Transparency health sector 122013

• 1. PERSPECTIVE DECEMBER 2013TRANSPARENCY IN HEALTHCARE DATA TRANSPARENCY IS A NEVER ENDING ISSUE THA HAS T GENERA TED A GROWING INTEREST WITHIN SEVERAL INDUSTRIES, INCLUDING HEAL THCARE Daniela Scaramuccia, Nunzio Guida

2. Transparency in healthcare Published by Value Partners Management Consulting Spa via Vespri Siciliani 9 20146 Milan, Italy December 2013 Written by: Daniela Scaramuccia, Nunzio Guida If you would like an electronic copy or more information on the issues raised in the report please contact: [email protected] If you would like to subscribe or to be removed from our mailing list please write to: [email protected] valuepartners.com Copyright Value Partners Management Consulting Spa All rights reserved 3. CONTENTSOVERVIEW 5 WHY TRANSPARENCY IN HEALTHCARE 7 DIFFERENT STAGES OF TRANSPARENCY EVOLUTION 9 CORNERSTONES FOR A TRANSPARENT HEALTHCARE SYSTEM 15 NEXT CHALLENGE? CHRONIC DISEASES MANAGEMENT 17 AUTHORS18PERSPECTIVE TRANSPARENCY IN HEALTHCARE 4. Transparency can be a strong driver for improvement and also help develop trust within the healthcare system, which is at the heart of the doctor-patient relationship45 5. OVERVIEWDATA TRANSPARENCY IS A NEVER ENDING ISSUE THAT HAS GENERATED A GROWING INTEREST WITHIN SEVERAL INDUSTRIES, INCLUDING HEALTHCARE. WHILST THERE HAVE BEEN RELATIVELY FEW FULL IMPLEMENTATIONS OF TRANSPARENCY WITHIN THE HEALTHCARE SECTOR TO DATE, IT IS BELIEVED THAT THERE IS MUCH MORE YET TO BE ACHIEVED. HISTORICALLY, THE SPREAD OF TRANSPARENT HEALTHCARE INFORMATION HAS ENCOUNTERED A RANGE OF BARRIERS. THE LACK OF TRUSTED AND COMPARABLE INFORMATION, ALONG WITH THE OPPOSITION FROM BOTH HEALTHCARE PROVIDERS AND INSTITUTIONS HAVE BEEN POSING OBSTACLES TO TRANSPARENCY. HEALTHCARE PROFESSIONALS OFTEN HAVE NEGATIVE PERCEPTIONS OF TRANSPARENCY; INSTEAD OF PERCEIVING IT AS A POTENTIAL FORCE FOR GOOD, THEY FREQUENTLY ASSOCIATE IT WITH UNWANTED INTERFERENCE FROM AUTHORITATIVE PARTIES, GUIDED BY SUSPICION AND NEGATIVE MOTIVATIONS RATHER THAN THE WIDER AMBITION OF IMPROVING HEALTHCARE. WE STRONGLY BELIEVE TRANSPARENCY CAN BE A POTENT DRIVER FOR IMPROVEMENT AND ALSO HELP DEVELOP TRUST WITHIN THE HEALTHCARE SYSTEM, WHICH IS AT THE HEART OF THE DOCTOR-PATIENT RELATIONSHIP. THIS PERSPECTIVE DISCUSSES BENEFITS FROM TRANSPARENCY IN HEALTHCARE AND PROVIDES A RANGE OF INTERNATIONAL EXAMPLES WHERE IT HAS BEEN DEPLOYED SUCCESSFULLY. AS WELL AS HIGHLIGHTING THE POTENTIAL OPPORTUNITIES, THESE BEST PRACTICES ALSO IDENTIFY THE KEY SUCCESS FACTORS TO IMPLEMENT TRANSPARENCY WITHIN HEALTHCARE.PERSPECTIVE TRANSPARENCY IN HEALTHCARE 6. Exhibit 1 48% of surgery admissions are provided by hospitals located outside the residential area of patients Outside the regionOutside the residential areaSame area100% 90% 80% 70% 60% 50%48%40% 30% 20%0%12345678910111213141516171819202122232425262728293031323334AVERAGE10%Exhibit 2 Patients with a higher level of education tend to choose higher volume medical institutions Hospital admissions of patients affected by breast cancer, according to educational qualification and number of breast surgeries per institution, Year 2009 Low volume (0-30 surgeries)Mid volume (31-150 surgeries)60%65%30%High volume (over 150 surgeries)70%30%10% No educational qualification / elementary school diploma25%5%5%Junior high school diplomaSenior high school diploma-10% 2% Degree +EDUCATION LEVEL Source: Value Partners Management Consulting88% 7. WHY TRANSPARENCY IN HEALTHCAREIn addition to the aforementioned strengthening of trust in the doctorpatient relationship, multiple benefits are driven by transparency. Three are the most relevant in our experience. First of all, transparency enables citizens right of choice. Research shows that when citizens are aware of relevant information concerning healthcare services, they tend to exercise their right of choice. They travel to receive the best treatment rather than relying on services immediately available in a particular geographical area. Even in regions with good healthcare systems, for example, on average over 45% of patients choose to go to hospitals located outside the area they live in (Exhibit 1).Propensity of citizens to exercise their right of choice is strongly linked to education levels Nevertheless, research indicates that the propensity of citizens to exercise their right of choice is strongly linked to education levels. Transparency, together with access to information, becomes an essential tool to increase the equality of access to services in a healthcare system, which aims at being universal (Exhibit 2).PERSPECTIVE TRANSPARENCY IN HEALTHCARESecond, transparency fosters improvement in healthcare performance. In general, the release of information and the subsequent comparison of healthcare systems in different regions directs the flow of patients and fosters all operators to improve their own results and share best practices. The same phenomenon occurs, for instance, in universities, where the release of international rankings directs the flow of students towards particular institutions. According to the QS World University Ranking for 2012/2013, the number of students enrolled in the top 100 universities increased at a growth rate 3-time higher than that of those universities ranked towards the bottom. Third, transparency drives productivity increase. Release of data encourages operators to improve their own productivity in response to the positive pressure generated by increased comparability. A typical example can be found in cases of reduced average waiting times in hospitals whose data is made public. 