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2 Better Health Toronto A Flagship Stop on McKesson s Better Health Tour On October 30, 2014, McKesson Canada hosted Better Health Toronto as the first stop on Canada s Better Health Tour. The Better Health Tour is bringing together health system leaders and practitioners to break down silos, share innovations, and develop practical solutions focused on improving Canada s health system. Better Health Toronto facilitated a unique exchange of ideas about the future of healthcare in Ontario and is one way that McKesson Canada is doing its part to support the emergence and adoption of new and effective innovations, policies, systems, and practices across Canada. Convening 108 senior leaders from 69 organizations and 12 sectors, Better Health Toronto launched the conversation on how we can work together to create sustainable health systems across Canada. The greatest opportunity is the collaborative approach to engaging that phenomenal insight and expertise of the private sector, business sector, policy makers, health system leaders, clinicians and consumers to rethink, redesign and embed innovations that achieve value for the public. Dr. Anne Snowden Professor and Chair, International Centre for Health Innovation, Richard Ivey School of Business We can t keep solving challenges in isolation. We need the courage to look to our neighbours and collectively take a giant leap forward. Alain Champagne President, McKesson Canada 2

3 Edisons i Thomas Edison s introduction of the electric light bulb a century ago epitomizes the systemic nature of technological transformation. He realized that the technology he envisioned no matter how innovative couldn t by itself sweep aside the kerosene-based lighting industry. Instead of asking how he could solve the technical problem of inventing a light bulb, Edison asked how he could get consumers to switch from kerosene to electricity. So, while scores of people worldwide worked on inventing a light bulb, Edison conceived a fully operational system. His technical platform included generators, meters, transmission lines and substations, and he mapped out both how they would interact technically and how they would combine in a profitable business. Edison, perhaps the greatest inventor in history, was as consumed with the business system as he was with the light bulb. Dr. Shaf Keshavjee, Surgeon-in-Chief, UHN Shirlee Sharkey, President and CEO, Saint Elizabeth Dr. Zayna Khayat, Senior Advisor, MaRS Health Better Health Toronto featured a keynote address from the Hon. Dr. Eric Hoskins, Ontario Minister of Health and Long-Term Care, alongside presentations from four subject matter experts Dr. Anne Snowden Professor and Chair International Centre for Health Innovation Richard Ivey School of Business Jaime Watt Executive Chairman of Navigator Ltd. Nik Nanos President and CEO Nanos Research Dr. Chatham Sullivan Innosight The Better Health Tour is bringing together Canadian leaders to address this growing healthcare confidence gap in our country. Canadians appreciate that innovation, rather than increased funding alone, is necessary to address the challenges facing our system. iii Presentations focused on innovation as a solution to the problems faced today and those we will face in the future. Key themes included: Collaboration across different sectors within the health system, Increased and improved use of technology, and Collaboration leveraging best practices and insights between public and private partners. SUSTAINABLE HEALTHCARE? Locally-accessible, high-quality and friendly healthcare is what Canadians want and need. However, public opinion research suggests that many Canadians are concerned and anxious about the future of our health system. Looking to the future, just over 1 in 4 Canadians think the quality of healthcare will be better for their children than it has been for them. ii We need to reach across the aisle and realize that this problem is bigger than any of us, and the only way we re ever going to solve it is if we come together. Jaime Watt 3

4 And they appreciate that opportunities to innovate exist. Big data and mobile devices are seen by over 68% of all Canadians as significant or somewhat significant opportunities to unlocking better quality, while there is an extremely strong belief among Canadians that we should be open to learning from healthcare experiences in other countries. iv Just over half of Canadian physicians are using EMRs, and this low level of adoption compared to other countries is a problem. Better Health Toronto is just one of many efforts taken by McKesson Canada to hear the voices from visionary leaders who believe in the importance of removing silos, embracing collaboration between the public and private sectors, and solving the problems that Canadians know are facing healthcare systems across the country. We have enormously new and exciting ways to deliver public services. Canada can be a global leader in integrating new treatments, new technologies, and new models. Matthew Mendelsohn, Director, Mowat Centre Innovation in healthcare is always important. If you ever get to a point where you think innovation is not important, it is probably when you need it most. Jessica Ching, Co-Founder and CEO, Eve Medical If you create a myopic focus, you ll still have errors. But what if we said in 5 years we will totally, once and for all, fix the electronic health record question as opposed to just talking about it. That s something you could mobilize people around. John Matheson, President, Strategy Corp. Ontario, like the rest of Canada, struggles to deliver consistent access to care due to the vast distances between rural and/or remote communities, and urban areas with specialized services. EUREKA MOMENTS With over 100 participants, Better Health Toronto offered an interactive forum for healthcare leaders to learn, discuss, and debate workable approaches to creating a healthier future within the context of a more sustainable healthcare system. Canada vs. the World A key question that was asked was what, if anything, should the Ontario healthcare sector do to address disparities in life expectancy and mortality rate differences based on geography? Better Health Toronto participants were asked to engage in open conversations on the current state of the health system in Canada (and in Ontario specifically), and challenged to provide suggestions that could help Canada catch up to other countries level of care. 4

