care century
• The best that limited money can buy
• Optimized procurement unlocks cash and strategic
  options
• Patient choice threat or opportunity for UK
  Hospitals
• Quality of care an international perspective
  for the NHS

White papers

• Developing perspectives of high-impact health
  systems reform, McKinsey Global Institute report
• Clinical leadership unlocking high performance
  in Healthcare by James Mountford and Caroline
  Webb
• No holds barred in management battle, HSJ, 2008

24
CONTENTS
Situation today and our perspectives
Achieving impact in health systems reform
Our experience
McKinseys health systems practice
Appendix
25
Dr. Nicolaus Henke
Dr. Nicolaus Henke is a Director of McKinsey
Company, based in London. He has also served the
Düsseldorf, Berlin, and New York offices. He is
Head of McKinseys Payor Provider Healthcare
Practice in Europe, the Middle East, and Africa
and chairs McKinseys work with national Health
Systems globally. He frequently speaks at
conferences and publishes on a broad range of
healthcare and talent management issues and is a
lecturer in health system policy in various
executive education programmes. His recent
experience includes UK health care management
Nicolaus is the overall head of McKinseys work
with the NHS. Topics of his involvement include
the future of commissioning, the regulatory
framework of the future health sector, the
assessment and compliance approach of Foundation
Trusts, the diagnostic and capacity adjustment
for Strategic Health Authorities, new models in
emergency care, designing payment by results,
patient expectations under choice, the state of
NHS finances and NHS financial management, and
governance in healthcare. Global Health systems
Nicolaus has practical experience from 17
healthcare systems and is serving various
governments and heads of state on overall health
system reform in countries as small as 600000
patients and as big as 70 million. He has worked
on a broad range of topics, such as health system
funding and payment reform, designing and
managing competing public payors, cost and
productivity programmes, hospital contracting,
case management, pharmacy benefit design and
management, benefits management, and regional
capacity planning. Nicolaus was an Investment
Adviser at Deutsche Bank AG for 2 years and
graduated with distinction with a Masters and
Doctorate degree in Business from the University
of Münster, Germany. He holds a Masters in
Public Administration from Harvards Kennedy
School of Government, where he was a John J.
McCloy scholar.
26
Dr. Axel Baur

• Dr. Axel Baur is a Partner in the Düsseldorf
  Office of McKinsey Company, Inc. and co-leader
  of both McKinsey's German Pharma/Healthcare
  sector and the Middle East Healthcare Practice.
  Since joining the office in February 1996, he has
  served a number of clients in various kinds of
  studies for different players in the healthcare
  industry, dealing with strategic, operational and
  organizational problem solving issues.
• Overview of recent studies
• Payor Provider engagements in Europe
• Development of a turnaround program and strategy
  work for a German insurance company. Based on a
  detailed analysis of the financial situation,
  identifying a gap of Euro 100 million, a
  comprehensive program was defined addressing all
  levers within public insurance cost management.
• Design of a hospital cost management program to
  manage 40 of a payor's expense. The program
  comprised contracting/negotiating elements,
  authorization procedures as well as claims
  management algorithms. In a last step these
  processes were imbedded in a new organizational
  structure
• Payor Provider engagements in the Middle East
• Strategy for an integrated provider. Three
  entrepreneurs were supported in their endeavor to
  build an integrated service provider in Egypt,
  the Kingdom of Saudi Arabia and the UAE. The
  project included a business plan, the investor
  communication and the overall financial plan
• Strategy for a hospital group in Saudi Arabia.
  The project focused on the future development in
  the Kingdom and the expected needs for tertiary
  care providers. The strategy depicted the
  required steps to be successful in the changing
  healthcare environment
• Healthcare system design for a GCC country.
  Following a holistic diagnosis of the country's
  healthcare system all key elements for the system
  were defined as well as the necessary migration
  path
• Axel Baur holds a degree in Biology and a Ph.D in
  Molecular Biology from the University in
  Darmstadt. His research activities focused on the
  molecular evolution/development of species.
  After his doctoral thesis he joined a biotech
  start-up, BRAIN. The company's focus is
  scientific consulting and customer research, he
  holds the patent on genetically engineered
  mistletoe lectine. Before joining McKinsey he
  received an MBA from INSEAD, Fontainebleau.

