region stockholm

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

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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)

5





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

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www.healthintegrator.se

Integrating and matching

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7

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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

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Number of days before and after the first diagnosis

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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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Bringing Stockholm forward together

Read more about the Health Impact Bond on:

https://www.sll.se/om-regionstockholm/Information-in-

English1/Investor-relations/health-impact-bond/

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region stockholm

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