5 Models and approaches from other jurisdictions are worth exploring. And the Better Health Tour is the start of the conversation on how we bring can make the most of international best practices within the context of our Canadian health system. And it s important to note where Canada stands compared to international leaders, because medical migration is a real issue. In 2011, 46,000 medical tourists left Canada to seek care elsewhere. And the costs continue to mount. That s why collaborative healthcare innovation and pulling together global best practices is a defined cure for the cost/time/quality problem facing every health system. Since 2011 this number has been declining, but is this a victory? Wait times have remained roughly the same for more than a decade. Be a silo buster. Accept when others have innovated, or made progress in a space that interests you. And then join forces with them. Dr. Zayna Khayat Sr. Advisor, MaRS Health 5

6 TOUGH QUESTIONS In advance of Better Health Toronto, in-depth interviews were conducted with our expert panelists. Each panelist was asked to respond to several questions to gain greater insight into their perspective on innovation in healthcare. Panelists included: Dr. Anne Snowden, Professor and Chair International Centre for Health Innovation, Richard Ivey School of Business Jamie Watt, Executive Chairman of Navigator Ltd. Dr. Shaf Keshavjee, Surgeon-In-Chief, University Health Network Shirlee Sharkey, President & CEO, Saint-Elizabeth Dr. Zayna Khayat, Senior Advisor, MaRS Health QUESTION: Why is now the time for healthcare leaders to be thinking about innovation? There s no question it s the courage to change. I think we have it today the people have figured out we ve got to have change. The status quo isn t sustainable and it s not going to work for them. The wolf is at the door. It s just costing too much money and it s growing faster than our ability to pay for it. Jamie Watt Scarcity breeds innovation. And I think there s an uprising of the citizen and the democratization of healthcare. We re kind of all done studying the health system and now there s an ability and demand to actually do something to modernize it. Dr. Zayna Khayat It s a convergence of technology, changing demographics, unmet needs. All of these things are reaching a critical mass and the growing consumer strength combined means there is an expectation and ability to deliver more. It s also because of the economics. That would be a much shorter answer. Shirlee Sharkey QUESTION: Do you see innovation currently in the Ontario health system? It s in our genes. Our zone of homecare is why we re different and successful. We knew that innovation was going to be critical for our success and we understood it in our specialty. Shirlee Sharkey Things that weren t possible 10 years ago are possible now. Things that weren t even possible 6 months ago can become possible now. With that pace you need to keep yourself on the forefront of innovation. Dr. Shaf Keshavjee We haven t accepted that something is not possible. Lung transplantation wasn t possible. Everybody else in the world tried and failed and we figured out a way to make it happen. Dr. Shaf Keshavjee Cataract surgery, they ve taken it from hospital-based procedure exposing you to risk, inappropriate resources and now it s 25 minutes in and out, with the same quality. That s process re-engineering Jamie Watt 6

7 QUESTION: What s your call to action for healthcare leaders in Ontario? Look at solutions with a new lens. In health it s easy to see the finish line, but examine the starting point. When someone starts to talk about what the answer is, stop and stretch out the potential solutions. Look at areas outside of healthcare for examples of how they re embracing innovation. We looked at a consulting company and got inspiration there, among other industries and fields. There s all sorts of stuff out there that may be new to you even if it s dated within its own industry. The hospitals, research institutes, ministry, industry they have to work together. Recent success and big improvements have been when they come together to solve problems. Major innovations come out of creating a culture of research and innovation. Create an enabling environment that allows discovery, then translation of that work into a breakthrough. Dr. Shaf Keshavjee Whenever we ve tried to change this from the top down, it hasn t worked. I m excited now because I think we re actually going to change it bottom up. Patients and people are saying we want this done differently. Throw of the shackles of this idea that the citizens, the people of Ontario, don t want change. They ve got the public on their side. Jamie Watt. You re a player in the game whether you re a company, advocacy group, government, or hospital. And there has to be alignment around a common vision for the population, a common innovation goal. We don t have that. Dr. Zayna Khayat Define the outcome you re trying to achieve. What does success look like and then engage those collaborative strategies to drive the innovation needed to get there. Dr. Anne Snowden Shirlee Sharkey 7