27
Dr. Viktor Hediger
Dr. Viktor is a Partner in McKinsey Company's
Dubai office. He is co-founder of and co-leading
the global McKinsey Health Systems Interest Group
and is leader of the Middle East healthcare
practice. Viktor has a particular interest in
health systems reform, holding an MD PhD MPH
degree (MPH in Healthcare Management from Harvard
School of Public Health, 2001/2002), with his
main focus being on Health system design and
implementation and Global Public Health. His
recent experiences include Health systems and
Public Health Strategic plan, health system
design and implementation of the healthcare
scheme in Cyprus Strategic plan for a leading
institution in the area of research for Tropical
diseases Health systems design and
implementation support for two Gulf countries
Health strategy for a Gulf country with main
focus on Tertiary Care Health system diagnostic
and Health system strategy for a developing
country in West Africa Global strategy for a top
tier global non-profit organization Strategy for
Director General at WHO when taking office in
2003 Payor and Provider Introduction of
innovative and novel approaches for a Health
Insurer in the field of customer segmentation to
boost profitability (Switzerland) Development and
implementation of a fully integrated care
delivery system for a German Payor, including
several hospitals and their referring ambulatory
physicians (Germany) Viktor holds an MD degree
(University of Berne, Switzerland, 1992-1998)
with a PhD in Neurophysiology (1994-1998). Before
joining McKinsey in 1999, he has worked as a
doctor in an orphanage for neurologically
handicapped children in South America. Trained a
military doctor (First lieutenant) in the Swiss
Army, Viktor is now acting as a communication
trainer and coach/facilitator for officers. At
the age of 15-20 he was part of the Swiss
National Judo Team.
28
Dr. Jean Drouin

• Jean Drouin is a partner in McKinsey and
  Companys London Office. He has extensive
  international health care experience and has
  worked in the US, Canada, Europe, Asia and
  Africa. Jean has served governments, hospital,
  pharmaceutical, and medical device clients on a
  variety of strategic, operational and policy
  issues.
• His experiences include
• Completing a capacity review of pediatric
  services in Ireland
• Designing the regulatory strategy, including all
  aspects of assessment, monitoring and compliance,
  for a European health regulator
• Developing the implementation plans for major
  health policy reforms in the UK, including the
  introduction of DRGs for hospital payment and the
  creation of a contestable market for hospital
  services
• Assisting a major pharma player to design market
  access interventions that address the needs of
  non-physician stakeholders across Europe
• Evaluating future opportunities in the diabetes
  market and developing a product portfolio
  strategy for a global medical devices company
• Helping the Canadian affiliates of two global
  pharmaceutical companies merge and design a new
  organization and business plan
• Conducting a cost/benefit analysis on the
  implementation of electronic physician order
  entry to reduce medical errors
• Developing the go-to-market strategy and
  implementation plan to drive a 50 increase in
  patient volume at an academic heart hospital
• Assisting a 1,600 bed Korean academic medical
  center improve performance through length of stay
  reduction, increases in OR efficiency and
  debottlenecking of radiology operations
• Jean is a co-leader of the Health Systems
  Interest Group. His research interests include
  health system reform, financing and regulation as
  well as clinical service configuration and
  pharmaceutical market access.
• Prior to rejoining McKinsey, Jean was at Goldman
  Sachs International in London, where he worked in
  the Health Care and Biotech Corporate Finance
  Group.
• Jean received M.D. and MBA degrees from Stanford
  University. He holds a degree in Molecular
  Biology from Princeton University, where he
  graduated Phi Beta Kappa. He also has a
  Certificate in Public and International Affairs
  from the Woodrow Wilson School.

29
Dr. Paolo De Santis
Paolo De Santis is a Partner in the Rome Office
of McKinsey Company. Paolo main areas of
competence are Public Sector, with a strong focus
on Health System, and Financial Institutions. In
the Public Sector field Paolo has worked in three
areas i) Productivity Enhancement with the
Italian Government ii) Health System Reforms in
Africa, Asia and Latin America iii) Regional
Economic Development in Africa. In the financial
sector Paolo has worked for major financial
institutions (both Italian and International),
insurance companies and asset managers in a large
number of areas both in retail and wholesale
banking. In the last 1,5 years Paolo has led
the openings of the McKinsey office in Cairo
where he has been working with the Egyptian
Government on a number of different topics. Among
others i) Country strategy for Foreign Direct
Investment attraction ii) Full development of a
city of 600,000 people Paolo De Santis entered
McKinsey in 1998. Before that Paolo was assistant
professor of Economics at the University of
Viterbo and taught economic dynamics at Luiss
University in Rome and Macroeconomics and
Microeconomics at Columbia University (New York).
Paolo has published several papers on
macroeconomics and economic policy. In 2002 and
2003 Paolo has been on a leave of absence working
as the Head of staff of the deputy Minister of
Economics and Finance of the Republic of Italy
leading several projects on matters included in
the powers of the deputy minister. Among those
i) The privatization program of the national
Postal and Railway operator ii) The Italian
government procurement reform program (through
Consip) iii) The rationalization of the IT
systems of the Minister of Economics and Finance
iv) The monitoring program of the cash flow of
the whole Italian Public Administration through
the creation of commonly adopted classification
codes of all revenues and expenses. During his
period as a Treasury official Paolo served as a
Board Member of SO.GE.I (IT company with about
500 mln euros of turnover) and Quadrilatero
(construction company with about 3 bln euros
investment program) Paolo holds a degree in
Economics from Università La Sapienza, Rome and a
Ph.D. in Economics from Columbia University, New
York.
30
Dr. Cristian Baeza

