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www.england.nhs.uk/expo | @ExpoNHS | #Expo18NHS
A partnership approach to support Value based Healthcare: ICHOM and J&J
CollaborationDr Rishi Hazarika, Vice President, Implementation,
Benchmarking & Education, ICHOM
Syed Rashid, Director of Market Access EMEA, Surgical, Johnson & Johnson VISION
This content has been developed with sponsorship from Johnson & Johnson, and paid for by Janssen-Cilag Ltd, Janssen pharmaceutical companies of Johnson & Johnson
PHGB/NPR/0818/0004aAugust 2018
www.england.nhs.uk/expo | @ExpoNHS | #Expo18NHS
Concepts for improving patient outcomes
How does a hospital use outcome data to improve culture and innovation
Dr Rishi Hazarika VP Implementation and Benchmarkingrishi@ichom.org
PHGB/NPR/0818/0004August 2018
4Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Healthcare spending is a global problem
4
5Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Yet there appears to be no correlation between spend and outcomes
5
2014 data
6Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Healthcare spending with diminishing returns
7Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
R&D productivity and spending is falling
8Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Even with 21st century medicine, variations in health outcomes is a worldwide problem
variation in 30-day mortality rate from heart attack in US hospitals
variation in bypass surgery mortality in the UK hospitals
Variation of major obstetrical complications among US hospitals
variation in complication rates from radical prostatectomies in the Dutch hospitals
variation in reoperation rates after hip surgery in German hospitals
variation in mortality after colon cancer surgery in Swedish hospitals
4x
9x
18x
20x
2x
5x
9Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
ICHOM was formed to drive the industry towards value-based health care by defining global outcome standards
Our missionWhere we come from
Three organizations with the desire to unlock the potential of value-based health care founded ICHOM in 2012:
ICHOM is a nonprofit▪ Independent 501(c)3 organization▪ Idealistic and ambitious goals▪ Global focus▪ Engages diverse stakeholders
Value =
Our mission
Unlock the potential of value-based health care by defining global Standard Sets of outcome measures that really
matter to patients for the most relevant medical conditions and by driving adoption and reporting of these
measures worldwide
Cost of delivering those outcomes
Patient health outcomes achieved
10Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
ICHOM is a non-for-profit, based on the principles of value-based health care. Founded by Harvard Business School, Karolinska Institutet and BCG
We believe in a model where value is at the center of health
care...
Providers“Compete to deliver high-
quality results at competitive prices"
Payers"Contain costs by paying for
results achieved”
Value =Cost of delivering those
outcomes
Patient health outcomes achieved
Patients will choose their provider based on its expected outcomes and their share of the cost
Providers will differentiate into areas where they deliver superior outcomes at competitive prices
Suppliers will market their products on value, showing improved outcomes relative to costs
Payers will negotiate contracts based on results and encourage innovation to achieve those results
... which will impact every stakeholder
11Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Institutions around the world are using ICHOM Standard Sets
32 Countries
650+ Organizations
15 National Registries
Non-exhaustive
12Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
'Value based health care' web searches have increased 400%, compared to 2012.1
Healthcare systems are taking bold steps to reform around VBHC
1. Google Trends, 2017; 2. Lancet Global Health Commission on High Quality Health Systems, 2016; 3.ICHOM and OECD Letter of Intent, 2017; 4. IMI 2017; Mark Drakeford, Minister for Health and Social Services 2014; 5. Value Based Health Care Global Assessment, The Economist 2016; 6.The 5th Annual Transparency in Health Conference, 2017; 7. NHS Wales, 2017; 8. NSW Health Innovation Symposium Elizabeth Koff, Secretary, NSW Health, 2016
Global CountryRegional
Health Ministers from over 35 OECD and partner countries are working to make person-centered care the new normal in health systems.3
The Innovative Medicine Initiative's Big Data for Better Outcomes program will use big data to improve patient outcomes.4
The Lancet defines "high quality care" as safe and respectful with potential to improve outcomes".2
