Medical Education within NephroCare Dr. Berit Goethel The fourth UEMS conference on CME-CPD Brussels, 24 th November 2018

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Medical Education within NephroCare Dr. Berit Goethel The fourth UEMS conference on CME-CPD Brussels, 24 th November 2018

Our vision is to improve Quality of Life & clinical outcomes for our patients Page 2

Fresenius as a global operating company is industry Page 3

Fresenius Medical Care is member of the Fresenius Group Ownership: ~31% Ownership: 100% Ownership: 100% Ownership: 77% Dialysis Products Health Care Services Hospital Supplies Hospital Operation Projects and Services for Hospitals Dialysis services Hemodialysis products Peritoneal dialysis products Care coordination IV drugs Biosimilars Clinical nutrition Infusion therapy Medical devices/ Transfusion technology Acute care and post-acute care Expertise in all areas and at all levels of medical care Project development Planning Turnkey construction Maintenance Technical and total operational management Revenue 2017: EUR 17.8 bn Revenue 2017: EUR 6.4 bn Revenue 2017: EUR 8.7 bn Revenue 2017: EUR 1.2 bn

Fresenius Medical Care operates globally > 3,750 own dialysis centers in 2017 > 320,950 patients haven been treated > 48 M dialysis treatments performed In around 50 countries Patient growth of ~6 % p.a. worldwide My question: outside nephrocare, who is running the clinics? Page 5

Our starting point with UEMS was challenging Page 6

Is there a possibility to move on? Page 7

NephroCare as service brand of FMC employs physicians and cares for > 100.000 patients NephroCare EMEA LA 2017 NephroCare Clinics > 980 Patients > 100,000 Employees > 29,000 Treatments For Europe, Middle East and Africa (EMEA): ~13,9 M ~2.000 physicians 26/11/2018 NephroCare @ Fresenius Medical Care Deutschland GmbH Head office: Fresenius Medical Care Deutschland GmbH 61346 Bad Homburg v. d. H. Germany Phone: +49 (0) 6172-609-0 Fax: +49 (0) 6172-609-2191 8

All patients, n Over 60.000 chronic HD patients* are treated within NephroCare EMEA 8,000 7,000 6,914 6,538 6,000 6,001 5,851 5,000 4,000 3,000 2,000 1,000 Hemodialysis patients: 4,932 4,788 4,708 3,938 Oct 2018: ~ 63,000 2,834 2,657 2,638 2,201 1,954 1,617 1,103 1,025 0 340 290 270 223 174 166 36 34 *: excluding Home HD

NephroCare offers a comprehensive range of services for patients with chronic renal failure Patient engagement care Page 10

Clinical & Therapeutical Governance is responsible for outcomes, QoL and values Patients Stakeholders satisfaction Risks prevention & management Page 11

We are convinced Page 12

We are creating values by offering medical education Medical Education Improve patient clinical outcomes & quality of life Accredited medical education is of high quality, supporting physicians with collecting credits

NephroCare Measure of Effectiveness Stuard 2018 NephroCare Annual Meeting

Prevalent Patients: Morbidity (crude data) National Research Council (CNR*) evaluation Dec 2014 - Sept 2018 EMEA NHSs: Less hospitalization days 110.000 x 3,7 = 407.000 days ~ 101.7 milio saving (Cost of hospidalization/day: 250 ) *CNR is the largest public research institution in Italy, the only one reporting to the Research Ministry # worst case scenario in case patients were dialyzed in our clinics during the hospitalization (10%) 26/11/2018 Stuard 2018 NephroCare Annual Meeting Page 15

Our starting point with UEMS was challenging Page 16

How did we move on after this yes? Page 17

Our first material Main author: Dr. Stefano Stuard Reviewers elearning: Internal: Dr. O. Arkossy Prof. G. Imamovic Dr. Janos Termeg Nicole Voigt Dr. Berit Göthel External: Prof. D. Brancaccio Page 18

We have received UEMS accreditation ELM: ELM: LEE: Blood pressure management in Chronic Kidney Disease Chronic Kidney Disease Mineral Bone Disorder Country Medical Directors Meeting 2018 ERA-EDTA: = European Renal Association European Dialysis and Transplant Association Page 19

EMEA CMDs meeting is an international scientific congress Page 20

Accredited material available via NephroCare Academy NephroCare physicians will be enrolled to the courses Page 21

NephroCare Academy website Page 22

Key points Why NephroCare receives UEMS accreditation Patients are treated in NephroCare clinics in EMEA NephroCare physicians are responsible for the quality of the treatment delivered to the patients the patients intermediate and final clinical outcomes NephroCare is responsible for the continuing medical education of its physicians Page 23

In the future, we want to develop more content Main author: Stefano Stuard Reviewers: Country Medical Directors (CMDs) of 26 EMEA countries 19 chapters >600 references Page 24

We want to establish a central accreditation office Central Accreditation office Risk stratification Progression Hospitalizations Educational courses Care mgmt. & coaching (risk-based) Scientific Case manager Self-mgmt. Meetings training Coordination between care givers Supported Improved by patient NephroCare s clinical outcomes high clinical & quality, processes quality of and life governance

Our vision is to improve Quality of Life & clinical outcomes for our patients Page 26

This is us Dr. S. Stuard S. Ramakers Dr. M. Savoia Dr. B. Göthel Dr. O. Arkossy Dr. V. Kovarova L. Constantinescu I. Morris Prof. D. Brancaccio Dr. J. Merello Country Medical Directors of 30 countries N. Voigt Dr. J. Termeg Page 27