laying the foundation for industry transformation€¦ · laying the foundation for industry...

How to measure outcome in healthcare, and how health ICT contributesLaying the foundation for Industry transformation

Bruxelles Nov 19, 2014

Blank.potx 1Draft—for discussion only

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Agenda

Defining value in health care

Changing the game

Setting global standards - ICHOM

eHealth as enabler of system transformation


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Health care systems under increasing scrutiny and challenge


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Large variation in the quality of breast cancer surgeryExample: BCG Health insurance project from the Netherlands

Average percentage of patients with remaining tissue

5

15

10

0

Number of breast cancer patientsper hospital (2008)

>4001

3.6

300–400

6.8

200–300

9.5

100–200

10.5

<100

13.5

Clear negative correlation between volume and remaining cancer tissue...

Clear negative correlation between volume and remaining cancer tissue...

1. Only 1 hospital with more than 400 patients in 2008 Note: Location volumes and results have been added up for a number of hospitals that treat breast cancer at several locationsSource: BCG experience

... but large variation - single low volume hospitals also with excellent results

... but large variation - single low volume hospitals also with excellent results

3.66.8

9.510.513.5

0

10

20

30

40

50

<100 100–200 200–300 300–400 >400

Percentage of patients with remaining tissue

Number of breast cancer patientsper hospital (2008)


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=

Value

Outcomes that matter to

patients

Cost per patient

Defining Health care value

ProcessesPatient

experience/engagement

Indicators

Patientinitial

conditions

Outcomes that matter to patients

Structuree.g., Staff certification, facilities standards

• PSA• Gleason Score• Surgical margin• (…)

Protocols/guidelines

• Survival• Continence• Erectile function• Anxiety

• Adequate information

• Expectations agreed with physician

• (...)

• Age• Comorbidity• (...)


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Agenda


Changing the game




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Outcomes transparency engages clinicians in changeExample: Swedish myocardial infarction registry

1. Percutaneous coronary intervention 2. on angiography and PCI 3. Riks-HIASource: SVT.se; Aftonbladet 2007-03-08; DN 2009-05-06; Dagens Medicin 2008-08-26; Läkartidningen nr 44 vol. 104, 2007; Värmlands Folkblad 10 Oct 2007

Care cycle redonePCI1 - unit establishedEmergency care expanded to 24/7 coverage

Care aligned with national treatment guidelines2

New specialist departments for specific coronary conditions startedStaffing improved

Kar

lsta

d ce

ntra

l hos

pita

l H

alm

stad

hos

pita

l

1 year mortality 20%, ranked #68 of 73 hospitals

Ranked #43 of 73 hospitals

Before

Quality index raised from 1 to 4Mortality reduced by 50%Ranked #45

Quality index3

raised from 1 to 8,30-day mortality reduced by 50%Ranked #22

After


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Data made public

2

3

4

5

6

2005 2006 2007 2008 2009

RIKS-HIA Quality index

+13%

+22%

Bottom half 2007 (n=34)All hospitals (n=69)

+7%

+40%

Outcomes transparency improves complianceExample: Swedish myocardial infarction registry


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Would you rather have a heart attack in Sweden or the UK?

59%

89%

7.6%

1.0

22%

78%

10.5%

1.37

30-day mortality

1. Acute Myocardial Infarction 2. Mortality rate adjusted for 17 casemix characteristics. 3. Primary PCI (Percutaneous Coronary Intervention) is recommended in guidelines in the USA since 2004 and in Europe since 2005 but did not become UK national policy until October 2008. β blocker at discharge has been recommended in guidelines in the USA and Europe since 1996 and in the UK since 2001, but statin therapy and ACE inhibitors or ARBs are still more commonly prescribed in the UK.Note: The study period was 2004-2010. Source: Chung et al, The Lancet, Jan 23, 2014.

Outcomes1

Primary PCI3

Treatment

β blocker at discharge4

Standardized mortality

rate2


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qA

Improvement – The Experience Curve revisited

Source: Hospital quality reports 2010

Martini Klinik does over 2k prostatectomies /year – largest in EU 5 year disease-specific survival

Martini Klinik 95%

Average Hospital 94%

Severe erectile dysfunction

75.5%

34.7%

Average Hospital

Martini Klinik

6.5%

43.3%Average Hospital

Incontinence

Martini Klinik

qA

qA


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Value cycle: starts with reliable outcomes data... Value cycle: starts with reliable outcomes data...

Feedback and learning

Transparent outcomes dataAnalyze variation

Identify current best

practices Change behavior

Value created at every stage of process

Transparent outcomes data drives HC improvement

Improved outcomes

Reduced variation

Reduced medical cost

Continuous improvement

Improved health care value

...to deliver VBHC competitive advantage

...to deliver VBHC competitive advantage

Value


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Outcome measurement changes the game

Silo optimization

Control

Component management

Holistic leadership

Engagement

End-to-end


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Strong trend towards VBHC strategy

HC system & policy

Payers

Providers

Suppliers


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VBHC with major implications for MedTech strat and ops

4'500 employees and 38 MedTech businesses covered globally1

Götz Gerecke

Partner & Managing Director,BCG Zurich


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Agenda


Changing the game




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1M GSM users 1994 6,000 M users 2014

Standardization

70 140k miles 24% cost savings


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International Consortium for Health Outcomes Meaurement

Source: ICHOM

ICHOM not-for-profit, largeset sponsors are patient advocacy organizations such as Movember and American Heart Assn

ICHOM facilitates a process with physician leaders and patient representatives to develop the