2012 2017
Interest
Wales—The NHS is embracing the principles of prudent healthcare through a patient-centered system.7
Dutch parliament urges move to outcome-based payments.5
Portugal—has worked to achieve financial solvency and sustainability, through innovation, outcomes measurement & cost reduction.5
National program launched in Israel to measure patient reported outcomes for stroke and acute myocardial infarctions.6
New South Wales—Australia— is reforming their health system from volume to value8
13Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
54
49
40
19
0
10
20
30
40
50
60
2015-2016
Burden of Disease Covered (%)
201720142013
ICHOM Standard Sets now cover >50% of global disease burden
24 ICHOM Standard Sets to-date
1. Localized Prostate Cancer *2. Lower Back Pain *3. Coronary Artery Disease *4. Cataracts *
13. Breast Cancer*14. Dementia15. Heart Failure16. Pregnancy and Childbirth17. Colorectal Cancer*18. Older Persons19. Overactive Bladder*20. Craniofacial Microsomia21. Inflammatory Bowel Disease
5. Parkinson’s Disease*6. Cleft Lip and Palate*7. Stroke *8. Hip and Knee Osteoarthritis*9. Macular Degeneration*10. Lung Cancer*11. Depression and Anxiety*12. Advanced Prostate Cancer *
22. Chronic Kidney Disease
23. Hypertension24. Inflammatory
Arthritis
Committed/In process
▪ Congenital upper limb anomalies
▪ Pediatric facial palsy ▪ Oral health▪ Inflammatory
arthritis▪ Diabetes (I+ II)▪ Atrial fibrillation▪ Overall adult health▪ Overall pediatric
health▪ Hand & wrist
conditions
• 15 Standard Sets published to date in peer-reviewed journals Percentage of global disease burden coverage is based on Global Burden of Disease Study 2016. Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2016.
14Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Outcomes are defined around the medical condition, not the specialty or the procedure
The Standard Set is a “minimum set” focused on the outcomes that matter most to patients
Patients are directly involved in defining the Standard Set
Patient-reported outcomes are included in every Standard Set to capture symptom burden, functional status and health-related quality of life
A “minimum set” of initial conditions/risk factors is included to facilitate meaningful Global comparisons
Time points and sources of data collection are clearly defined to ensure comparability of results
Framing principles for ICHOM standard sets
1
2
3
4
5
6
15Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
We group outcomes based on Professor Michael Porter’s value-based health framework
Survival Mortality rates
Degree of health achieved or maintainedFunctional level achieved, Pain level achieved, Ability to return to work
Time to recovery and return to normal activitiesTime to begin treatment, Time to return to physical activities/work
Sustainability of health /recovery and nature of recurrencesMaintained functional level, Ability to live independently, Need for revision
Long-term consequences of therapyLoss of mobility, Susceptibility to infection, Loss of vision due to complications
Tier 1
Health status achieved or retained
Tier 2
Process of Recovery
Tier 3
Sustainability of health
Disutility of the care or treatment process (ineffective care/surgical complications)
Length of stay, Infection, Need for re-operation, PE, DVT
16Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Survey 2 round Delphi process
Research & propose scope
Literature review of outcome domains and definitions
Patient focus group (FG)
Validation of outcome domains (distribute survey via patient organisations )
Literature review of risk factor domains and definitions
Working Group
Process
Literature input
Patient input
Standard Set
Launch
Meeting 7*Review &
transition to implementation
Meeting 6 StSet and
publication wrap-up
Meeting 5Case-mix
definitions
Meeting 4Case-mixdomains
Meeting 3Outcome wrap-up
Meeting 2Outcome
definitions
Meeting 1Outcome domains
Working Group
LaunchScope
Open review periodExternal
Input
ICHOM Standard Set Methodology v2.0, currently in use
* Most meetings are telephonic or via video
A Standard Set is defined through series of teleconference calls, supported by research and patient input
17Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
ICHOM Standard Set for Cataracts: Outcomes
Treatment approaches covered
▪ Phacoemulsification▪ Sutured extra-capsular cataract
extraction▪ Sutureless extra-capsular cataract
extraction▪ Intra-capsular cataract extraction
A "reference guide" contains all the details to measure in a standard way the outcomes recommended.
18Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
International leaders from seven countries helped develop the ICHOM’s cataracts standard set. There are now 73 sites measuring the set, including the Malaysian, Swedish and Euroqolregistries
John Sparrow, National Ophthalmology Database
Nigel Morlet, Curtin Health Innovation Research Institute Konrad Pesudovs, Flinders University
Ingrid Kossler, European Cancer Patient Coalition
Mats Lundstrom*, Lund UniversityAnders Boman, St Erik Eye Hospital
Suzann Pershing, American Academy of Ophthalmology
*Patient representative; ⱡWorking Group lead
Haripriya Aravind,Aravind Eye Care System
Goo Pik Pin, National Cataract Registry
19Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Outcomes collected
20Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Overview of the case-mix adjustment factors
Risk Factor/Initial Condition Measure DetailsDemographic FactorsAge Date of birthSex Sex at birth
Baseline Visual StatusXPre-operative visual acuity For surgical eye & fellow eyeTarget refractive error For surgical eye
Ocular ComorbiditiesGlaucoma N/AMacular degeneration N/ADiabetic eye disease N/AAmblyopia N/AOther N/APrior Ophthalmic InterventionsPrevious cataract surgery on fellow eye N/APrevious corneal refractive surgery N/APrevious vitrectomy N/AOther N/ATechnical FactorsDense brown or white cataract N/ACorneal opacities N/APseudoexfoliation N/APupil problems N/ASurgical technique N/A
21Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Condition
Cataracts
PROM Licensing
Free
PROM and measurement cycle for the cataract standard set
Number of data items in Set
35Catquest-9SF
22Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
PROM for the cataracts standard set: Catquest-9SF
Validated translations (open source):
• Danish• Dutch• English• French• German• Italian• Slovakian• Spanish• Swedish
23Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Why the patient’s perspective matters
Study
Analysis of clinical outcomes and patient-reported outcomes in Swedish Cataract Registry▪ 9,707 patients
Of those, nearly all those surveyed showed clinical outcome improvement (VA)▪ 97.8%
Interestingly, of those 97.8%, 7.4% reported being worse off visually than before?
How is this possible?
Findings
Source: Lundstrom M, Stenevi, Ulf. Analyzing Patient-Reported Outcomes to Improve Cataract Care. Optometry and Vision Science, Vol. 90, No. 8, August 2013.
1.1
0.2
1.4
0.5
1.6
0.2
1.4
-0.2
0.3
-2.9
-2.9
-2.8
-2.1
-2.4
-2.1
-2.6
-3.8
-3.3
-4 -3 -2 -1 0 1 2
Satisfaction with vision
Seeing to walk…
Seeing price tags
Seeing to do handicrafts
Difficulty in general
Reading text on TV
Seeing to do activities
Reading newspapers
Recognizing faces
COM+/PROM- All others
24Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Fishbone diagram showing parameters that might influence the patient-reported outcome as reflected by the Catquest-9SF
25Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
The Martini Klinik – outcomes applications in practice
▪ The Martini Klinik started to collect outcomes in 1993 using a methodology very similar to ICHOM’s. >2200 PA 50% Germany <50 200+ per surgeon
▪ One of the leading organisations in developing the ICHOM Standard Set for Prostate Cancer.
