Unleashing Innovation: Excellent Healthcare for Canada Report of the Advisory Panel on Healthcare Innovation
Dr. Cyril B. Frank (1949-2015)
Other Panel Members Neil Fraser President of Medtronic of Canada Ltd. Has held a range of advisory roles including as a member of the Ontario Health Innovation Council Francine Girard (Deputy Chair) Dean and Associate Professor at the Faculty of Nursing at the Université de Montréal (until spring 2015) Chaired the Quebec Task Force on Working Conditions of Nurses and in 2013, was a member of the Comité interministériel du Québec sur le futur de la formation infirmière Toby Jenkins Executive Fellow at the School of Public Policy, University of Calgary, involved in health and urban policy Board member of Canada Lands Company and chair of the Risk Management Committee, as well as a board member of TVOntario Jack Mintz President's Fellow of the School of Public Policy at the University of Calgary after serving as the Palmer Chair and Director since 2008 Serves on the boards of Imperial Oil Limited, Morneau Shepell and is chair and Vice-President of the SSHRC. Christine Power CEO of the Canadian Patient Safety Institute (as of March 2015) Previously, served for eight years as president and CEO of Capital Health, Nova Scotia
Overview of Panel Mandate and Activity The federal Minister of Health, the Honourable Rona Ambrose, launched the Advisory Panel on Healthcare Innovation on June 24, 2014. Mandate: Identify the 5 most promising areas of innovation in Canada and internationally that have the potential to reduce growth in health spending while leading to improvements in care. Recommend 5 ways the federal government could support innovation in these areas. Panel work included: Consultations with stakeholders and public (with over 400 written submissions) Literature review and commissioned research Engagement with international and domestic experts Report released on July 17, 2015
International Comparisons of Health Spending
Nation Summary Scores on Health Systems Performance
Overview of Findings Two essential healthcare innovation enablers: Healthcare Innovation Fund Healthcare Innovation Agency of Canada Five key areas of healthcare innovation: Patient engagement and empowerment Health systems integration with workforce modernization Technological transformation via digital health and precision medicine Better value from procurement, reimbursement and regulation Industry as an economic driver and innovation catalyst Two themes for targeted federal focus: Consensus building nationally Financial fairness
Pan-Canadian Health Organizations Funded by the Federal Government 8
Breaking the Gridlock: Key Enablers A federal Healthcare Innovation Fund is essential to support initiatives that break down structural barriers to change and accelerate the scale-up of promising innovations Aim would be to enhance the quality and value of healthcare while improving health system performance Non-formulaic, not used for insured services Strategic investor to support coalitions of willing partners from various sectors Initial term of 10-years and, in ideal circumstances, move towards a steadystate target of $1 billion per annum as early as 2020. Healthcare Innovation Agency of Canada (HIAC) likewise critical to facilitate collaboration among stakeholders and governments, support work across the five areas, and manage the Innovation Fund Would fold in expertise and focus of CFHI, CPSI, and, after a transition period for completion of its existing projects, Infoway
Percentage of Doctors Reporting That Almost All Their Patients Can Get a Same or Next-Day Appointment
1. Patient Engagement and Empowerment Findings Many promising innovations across Canada A gap persists between the rhetoric of patient-centred care and reality for many patients and families Patient engagement is critical at all levels: individual, organizational and system-wide Set of Recommendations, e.g. Develop and implement measures to promote patient and familycentered care in partnership with governments, patients, providers and others health literacy, patient portals, m-health/virtual care, engaging patients and families in the design and evaluation of healthcare services
2. Health Systems Integration with Workforce Modernization Findings More integrated care is critical to improving quality of care and health outcomes, and optimizing scopes of professional practice Highly integrated systems (e.g., Kaiser Permanente) rely on: Inter-professional teams of providers Seamless collaboration across organizations and sectors Information technologies to link providers, patients, and settings Integrating payment models and provider accountabilities Emphasis on outreach and prevention/wellness Steps towards integration: US experimentation, not least bundled payment models In Canada, integration of care largely unrealized Fragmentation of care a particular issue for First Nations
2. Health Systems Integration with Workforce Modernization Set of Recommendations Support provinces/ territories and regional health authorities in implementing highly integrated delivery systems that test new forms of payment, where care is organized and financed around the needs of the patient. Ensure integrated delivery arrangements address social needs and determinants of health, protect and promote health, and prevent disease Support the adaptation and scaling-up of partial integration models, viz. Bundled Payments. Support implementation of the Canadian Academy of Health Sciences 2014 report Optimizing Scopes of Practice.