8. Exhibit 3 NHS Choices offers a wide range of services to meet users needsSupports citizens in choosing the most suitable health services. Users can specify the nature of required procedure and a postcode or town to compare relevant institutions against certain criteriaGuide provides citizens with information on diseases and relative treatments. It also offers symptom control measures and online supportPatients comments and feedbacksProvides an unbiased and evidence-based daily analysis of the science behind health stories making the newsA guide to social careExhibit 4 Transparent information enable citizens right of choice Screenshot of page that appears when you ask for information on hip surgery in the London areaOnce one has chosen the nature of treatment and the geographical area, it is possible to generate a set of institutions to be comparedSelection of volume, quality, outcome and efficiency indicators, which help with user choiceUser ratings (similar to Trip-Advisor)Source: NHS Choices website 9. DIFFERENT STAGES OF TRANSPARENCY EVOLUTION The level of transparency within a health service is typically linked to its stage of development. In fact more advanced national systems usually offer an improved flow of information about financial, operational and clinical performance. Nevertheless, also in most advanced countries, the level of transparency granted by Institutions is very different. The UK represents one of the most high-profile examples of a transparent approach to healthcare provision. The National Health System (NHS) has developed an online portal to help provide citizens with the necessary tools to benefit from well-informed health decisions: NHS Choices. This idea is referenced explicitly within the pay-off of NHS Choices itself: Your health, your choices. NHS Choices was launched in 2007 and has built its success by adopting a model that actively involves and generates benefits for all relevant stakeholders, including citizens, operators and sponsors. The primary objective of the content provided on the website is to deliver a comprehensive service offering to citizens (Exhibit 3). These services range from the release of over 650 performance indicators related to different health services, so as to allow users to best choose the hospital or practice that suits their needs (Exhibit 4) to services which aid the self-management of health issues including symptom checkers, medical examination bookings and advice on how to follow a healthy lifestyle etc.PERSPECTIVE TRANSPARENCY IN HEALTHCAREFurthermore, NHS Choices helps to improve health services through the provision of services to professionals such as information on specific treatments, training services and guides to specific health services. In addition, the website also publishes performance results organised by health unit and provider. The value that the NHS Choices website brings to stakeholders is evident from the growth in the number of its users. Since 2011, the number of users registered on NHS Choices has increased by over 76% and now has over 27 million visitors per month. As a result, the NHS Choices website is the most popular European Portal for healthcare. Further results collected through surveys (Exhibit 5) also highlight the benefits that this service brings. This benefit is not merely limited to citizens, however, with positive feedback also coming from industry professionals who consult the website both for themselves and their patients - 12% of them use it every day, 67% more than once a month and 90% would suggest using it to colleagues (Exhibit 6). Driven by its success, each year it integrates new initiatives to try and improve its service offering to citizens through an increased quantity of information being offered and the development of new services and new channels. As part of its multi-channel approach, NHS Choices has also been present on both Facebook and Twitter since 2010, and has attracted over 150,000 followers. 10. Exhibit 5 Results of the NHS Choices website are positive, both in terms of usage trends and of users satisfaction USAGE (MILLIONS OF VISITORS PER MONTH)USERS FEEDBACKS (FROM PATIENTS) Would you recommend NHS Choice to other people?