Value-based Health Care - Unispital Basel · Value-based health care is the emerging paradigm 1. M. Porter: Redefining Health Care, 2006 Source: "Redefining Healthcare", BCG analysis
Post on 27-Sep-2020
2 Views
Preview:
Transcript
Value-based Health Care
Jens Deerberg-Wittram, MD
BASEL, SEPTEMBER 20TH 2018
1 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
2 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
In 1995, McArthur Wheeler robbed two banks after covering his face with lemon juice.
He believed, because lemon juice is usable as invisible ink, it would prevent his face from being recorded on surveillance cameras
But I wore the juice...!
3 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Dunning-Kruger effect: Incompetent but confident
Source: Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments, Kruger, J., Dunning, D. (1999)
4 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
1:60 mortality rate in base jumping
5 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Significant mortality differences in Swiss hospitals
61×
#64
12.3
4.3
#20
2.7
#1
0.2
6.7
#1
2.9
4.5×
#10
12.9
Pancreatic resection (cancerous lesion) Colorectal resection (cancerous lesions)
% mortality % mortality
• 53 hospitals perform procedure (15×)
• 30 hospitals perform less than 10 cases/yr
• 103 hospitals perform procedure (72×)
• 17 hospitals perform less than 10 cases/yr
9×
#5
3.6
2.0
#1
0.4
Open heart valve replacement Aortic aneurysm surgery
% mortality
• 22 hospitals perform procedure (232×)
• 3 hospitals perform less than 10 cases/yr
Source: BAG 2016, BCG analysis
8×
#30
66.7
47.8
#20
42.6
#1
8.0
% mortality
• 40 hospitals perform procedure (50×)
• 10 hospitals perform less than 10 cases/yr
6 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Average mortality rates of reporting Swiss Hospitals
Pancreatic
resection6.7%
5×
3×
Lungs/branchial
resection2.2%
Colorectal
resection4.2%
Base-Jumping 1.4%
Openheart valve
replacement2.0%
7 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
8 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Health care costs are rising at unsustainable rates
250
200
150
100
Income
HC Spend
GDP
20162010200520001995
HC expenditure 2016:
17.2% of GDP
HC expenditure 2016:
11.0% of GDP
100
300
200
Income
HC Spend
GDP
20162010200520001995
400
300
200
100
1995
Income
HC Spend
GDP
2016201020052000
300
200
100
Income
HC Spend1
GDP
20162010200520001995
HC expenditure 2016:
9.7% of GDP
HC expenditure 2016:
10.5% of GDP
HC expenditure 2016:
12.4% of GDP
400
300
200
100
HC Spend
GDP
201620102005
Income
20001995
1. Long-term care spending included in HC Spend in Sweden after 2011, thus HC spend for Sweden is indexed 1995–2010 and 2011-2016 with HC being same as GDP growth 2010-2011
Notes: Index 100 at 1995, based on local currencies; Income = Personal Disposable Income
Source: WHO; EIU; BCG analysis
HC expenditure 2016:
11.3% of GDP
400
300
200
100
2010
GDP
201620052000
HC Spend
Income
1995
9 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Switzerland outgrowing OECD in joint replacements
308
299
241
234
204
182
166
148
113
62
500 350300250200150100
OECD
UK
USA
Sweden
France
Germany
Switzerland
Israel
Spain
Canda
Per 100 000 population
240
226
206
178
160
149
126
124
120
55
250200150100500 300
Per 100 000 population
Israel
Spain
Sweden
OECD
UK
France
Canda
Germany
USA
Switzerland
Source: OECD report "Helath at a glance 2017", BCG analysis
Primary hip replacements (2016) Primary knee replacements (2016)
10 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Price differences in hip replacement surgery
0
30,000
20,000
10,000
12,467
ES
11,220
CH
10,224
BE
10,029
IT
9,605
NL
8,671
GE
7,570
SE
6,707
UK
6,054
FR
5,365
Cost of hip replacement surgery (€)
US
23,669
AU
8,383
Ø
+91%
Note: All reimbursement rates in EUR (PPP)Source: BCG Analysis, country specific DRG databases
Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
11
Switzerland – as much as many
other countries - is suffering
from serious quality and cost
issues in health care
12 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Value-based health care is the emerging paradigm
1. M. Porter: Redefining Health Care, 2006Source: "Redefining Healthcare", BCG analysis
ConceptInitial description
Health outcomes that
matter to patients
Cost of delivering
the outcomes
Central goal in health care becomes value for the patient,
not volume, cost containment or meeting single medical parameters
Value1 =