Eric Topol Cardiologist-Futurologist
3. Technological Transformation via Digital Health & Precision Medicine Findings Digital health and data-driven care holds significant potential, but Canada has fallen behind: Uneven standardization and use of EHRs; limited m-health/virtual care Uneven use of data to generate actionable, real-time information for decision making Knowledge gaps need to be filled, e.g., First Nations health and health care, how private dollars are spent, patient-oriented outcome measures Canada is woefully unprepared for shift to precision medicine Moving forward on research, but lagging in implementation as others advance Set of Recommendations, e.g., Accelerate standardization and meaningful use of EHRs; open up records to patients Develop Infoway 2.0 inside new Agency Develop and begin activating a National Strategy for Implementation of Precision Medicine, in concert with P/Ts and health research agencies
Prescription Drugs - 2005 and 2013 Average Foreign to Canadian Price Ratios
4. Better Value from Procurement, Reimbursement & Regulation Findings Canada does not have a strong value-for-money orientation in healthcare. Changes to healthcare finance, purchasing and regulation needed. Innovators frustrated by a multi-tiered system for regulatory approval and fragmented purchasing. Set of Recommendations, e.g. Coordinate existing federal drug plans and join the Council of the Federation s pan-canadian Pharmaceutical Alliance Engage private plans; transparency in regulatory processes; focus on value of pharmaceuticals and devices; coordinate and collaborate across jurisdictions. Review PMPRB re: effectiveness of its role in protecting consumers against high drug prices National Pay Commission/HHR analyses of scopes of practice in relation to value Support a range of activities including the implementation and evaluation of the Choosing Wisely Canada campaign
5. Industry as an Economic Driver & Innovation Catalyst Findings Healthcare products and service industry has potential to create economic prosperity while improving care. Denmark and UK have policies and processes to partner with industry for mutual benefit. Canada has unrealized potential to punch above its weight in the development, commercialization, adoption and export of innovative healthcare products and services Federal leadership needed through a single organization mandated to drive partnership of mutual benefit to industry and Canadians Set of Recommendations, e.g. Create a Healthcare Innovation Accelerator Office inside the new Agency Accelerate the adoption of potentially disruptive technologies that promise better value for money to the system and benefit for patients Greater regulatory harmonization and convergence with international standards Develop whole-of government federal strategy to support the growth of Canadian commercial enterprises in the healthcare field
Targeted Areas of Federal Focus: Consensus-Building Nationally Consensus building nationally on ethical, social and legal issues is critical to enabling healthcare innovation Health Canada in partnership with HIAC should take the lead in consultation and consensus building across provinces and territories to anticipate emerging issues, and resolve legislative ambiguities, e.g.: Protection of patient privacy while enabling innovation (e.g., in digitized care and mobile health) Patient protection against potential genetic discrimination Physician assisted dying "Much of healthcare focuses on curing the incurable. I wonder about the cost and suffering caused by attempts to preserve life when quality will be limited. Now that is loaded, because I also realize that quality exists in many different packages and it is not my decision to determine this for others Perhaps more conversations about 'expectations' and ethics could make some of the muddy waters clearer. - Public Submission
Percentage of Households with Out-of-Pocket Expenditures on Healthcare More Than 5 Percent of Total Household Income, by Household Income Quintile, Canada Excluding Territories, 1997 to 2009 Source: Statistics Canada, Survey of Household Spending
Targeted Areas of Federal Focus: Ensuring Financial Fairness in Healthcare Out-of-pocket spending on healthcare is rising in relative terms, creating an inequitable burden on lower-income Canadians New tax credit to help relieve burden on lower-income earners Income-scaled Refundable Health Tax Credit (RHTC) would be applied in conjunction with the existing Medical Expense Tax Credit RHTC = tax relief of 25 percent on eligible out-of-pocket healthcare expenditures up to $3,000 per year, starting with first dollar spent on eligible expenses Funded by taxing employer-paid health and dental benefits
Conclusion Urgent need for renewed commitment to collaboration and shared political resolve on the part of all jurisdictions to improve Canadian healthcare systems New model for federal engagement in healthcare should be built on: an ethos of partnership a shared commitment to scale existing innovations and make fundamental changes in incentives, culture, accountabilities, and information systems prudent investment and catalysis through a centre of excellence The Panel is firmly convinced that concerted action on its recommendations can make a meaningful difference that will be seen and felt across Canada by 2025