+76%Would you recommend NHS Choice to other people?2%279%Lifestyle Improvement26%7%11% 35%Symptoms control39%15Medical information5%7% 79% 86%20112013Yes, absolutelyYes, probablyNoNot sureExhibit 6 Even feedbacks from professionals using NHS Choices is positive PROFESSIONALS USING NHS CHOICE (%)WHY PROFESSIONALS CONSULT THE WEBSITE (%)Specialist21Family doctor16Practice manager12Pharmacist9Registered nurse 8Hospital manager8Information on health services27Information on a healthy lifestyle13Better management of already existing diseases 12Junior specialist physicianSymptoms checking75Getting news on healthcare system8Training search16Information on long-term disabled citizensJunior specialist nurse6Receptionist / Assistant6Booking a medical consultation at the hospital7Information on how to solve dependences (e.g. alcohol)NHS management490% would suggest it to a colleague 12% use it everyday Over 68% use it more than once a monthSource: NHS Choices Annual Report 2012-20134 2Job search5Information on vaccines for travels Subscribing to the information service3 2 11. In addition to the effective involvement of all relevant stakeholders, the success of NHS Choices has been attributed to its governance mechanism and the websites content offering. The governance model was designed in such a way so as to generate commitment and approval among all involved parties by the Department of Health. This was realised through the creation of committees, composed of representatives from each of the relevant institutions, who defined the program guidelines and worked to achieve set targets. Florida has recently taken steps to revise their informational health website, run by the Agency for Health Care Administration (AHCA). It aims at simplifying access to information relating to the quality of different medical services, associated fees and relevant performance levels in a way which is easily understandable for all. The website is divided into two sections - one for citizens and one for professionals so as to most efficiently convey the information in a targeted manner. From a content perspective, the portal doesnt merely focus on the comparison of performance between different medical organisations, but also provides citizens with a range of easily accessible educational services (Exhibit 7).PERSPECTIVE TRANSPARENCY IN HEALTHCAREInterestingly, the portal also includes a symptom navigator, which is a tool that allows the user to identify symptoms and hence develop a preliminary diagnosis (Exhibit 8). In a similar manner to other countries, the Ontario province of Canada also splits their website into two separate sections. The first section of the website aims at providing citizens with information on a range of topics including which services are available throughout the province, where the nearest doctor is located and the waiting times for diagnostic procedures and surgeries in different hospitals (e.g. CAT, MRI scans etc.). In addition to giving information to citizens, the website aims at reducing the administrative burden on citizens by making medical forms, such as those used for x-ray scans or for disabled citizen home assistance requests, available online. A secondary section of the website helps providing relevant information to healthcare professionals. This section of the website includes information focused on healthcare programmes and their level of usage as well as legislative updates. Professionals are also able to find advice on how best to manage medical emergency situations (e.g. influenza pandemics, blood supply problems). This website thus enables healthcare professionals to improve their level of service in both everyday situations as well as in extraordinary circumstances. 12. Exhibit 7 FloridaHealthFinder.gov is built around easy access to information and organized into different sections Specific sections for patients and professionalsSupport to facilitate information accessPublic reporting includes quality, fees and institution performanceEducational service enabling the user to get a deeper knowledge on medical issuesExhibit 8 The symptom navigator enables an easy identification of symptoms, and a corresponding link to a preliminary diagnosis Screenshots of the symptom navigator, possible causes and additional information on symptoms SYMPTOMS DESCRIPTIONPRELIMINARY DIAGNOSIS AND ADDITIONAL INFORMATION Identification of preliminary diagnosis for the selected illnessSymptom are identified by selecting the form of illness and patient type (man/woman/child)Information on possible causes and suggestions for treatment of symptomsSource: Florida Agency for National Health Care Administration (www.floridahealthfinder.gov)12 13 13. Singapore has also made great steps in promoting a transparent approach to its national health service. Through their website, the Ministry of Health provides information to citizens on how to have access to the healthcare system, news and fees charged for different services. Moreover, through the website, data concerning the level of services offered by hospitals to citizens are also released, including occupation rates within hospitals and waiting times for