• Cristian Baeza is a Senior Expert in Health
  Systems Policy, Financing, and Health Insurance
  in McKinsey Companys Washington DC office,
  which he joined in 2008. Cristian leads the
  Health System Financing Group at the firm and his
  recent projects have included
• Leading work in regulation, health financing, and
  food regulation in GCC countries
• Advising on the strategy development for a large
  international health foundation
• Supporting work in health financing and health
  insurance in the Middle East and Latin America
• Cristian has published articles on financing
  health systems, health and global development,
  including Healthy Development The World Bank
  Strategy for Health, Nutrition and Population
  Results. He is also a co-author of the book
  Financing Health Systems in the 21st Century
  (OUP 2006) and Health Systems Improving
  Performance (World Health Report, 2000, WHO).
• Prior to McKinsey, Cristian was Director of
  Health, Nutrition and Population at the World
  Bank, a senior health systems and health
  financing specialist at the International Labour
  Organisation and CEO of the Chilean National
  Health Insurance Fund, FONASA. Cristian is a
  medical doctor with an MPH (Master of Public
  Health) from Johns Hopkins University and an MSc
  (Master of Science) in Neurosciences from the
  University of Chile.

31
Dr. Farhad Riahi

• Dr. Farhad Riahi is a Partner in McKinsey and
  Companys London office. He is a leader of our
  UK Healthcare Practice and of our Global Public
  Health Practice. He is also a practicing
  physician, and work with native communities in
  northern Canada.
• Farhad leads our work on improving health
  outcomes and quality of care, and on improving
  the performance of complex healthcare
  organisations. This includes
• Using evidence-based, cost-effective
  interventions to help payors improve the quality
  of care delivery (Commissioning for Quality),
  particularly for chronic conditions
• Designing payor strategies that bring together
  rigorous health needs analysis with
  private-sector approaches to prioritisation and
  planning
• Improving the performance of international
  health organisations (e.g., WHO, Stop TB
  Partnership) and of UK regional payors through
  best-practice performance management and
  capability building
• Strengthening medical education and training
  through changing structure, financing, and
  performance management of the education and
  training process
• ,
• Farhad serves clients at all levels of the UK
  health system, including hospitals (performance
  transformation of front-line clinical services),
  regional payors, and the Department of Health.
  He also works with the World Health Organization
  and associated global health partnerships. He
  has also served clients in France, Canada, and
  the Middle East.
• Farhad holds an MD from McGill and an MBA from
  Wharton.

32
Margareta Harrit

• Margareta is the Practice Manager of the McKinsey
  Health Systems Group. Since joining the firm in
  2004, Margareta has worked on healthcare, global
  public health and pharmaceutical studies
  particularly in Europe, China and the US.
  Margaretas work focuses on overall healthcare
  system diagnostic as well as the broad area of
  prevention, both of communicable and non
  communicable diseases. Her recent experiences
  include
• Health Systems
• Create, in collaboration with IASO, a framework
  and tool for evidence based obesity prevention
  and reduction measures
• Create framework to diagnose performance levers
  of a national health system
• Develop tool to track health systems performance
  for regional decision makers through a clinical
  pathway approach
• Design global workshop for Ministers of Health
  and private sector CEOs to share and build
  perspectives on public and private collaboration
  in healthcare provision and financing in low,
  middle and high income countries
• Pharmaceuticals and Global Public Health
• Margareta has been involved in numerous vaccines
  studies (product strategy, market access,
  licensing strategies, capacity planning, pandemic
  planning) both from a profit and non profit
  perspective and co-authored articles on Avian Flu
  and Global vaccine production
• Strategy, capability building and organization
• She spent 5 months with a pharmaceutical company
  focusing on CNS products leading a capability
  building programme for the companys market
  research division
• Margareta also assisted a Belgian foundation
  develop their vision, mission and 2 year road map
  
• Margareta holds an MA degree and a BSc from the
  Sorbonne University in Paris IV. Prior to joining
  McKinsey, Margareta
• worked at the European Parliament and in a non
  profit organization facilitating content and best
  practice sharing on
• Corporate Social Responsibility between member
  organizations and the European Institutions.