13 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Outcome measurement the first step towards value-based health care
Health system are optimized for
continuous improvement in value
delivered to each population segments
Standardization of outcome metrics
enables anonymous comparisons across
and within health systems
Individual organizations begin measuring
quality and reducing variation of patient
outcomes resulting from treatment/products
Phase IV
Phase II
Phase I
Phase III Public reporting creates incentives
(financial and non-financial) to improve
value
Characteristics of the phases
in the Transformation Roadmap
For each phase understand the meaning
for each dimension of the health care
system
Payments
Delivery organization
Informatics
Benchmarking
research & tools
14 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Individual organizations are measuring outcomes
15 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
ICHOM defines global standards for outcomes that matter to patients
A physician-patient partnership ICHOM facilitates
a process with physician leaders and patient
representatives to develop
the Outcomes Minimum Standard Set
ICHOM is an independent not-for-profit organization,
main funding patients, payers, providers and governments
Source: ICHOM, the International Consortium for Health Outcomes Measurement
16 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Standardization of outcome metrics
Outcome hierarchy by Michael Porter
Tier 1
Health status
achieved or retained
Tier 2
Process of recovery
Tier 3
Sustainability of
health
Survival
Degree of health or recovery
Time to recovery & return to normal
activities
Disutility of care or treatment process
(e.g., complications)
Sustainability of health or recovery and
nature of recurrences
Long-term consequences of therapy
Source: M. Porter. What is value in health care? NEJM 2010
17 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
INFLAMMATORY BOWEL
DISEASE
INFLAMMATORY BOWEL
DISEASE
Source: ICHOM
ICHOM has already developed 23 Standard Sets covering over 50 percent of the global disease burden
1. Bipolar disorder
2. End stage renal failure
3. Hypertension
4. Malaria
5. Adult population health
6. Substance use
7. Oral health
8. Inflammatory arthritis
9. Congenital hand malformations
10.Rotator cuff disease
11.Brain tumors
12.Upper GI cancers
13.Type 1 diabetes
14.Arrhythmia
Standard Sets
2012–2017
Ongoing discussions
to launch …
18 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Public reporting of outcomes across NHS England
Source: NHS Choices website
19 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Bundled payment for hip- and knee
surgery
• Payment of 56,300 SEK (~€6,300)
to cover full cycle of care,
including diagnostics, surgery with
post-operative care, implant and
follow-ups
Complication guarantee
• Provider financially responsible for
non-acute complications related
to the primary surgery up to 2
years post-operation
Result dependent payment
• 3.2% of the reimbursement was
retained and paid out if the
provider achieved defined goals
Financial incentives to improve value
Model design
Outc
om
es
Cost
s
Note: 2007-08 and 2009-10 were the 2 years before and after the new model was introduced.
Source: New reimbursement model for care choice hip- and knee prosthesis surgery – Follow up report; BCG analysis
0
2
4
6
8
3.9%5.0%
2y complications
4.9%6.0% -44%
-19%
-23%-18%
30d cardiov. event
Complication risk %
0.6%1.0%
2y implant revision
1.6%2.0%
2y re-op rate
2009-10
2007-08
0
30
60
90
120
Cost per patient (kSEK)
-20%
2009-10
66
2007-08
83
0
100
200
300 -17%
12 months
pre surgery
12 months
post surgery
2009-10
182220
2007-08
Days of sick leave
Costs and sick leave decreased with ~20%
Outcomes improved with more than 18%
20 Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
Integrate care delivery
between separate
facilities
Expand excellent
services geographically
Organize into integrated
practice units
Move to value-based
reimbursement models
Measure outcomes and
costs for every patient
1
2
3
4
5
6
Build an enabling IT platform
What Swiss providers should do in order to drive value?
Source: M. Porter, the strategy that will fix health care. HBR
Copyri
ght
© 2
017 b
y T
he B
ost
on C
onsu
ltin
g G
roup,
Inc.
All r
ights
rese
rved.
21
Soon, there will be a time that
our scholars and colleagues
will not be satisfied with
general comments on quality.
Instead they will call any
doctor a charlatan who is
unable to quantify his medical
outcomes.
Theodor Billroth, 1860
top related