particular services. This so as to foster competition between institutions, but also supporting citizens empowerment and choices. Italy is at an evolutionary stage of transparency within healthcare. However, thanks to the collaboration between national and regional institutions including the Ministry of Health and the National Agency for Regional Health Services (Agenas), progresses have been made within the last few years. In this context, two specific initiatives are worthy of mention:In Italy, whilst these actions to promote transparency are undoubtedly positive, they have not yet realized the full potential of transparency PERSPECTIVE TRANSPARENCY IN HEALTHCARE Outcomes National Program (Programma Nazionale Esiti) by Agenas introduced in 2008, the program publishes hospital assistance outcomes for all the Italian medical institutions comparing their performance to a series of indicators. These data are available only to authorities and institutions of the National Health Service and was published for the first time in 2011. Regions Network (Network delle Regioni) introduced in 2008, the program enables performances comparison between providers and PCTs (ASL) of the regions involved in the network. Shared data include efficiency, waiting times, patients satisfaction. Since 2010, the report has become public and accessible to all stakeholders, but yet, for the wider public it is not ready to use. Therefore in Italy, whilst these actions to promote transparency are undoubtedly positive, they have not yet realized the full potential of transparency. Information are shared within stakeholders, while users have little access to it and, anyhow, struggle to interpret these data if they are not professionals or sector experts. 14. The need for transparency from a users perspective is clear. As a result, private companies have begun to design and implement public reporting initiatives, for instance: Dr Foster: a privately founded English website provided through the collaboration between the Information Centre for Health and Social Care, relevant health organisations and local authorities. This portal provides comparative information on the UKs health and social care services, helping citizens decide the most appropriate healthcare solution for them according to geography and procedure Healthgrades: an American website that specialises in the release of important data about doctors and hospitals. The site is divided into four sections: users, doctors, hospitals and consultants. This separation enables the delivery of information in a more targeted and tailored manner helping to make the service more effective. It attracts around 225 million visitors per year14 15 Doveecomemicuro.it an Italian website recently developed by a group of researchers led by the Universit Cattolica-Policlinico Gemelli in Rome with the aim at assisting citizens in their healthcare choices. The launch is very recent and it is early to measure success, however, the first day the website recorded 36.000 individual visitors and 300.000 visited web pages. 15. CORNERSTONES FOR A TRANSPARENT HEALTHCARE SYSTEM There is no one single model for healthcare that can be applied effectively across countries. However, by looking at the most relevant international experiences it is possible to define which critical features determine the success of a healthcare transparency programme. We have identified three basic principles on which any model for healthcare transparency programmes should be founded. Principle 1. Centralization of information management. Information management functions (e.g. data gathering, analysis, release, etc.) should be centralized and should be overseen by a central authority controlled by the local Ministry of Health. Centralization increases accountability and reliability as well as guaranteeing comparability of information. Principle 2. Implementation of an effective governance structure. A governance structure should be created that incorporates the best expertise whilst involving key stakeholders and relevant authorities. Governance structured in this way guarantees effective representation and alignment of relevant parties and overcomes possible obstacles. The structure should include (amongst others) separate committees for strategic planning, management, coordination, and quality. Principle 3. Development of tailored content to meet the needs of stakeholders. Informational content should be developed so as to meet the needs of different stakeholders: citizens, operators and sponsors. This content should be made available by a consolidated information portal, and include information that enables:PERSPECTIVE TRANSPARENCY IN HEALTHCARE1. Comparison of performances across institutions and best practice sharing, so as to improve the whole system performance. Key metrics include: productivity indicators (e.g. number of operations performed per hospital, per surgeon, etc.), accessibility indicators (e.g. average waiting time, etc.) and