Outcomes Minimum Standard Set

2013 Conditions▪ Solitary prostate cancer▪ Lower back pain▪ Cataract▪ Coronary artery disease

2014 Conditions▪ Parkinson’s disease▪ Cleft Lip and Palate▪ Stroke▪ Hip and knee osteoarthritis▪ Macular degeneration▪ Lung cancer▪ Depression and anxiety▪ Advanced prostate cancer


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Example: ICHOM Prostate Cancer Working Group

Adam Glaser, St James’ Institute of Oncology; NHSJim Catto, University of Sheffield, European Urology

Kim Moretti, South Australian Prostate Cancer Clinical Outcome CollaborativeMark Frydenberg, Prostate Cancer Registry of VictoriaIan Roos*, Cancer Voices Victoria

Frank SullivanProstate Cancer InstituteJohn Fitzpatrick, Irish Cancer Society

Hartwig Hulandⱡ and Markus Graefen, Martini KlinikMichael Froehner, Günter Feick*, BundesverbandProstatakrebs Selbsthilfe (BPS); Europa UOMOThomas Wiegel, University Hospital Ulm

C.H. Bangma,Erasmus Medical Center

Anna Bill-Axelson, Swedish Prostate Cancer Registry

Francesco Montorsi, European Urology Editor in ChiefAlberto Briganti, Vita-Salute San Raffaele University Hospital, Milan

Jabob Ramon,Sheba Medical Center

Steven Jay Frank, MD AndersonDavid Swanson, MD AndersonAndrew Vickers, MSKCCAdam Kibel, Dana Farber/BWHMichael O’Leary, Dana Farber/BWHAnthony D’Amico,Dana Farber/BWHNeil Martin, Dana Farber/BWHMichael Blute, MGHHoward Sandler, Cedars‐SinaiRonald Chen, University of North CarolinaDan Hamstra, University of MichiganAsh Tewari, Weill Cornell Medical College

*Patient representative; ⱡWorking Group lead


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ICHOM Standard Set for Localized Prostate Cancer

Treatment approaches covered

▪ Watchful waiting▪ Active surveillance▪ Prostatectomy▪ External beam radiation therapy ▪ Brachytherapy▪ Androgen Deprivation Treatment▪ Other

© 2013 ICHOM. All rights reserved. When using this set of outcomes, or quoting therefrom, in any way, we solely require that you always make a reference to ICHOM a s the source so that this organization can continue i ts work to define more standard outcome sets.

Details1 Recorded via the Clavien-Dindo-Classification2 Recorded via the Common Terminology Criteria for

Adverse Events (CTCAE), version 4.0 3 Recommended to track via the Expanded Prostate

Cancer Index Composite (EPIC)-26


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Strong global demand to measure and compare outcomes

More than 40 organizations have started to actively measure the ICHOM Standards; 200 more interested

To name a few...

▪ MD Anderson (US)

▪ Mayo Clinic (US)

▪ Stanford Hospitals & Clinics (US)

▪ Dana Farber/Brigham and Women’s Hospital (US)

▪ Martini Klinik (DE)

▪ Hamburg Brachytherapy (DE)

▪ Irish Prostate Cancer Outcomes Registry (IE)

▪ Australian Prostate Cancer Clinical Registry (AU)

▪ Santeon Hospitals (NE)

▪ Aravind (IN)

▪ Fortis Health Care (IN)

▪ ...


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Agenda


Changing the game




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Broad trends relevant to eHealth

Health care trends

Socio-economic (mega) trends

IT trends

Digitization of the enterpriseProcess automation & digitization of health care data (eg, EMR, HIE)

Value from dataAchieving value from data – better outcomes at lower cost spend (value-based healthcare)

Disruptive products and servicesIncreasing patient engagement and self-help

EcosystemsIncreasing collaboration and cooperation across Payors/Providers, MedTech, Pharma


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Big Data mHealth

Digital HospitalsRegional and national

electronic health records


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ICU

Patient group 3

Patientgroup 1

Patientgroup 2

Patientgroup 4

Clin

icia

n 4

Clin

icia

n 1

Clin

icia

n 2

Clin

icia

n 3

Rad

iolo

gy

Ane

sthe

siol

ogy

and

OR

Lab

and

path

olog

y

Para

med

ics

Common functions/resourcesPatient-group

specific expertise

HospitalOther

providers

Prim

ary

care

Oth

er h

ospi

tals

Oth

er ty

pes

of c

are

e.g.

, re

hab,

eld

erly

car

e et

c.ER

Disease or condition

Networks of care

Hea

lth o

utco

mes

and

cos

ts

per p

atie

nt

Cost per activity and ability to meet needs of each disease or condition

Out

patie

nt c

linic

s

In-p

atie

nt c

linic

s

S BCG l i

Value based health care systems track Outcomes and Costs by patientgroup and population segment


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Phenome

Holistic patient profile of high-throughput, in-vitro biological, clinical, behavioral, & environmental data measured in ways designed to be minimally intrusive

Late presentation of diabetes - secondary effects already underway, e.g. atherosclerosis

Traditionalclinical

parameters

High quality care – annual BMI check with recommendation to "lose weight"

Big Data and mHealth enables Personalized healthcareExample diabetes

Genetic predisposition

Pre-symp. phenotypic expression

Early signs Symptoms Co-morbid. Complications Death

Health management

Pre-symptomatic tx: ACE-inhibitor based on proteomic screen 3 years before microscopic proteinuria

Individualized therapy based on biological, behavioral, social once sugars elevated

Behavioral & social

information

Real-time, continuous data capture + engagement through mobile and social techs enhance traditional medical practice

GenomeGenomic mapping a standard pre-natal screen reveals risk of Type 2 diabetes

The goal: longer, healthier,

higher quality of life


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