TOWARDS DELIVERING VALUE BASED HEALTH CARE - BEMEDTECH ACADEMIC LECTURE

Size: px

Start display at page:

Download "TOWARDS DELIVERING VALUE BASED HEALTH CARE - BEMEDTECH ACADEMIC LECTURE"

Annabella Lambert
6 years ago
Views:

1 TOWARDS DELIVERING VALUE BASED HEALTH CARE - BEMEDTECH ACADEMIC LECTURE PROF DR WALTER VAN DYCK DIRECTOR VLERICK HEALTHCARE MANAGEMENT CENTRE CO-DIRECTOR HEALTH SCIENCES BUSINESS INSTITUTE, KUL & VBS NOVEMBER 14 TH, 2017

2 ISPOR 20 TH ANNUAL EUROPEAN CONGRESS FIRST PLENARY SESSION Value is the only goal that can unite the interests of system participants triple win Improving value is the only real solution The question is how to design a healthcare delivery system that substantially improves patient value 2

3 I AGREE WITH PORTER S ANALYSIS ON THE NEED FOR VALUE-BASED HEALTHCARE DELIVERY( ) The overarching goal in health care must be value for patients, not access, cost containment, convenience, or customer service Value = Health Outcomes costs of delivering the outcome Outcomes are the health results that matter for a patient s condition over the care cycle Costs are the total costs of care for a patient s condition over the care cycle Patient choice and competition for patients are powerful forces to encourage continuous improvement in value and restructuring of care Creating positive-sum competition on value is fundamental to health care reform in every country

4 THE NEED FOR MEASURING, STANDARDIZING AND LEARNING OF PATIENT OUTCOMES 4

5 THE NEED FOR A FULL VIEW ON COSTS Naredi, European CanCer Organisation, ISPOR 2017, Glasgow 5

6 VALUE-BASED HEALTH CARE DELIVERY (MICHAEL PORTER ) 6

7 FROM SILO (SPECIALISM)-BASED TO PROCESS THINKING BEYOND HOSPITAL BORDERS 7

IPU S ALLOW FOR IT-ENABLED OUTCOME-BASED MEASUREMENT Activity-based cost measures per patient/medical condition 8 Porter (2012) process measures Outcome

8 IPU S ALLOW FOR IT-ENABLED OUTCOME-BASED MEASUREMENT Activity-based cost measures per patient/medical condition 8 Porter (2012) process measures Outcome measures To which I add: go for frontloading i.e. the sooner (and better) variability is characterized and acted upon, the lower will be the process costs

9 WHERE ARE WE ON IMPLEMENTATION? AN INTERNATIONAL COMPARISON Source: Economic Intelligence Unit: Value based Healthcare: A Global Assessment 9

10 WHERE TO START? IDENTIFYING OPPORTUNITY AREAS Furr et al (2016), HBR 10

11 TAKING AN OUTCOME-BASED PATIENT PATHWAY VIEW, TECHNOLOGY-ENABLED AND DELIVERED IN A NETWORKED HCP DELIVERY CONTEXT 11

12 TECHNOLOGY CREATES VALUE APPROPRIATED BY VALUE CHAIN STAKEHOLDERS: THE VCA MODEL Look at technology taking a multi-stakeholder VCA perspective How can it increase patient value? How can it improve process & org costs? How can it enable core, adjacent or transformational service offerings? 12

13 OECD (2017), New Health Technologies: Managing access, value and sustainability 13

14 BE A HEALTH SYSTEMS THINKER TWO EXAMPLES 14

15 FROM CURE TO CARE: TOWARDS A MINDSET OF SYSTEMS THINKING, ALSO FOR IPU S Breast cancer PREDICTION PREVENTION TREATMENT MONITORING Post-operative m-health

16 BE A WHOLE SYSTEMS THINKER IN DESIGNING HEALTH CARE SOLUTIONS Van Dyck et al (2012)

17 ON AVERAGE, THE IMPLEMENTATION OF NEW SCREENING STRATEGY REDUCES TOTAL PATIENT COST OF HEALTHCARE BY 37% WITHOUT AFFECTING AVERAGE QALY Average Cost per Patient over 25 years Average QALY per Patient % QALY % Current Situation "EHR+SNP" Scenario 0 Current Situation "EHR+SNP" Scenario * Willingness-to-pay = / QALY Van Dyck et al (2012)