8 ASK THE AUDIENCE To wrap up the Better Health Toronto event, our panel of experts engaged with audience members to discuss solutions on issues identified throughout the day: Scaling Innovation Demand more in everything. Be a scale-erator. Scale has to be built into the design of everything you do. Enough with great ideas, let s put them to work. Dr. Zayna Khayat Embrace and empower geography. Let s get all the hospitals in the GTA, at the very least, to have some common system that let s you scale up your pilot projects. And then go provincial. Chris Holling, Toronto Region Board of Trade Examine life patterns of people and find those intersections. We all get CPP when we hit a certain age what is the chronic disease management system that comes into play when everyone hits a certain age? Shirlee Sharkey Consuming Healthcare Canadians are going to demand both choice, and change. They are going to be tremendous drivers of change. How can we inject choice and change into the system in a way that preserves people from losing their house or being denied care? Jamie Watt The secret sauce to innovation is really developing solutions from the perspective and the experience of the people that use healthcare. Chatham Sullivan, Partner, Innosight We have to tie this back to consumer choice. Right now our policies don t allow us to do that. Policymakers need to open up that idea and let patients choose their treatment and where to get it. Smoking cessation is a good example of where that could work, or even postsurgery monitoring let them choose at home or in the hospital. Neil Fraser, Medtronic Canada Informing Choice Patients having access to their own information really empowers people. Now, that gives patients voices around healthcare so that when we are looking at innovation, you have a larger cohort who is comfortable speaking out about the way the system should be. Neil Shah, SickKids Access to data let s people make the right decisions, and that s going to drive change, drive the conversation around politics that the consumer is going to drive. Stuart Feldman, Point Click Care Consumers aren t all the same. Kamloops to University Ave. to rural Newfoundland is very different. Segmenting the population and looking at what s meaningful and valuable to each one will show you the opportunities. Dr. Anne Snowden 8

9 SO WHAT? Important truths were reinforced at the Better Health Toronto tour stop: There is a defined need for Canadian health systems to embrace innovation and secure the sustainability of the system. Between 2004 and 2013, spending on public health in Canada rose 54.3% Any conference, meeting, Board retreat you do, kick it off by bringing in a patient to share their story. Lead with that and I guarantee it ll galvanize everybody, every session. Dr. Zayna Khayat Canadians want a seamless, integrated system that is designed to be responsive to their needs, as consumer of healthcare. 33% of patients in Canada said they waited six days or more for an appointment with a doctor or nurse when they were sick or needed care There is an urgent need to share and embrace innovative approaches between the public and private sectors. 15% of physician visits can be treated in a lower cost setting, such as a neighbourhood pharmacy, yet these services cost the Canadian health system over $3 billion dollars a year. These conclusions are the call to action for all health system leaders to push the envelope on implementing innovation. McKesson Canada is bringing innovation to life, and wants to invite every Canadian innovator to share their stories of how we can and are delivering the next evolution of Canadian healthcare. Three specific innovations currently being driven by McKesson Canada and its partners are: The whole EMR discussion. Sure government is wary of that because of the past, but if a coalition of IT companies comes together to say we want to approach this problem together, that s a solution. Alain Champagne 1. A collaboration with the government of New Brunswick on a province-wide, hospital pharmaceutical supply chain, which is reducing costs, decreasing fatal adverse drug reactions, and protecting patients with safer tracking and controls 2. A partnership with the Nova Scotia Department of Health and Wellness to roll out RelayHealth, a cost-effective, secure, cloud-based software system that coordinates and connects over 5,000 9

10 patients and providers, increasing primary care capacity by 20%, without any new physicians 3. The launch of McKesson Ventures, an international venture capital fund to fuel patientcentric healthcare innovation to address the emerging challenges facing the healthcare industry. This is just the beginning for McKesson Canada. And the hope is that as the conversations started at Better Health Toronto continue across Canada, every healthcare leader will share their innovative approaches, driving the Canadian innovation landscape, and promoting implementation. THE WAY FORWARD embrace change as seen with Canadians growing use of pharmacy-based care. Moving forward, participants in the Better Care Toronto tour stop believe: Fostering an environment to implement innovation will be necessary to deliver a sustainable healthcare system There is a responsibility to promote and share innovative practices, approaches, and technology as a means to driving wider adoption and the ongoing evolution of the system Close collaboration between the public and private sectors is the answer to the tough challenges facing health systems across the country Delivering and implementing the higher-quality, costeffective solutions Canadians need will not be easy. It will require provider groups and partners to work together in new and different ways. And it will require courageous leadership from policymakers and health system leaders to make important but necessary decisions that will unleash creative solutions helping to ensure that Canada s health system remains among the best in the world. Dr. Erik Hoskins, Ontario Minister of Health and Long Term Care While Better Health Toronto participants appreciated the challenges of ensuring the sustainability of Canada s healthcare system, a sense of optimism and excitement prevailed. From accelerating the use of information and communications technology, to moving to patientcentred and silo-free health system design, there was no shortage of strategic ideas. Unifying the perspectives we heard was an important underlying premise: higher quality and lower-cost are not mutually exclusive. There are innovative solutions that can help deliver both, clearing the way for even higher standards of care for a growing volume of people who need it. Canadians remain proud of our health system and are not only aware that new approaches to care will be needed, but are eager to Healthcare it is built into and part of the Canadian identity. Dr. Anne Snowden i Portions of this section originated from the following Innosight publication: HBR, Mark Johnson and Josh Suskewicz, How to Jump-Start the Clean Tech Economy, November ii P. 5 Nanos Research Healthcare Survey 2014 for McKesson Canada. N=1000 Stat Sig = accurate within 3.1%, 19 times out of 20. iii P. 7 of Nanos Research Healthcare Survey 2014 for McKesson Canada. N=1000, 3.1%, 19 times out of 20. iv P. 8 and 9 of Nanos Research Healthcare Survey 2014 for McKesson Canada. N=1000, 3.1%, 19 times out of