33
Toby Lambert

• Toby Lambert originally joined McKinsey
  Companys London office in 2002, and after two
  years in the Dubai office, is now an Practice
  Expert in London, covering Health Systems and
  Health Systems Reform. Since joining the firm, he
  has worked primarily in the Healthcare sector.
  Recent projects have included
• Planning, setting up implementing a leadership
  academy to inculcate skills in a middle income
  country
• Planning the institution of a new national social
  health insurance system
• Implementing the pilot of a new social health
  insurance system in a middle income country
• Planning implementing a new regulatory regime
  covering providers, professionals and
  pharmaceuticals
• Evaluating the impact, effectiveness and
  efficiency of a disease focused Global Public
  Health partnership
• Formulating the strategic plan and operating
  model for an integrated payor-provider in Latin
  America, including supporting on their
  acquisition of another similar integrated
  payor-provider
• Supporting the Department of Health in
  formulating their options as part of the wider
  regulatory review of health and social care
• Assessing the Fitness for Purpose of primary care
  organisations across their risk of financial
  failure, governance, and their ability to
  commission care effectively
• Diagnosing the issues facing a major Middle
  Eastern countrys healthcare system. Having
  formulated the main ethical, financial and
  operational challenges facing the country, work
  then moved on to setting the frame for addressing
  those problems through introducing a public
  health insurance model and redefining the roles
  and responsibilities of all healthcare players in
  the country
• Developing the blueprint for the redesign of a
  Gulf countrys public healthcare system. Work
  included formulating the options for a health
  system along the axes of access, financing,
  regulation and provision based upon international
  comparison, and then supporting the client in
  understanding the ramifications of each potential
  choice of healthcare system and hence selecting
  their ideal model. Follow on work is focusing on
  transforming the healthcare system to meet the
  blueprint
• Assessing the feasibility of a dedicated tertiary
  healthcare provider in a Gulf country. Work
  included assessing the required caseload, the
  potential market attractiveness of such a
  hospital and how it would complement the existing
  health facilities of the country
• Formulating the strategic plan for a leading
  Middle East tertiary health care centre. Having
  conducted internal diagnostics on the hospital
  and an external diagnostic on trends in
  healthcare in the country, the work then focussed
  on delivering operational improvements to support
  the hospital in achieving its strategic goals
• Developing the regulatory mechanism for a UK
  governmental healthcare initiative, through
  defining the scope and strategy of an independent
  healthcare regulator and further assessing
  hospitals with a view to giving them
  authorisation under the new regulatory regime
• Evaluating and supporting the MA strategy of a
  US medical products producer. The work focussed
  initially on quantifying the worldwide market and
  future growth rates for orthopaedic
  reconstructive products, identifying synergies
  with merger partner and formulating the future
  plan for the combined entity. When acquisition
  turned contested, returned to evaluate potential
  responses to the other bidder
• Prior to joining McKinsey, Toby worked with the
  National Health Service in the UK as a knowledge
  manager. Toby has obtained an MPhil in Byzantine
  Studies and a BA in Modern History from Oxford
  University.

34
Deepak Khandelwal

• Deepak Khandelwal is a Principal in the Toronto
  office of McKinsey Company. He co-leads
  McKinsey's Canadian Healthcare practice and is a
  leader of the Firms Operations practice. His
  client work focuses on strategy, operations, and
  organization issues across a wide range of
  industries including customer care, healthcare,
  and retail.
• Deepaks recent study experience includes
• Improving patient access and flow (ED-GIM) at
  several Canadian hospitals and thereby increasing
  patient and staff satisfaction
• Determining the quantitative and qualitative
  benefits of IT investments in a healthcare region
• Diagnosing and implementing solutions to increase
  CT/MRI throughput via operational process
  improvements
• Improving the effectiveness of support functions
  in a North American hospital
• Leveraging lean principles to improve the store
  operations of a retailer
• Improving the process operations of a
  foodservices company
• Developing the customer contact centre strategy
  for a healthcare company
• Improving the financial performance of the
  customer service division of a North American
  financial institution
• Developing and implementing a new business
  strategy and organization for a customer care
  service provider
• Developing knowledge management and talent
  management strategies for a North American
  institution
• Prior to joining McKinsey in 1994, Deepak worked
  with IBM and ran his own company, Deepak
  Enterprises. He earned a BSc in electrical
  engineering from the University of Saskatchewan
  and an MBA from the University of Western
  Ontario. Deepak is married to a
  gastroenterologist and has two kids.

35
Dr. Tilman Ehrbeck
Tilman is a partner in our Global Healthcare
Payor and Provider Practice. He joined McKinsey
in 1996 and has been based in New Delhi since
2005. Tilman has served for-profit and
non-profit health care providers and insurance
companies on issue of growth, organization,
business performance and service operations in
North America and more recently India. Before
moving to India, Tilman led McKinseys
proprietary consumer research on opportunities
and challenges associated with the rise of
consumer-directed health plans in the U.S.
Tilman is a German national. He holds a Ph.D.
in economics and a B.A. in business
administration.