18 A MOVE TO THE ENTRY POINT OF THE CLINICAL PATHWAY Van Dyck et al (2012)

19 19

20 ANOTHER EXAMPLE MOVEUP Mobile health technology solution for patients who underwent hip or knee replacement surgery

21 MOVEUP

22 ADHOPHTA (2016) TICO, YES BUT AdHopHTA Handbook 2016, p

23 MOST IMPORTANT CRITERIA FOR EVALUATING INNOVATION OPPORTUNITIES (EUNETHTA, 2016) i.e. Strategic fit and/or Innovation providing a present (key) or potential future (pacing) competitive advantage (Kidholm et al. 2014, Kidholm et al. 2015). 23

24 ALSO THINK YOUR VALUE APPROPRIATED FROM THE TOTAL VALUE CREATED 24 Garcia et al (2015)

25 AN MHEALTH SOLUTION ENABLING A BUSINESS MODEL CHANGE IN A MODIFIED HCP ECOSYSTEM National Payer Medical Device company (hips, knees ) Surgeons Hospital MoveUp Solution Patient Physiotherapist For the National Payer: From individual hospital physiotherapist fee-forservice to bundled payment received for an outcome-based rehab schedule, executed by a larger pool of physiotherapists. External-tohospital Physiotherapist

26 COST BENEFIT ANALYSIS PREFERRED TO COST EFFECTIVENESS OR UTILITY, AS USED IN PHARMA VALUE COST (INVESTMENT, COSTS, PEOPLE EFFORT) 26

27 HOWEVER, IT IS IMPORTANT TO HAVE AN INNOVATION CONCEPT LAID OUT INDICATING EFFORTS OPTIMIZING THE CORE, PREPARING FOR TRANSFORMATION mhealth Project Analytics Project Investment Project mhealth Project Continuous improvement Nagji & Tuff (2012)

28 MCKINSEY HORIZONS OF GROWTH: IMPLEMENTING THE SET OF HB-HTA SELECTED INNOVATION PROJECTS 28

29 IPU-BASED NETWORK STRUCTURES GEARED TO EXPLOITATION AND EXPLORATION Innovator Nodes Lead Factory Supplementary Nodes Robot centre A Central treatment Unit Complementary Nodes Robot centre B Decentral Screening Unit 29

30 VALUE-BASED HEALTHCARE: DELIVERED IN HCP NETWORKS DESIGNED FOR AMBIDEXTERITY Organize networks to achieve operational efficiency while simultaneously being able to reconfigure the operations of these networks to adapt to new circumstances and explore new opportunities The lead factory concept benefits from an efficient knowledge transfer. Particularly, it is more profitable than the archetype network under the following conditions: there are a high number of production plants; the adaptation costs for implementing the transferred prototype from the lead factory to the plant are low; the manufacturing costs for the prototype are high; the manufacturing processes are not highly specific or knowledge intensive. Deflorin et al. (2011) 30

Innovation Concept stating where to play and how to win pursuing which

31 END CONCLUSION: SETTING HCP VBHC STRATEGY Ambition Concept Plan Setting Innovation Ambition within an ambidextrous networked HCP structure Having an Innovation Concept stating where to play and how to win pursuing which opportunities Planning for Innovation using the appropriate org formats (investment, line actions, ventures)

32 THE VALUE-BASED HEALTH CARE STRATEGIC AGENDA As cited in the first plenary meeting at ISPOR, Glasgow, Nov 2017 Re organize care around patient conditions, into Integrated Practice Units Measure Outcomes and Costs for Every Patient Move to Value Based Reimbursement models, and eventually Bundled Payments Integrate Multi Site Care Delivery Systems Expand or Affiliate Across Geography Build an Enabling Information Technology Platform

33 THANK YOU!

Measuring Outcomes. The Key to Value-Based Health Care

Measuring Outcomes. The Key to Value-Based Health Care Measuring Outcomes The Key to Value-Based Health Care A Harvard Business Review Webinar featuring Christina R. Åkerman and Caleb Stowell International Consortium for Health Outcomes Measurement (ICHOM)