effectiveness indicators (i.e. outcome/ results). In our experience it is relevant to ensure that metrics are: Reliable and relevant to processes that operators are able to impact upon Selected, developed and implemented in a transparent manner Easily comprehensible for all stakeholders, not only by professionals 2. Citizen empowerment. Empowerment of citizens should be enabled by making information on hospitals and performance available to all, and by offering educational contents and services to increase citizens ability to manage the healthcare services they receive. Examples of information and services that enable citizen empowerment include the following: Information regarding relevant treatment options according to medical condition Information regarding particular symptoms and medical conditions relating to symptoms Online consultations, available at short-notice Online booking of appointments and examinations 16. Exhibit 9 Healthcare demand and funding are moving from hospital to district careHOSPITALIZATION RATE TREND (HOSPITALIZATION PER 1000 INHABITANTS)190 180-26%170 160Significant decrease in the hospitalization rate over the last 15 years (-26%) despite the increase in population aging150 140 130 120 110 1001997199819992000200120022003200420052006200720082009201020112012HEALTH CARE FUNDING EVOLUTION55%50% Since 2010 the funding gap between hospital and district care has deeply increased showing a strong tendency to move care from hospitals to districts (including primary care)45%40%5%0% 2003200420052006200720082009201020112012 Hospital care Districts care Collective health care in working environment and daily experienceNote: All the analysis refer to Italian Healthcare system (2010) 17. NEXT CHALLENGE? CHRONIC DISEASES MANAGEMENT Examples described in the perspective are still primarily focused on hospital performances. However, the demand of care, following aging and innovation trends, is moving more and more from hospitals to districts (including primary care) and home. And the result of this, coupled with hospitalization rate in sharp decline, is the increase of healthcare assistance and spending in district and primary care services, mainly focused on chronic disease management (Exhibit 9).Transparency follows the evolution of helthcare dynamics, therefore its now time to focus on the next real challenge: chronic desease managementPERSPECTIVE TRANSPARENCY IN HEALTHCAREThis trend implies a greater interest in controlling district care and home assistance providers. Therefore, it is urgent and necessary to improve transparency in this area, increasing the availability of data on clinical processes, from diagnosis to treatment and on outcomes related to chronic diseases. This area is still almost unexplored by different healthcare systems. That, is the next challenge. 18. AUTHORSDANIELA SCARAMUCCIA Partner, Milan Office [email protected] GUIDA Associate, Milan Office [email protected] 19 19. Transparency enables citizens right of choice. Transparency fosters improvement in healthcare performance. Transparency drives productivity increase.PERSPECTIVE TRANSPARENCY IN HEALTHCARE 20. ABOUT VALUE PARTNERSFounded in Milan in 1993, Value Partners rapid growth testifies to the value it has created for clients over time. Today it draws on 25 partners and 280 professionals from 23 nations, working out of offices in Milan, London, Istanbul, So Paulo, BuenosValue Partners professionals developed significant experiences, working with leading payors, providers, pharma and medical devices companies, regulators and industry associations and allowing to forge connections among industry stake-For more information on the issues raised in this note please contact the authors.Aires, Beijing, Shanghai, Hong Kong and Singapore.holders always providing a unique perspective on the rapidly changing value chain of the industry.Milan London Istanbul So Paulo Buenos Aires Beijing Shanghai Hong Kong SingaporeValue Partners has built a portfolio of more than 350 international clients from the original 10 in 1993 with a worldwide revenue mix. With a proven track record in supporting leading international players in the Life Sciences Sector (healthcare, pharmaceutical, and medical devices) Value Partners represents a trusted advisor that combines a strong understanding of the commercial challenges and opportunities of this industry with a proven capability of delivering long term lasting results.In Life Sciences sector we cover the main areas of intervention such as: strategic planning, organizational structure redesign, key processes reengineering (driven by a lean approach), cost control, regulatory police design, supply chain improvement, go-to-market and market entry strategies.Find all the contact details on valuepartners.comBesides Life Sciences, Value Partners also provides services in telecommunications, media, finance, energy, manufacturing and high-tech industries.Copyright Value Partners Management Consulting Spa All rights reserved