Martini Klinik German Average
5-year survival rate 95% 94%
1-year continence rate 93.5% 56.7%
Severe urinary incontinence 0.4 4.5
Severe erectile dysfunction 34.7 75.5
Culture Innovation adoption Business performance
▪ Unblinded comparisons on a 6 monthly basis
▪ Mentoring and networking, non-hierarchical
▪ High research output >50 papers
▪ High staff satisfaction, low turnover
▪ Frequent outcomes review enables rapid prototyping
▪ Findings of a Korean paper prototyped within the unit
▪ Adoption of outcome measurement in 12 months vs 17 years
▪ 18% annual growth rates domestically
▪ Capturing international market share – Swiss insurer
▪ Developing outcome based payment bundles
26Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
27Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
28Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
29Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
QI improvement – virtuous learning cycle
Collect data
Identify outlier
performance
Learn from outlier
performance and best practice
codification
Test value improvement
strategies
Diffuse
Inter-organisationalapplications
Intra-organisationalapplications
30Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.
Bergman Clinics, Naarden, Netherlands (3 sites)
St Erik Eye Hospital, Stockholm, SwedenSahlgrenska University Hospital, Gothenburg, Sweden
GLOBE Benchmarking Programme
Imperial College Hospital, London, UKRoyal Free London, London, UK (3 sites)Aneurin Bevan University Health Board, UK (2 sites)Ramsay Health Care UK, UK (25 sites)Moorfields Eye Hospital, London, UK
Malaysian National Cataract Surgery Registry, Malaysia (3 sites)
Sheba Medical Center, Tel Hashomer, Israel
Aravind Eye Care System, India (10 sites)
Humanitas Research Hospital, Milan, Italy
CAT Sites
José de Mello Saúde, Lisbon, PortugalLuz Saúde, Lisbon, Portugal
Agenda
• Ageing population & healthcare budget pressures
• Future value
• Value Based Healthcare Initiative
• European Cataract Implementation Community Programme
• Will be at the forefront of Value Based Healthcare?
Ageing population and healthcare budget pressures and priorities
• Most Economically Advantageous Tender (MEAT)
• Looking beyond the products and having a product + service based contract
New tendering requirements
• A shift by Ministry of Health’s towards performance based payment due ageing populations and demand on healthcare coverage
• Patient and Clinical outcomes measures in the real world setting.
Performance based payments
FV = ID
Data
Future Innovation (Connect + Combine + Share)
value = Outcomes x Personalization
For people Participatory Data streams Traditional and Platforms
For physicians Precise non-traditional of careFor payers Predictive partnersFor policymakers Proactive
Source: EY Progressions 2018, When the human body is the biggest data platform, who will capture value?
A new equation for delivering value :
Future value (FV) is driven by innovation (I) that focuses on OUTCOMES with a high degree of personalization and is fuelled by
unlocking the power of data (D).
FV = ID
DataFuture Innovation (Connect + Combine + Share)
value = Outcomes x Personalization
For people Participatory Data streams Traditional and Platforms
For physicians Precise non-traditional of careFor payers Predictive partnersFor policymakers Proactive
Source: EY Progressions 2018, When the human body is the biggest data platform, who will capture value?
A new equation for delivering value :
Future value (FV) is driven by innovation (I) that focuses on
OUTCOMES with a high degree of personalization and is
fuelled by unlocking the power of data (D).
Value Based Healthcare (VBH) Initiative
Measuring Outcomes
• Combined partnership with ICHOM to
mobilise Real World evidence and
benchmark
• Shape future tendering requirements
• “First Mover” leadership in Value Based
Healthcare in Ophthalmology
• Personalise our marketing strategies based
on value and informed choices in the future
JNJ Surgical Vision EMEA
ICHOM Cataract standard set is an established practice and amongst 24 other
standard sets being implemented to drive outcome measures to achieve VALUE
IMPROVEMENTS.
Authorised permission by ICHOM to use this content.
Johnson & Johnson Vision (JJV) : European Pilot of Implementation of the ICHOM Cataract Standard Set
Centres
Recruited
• Finland (1), Germany (3), Italy (2), Netherlands (2), Spain (4), UK (1).
Implementation
ICHOM & Quodem
• Cataract Standard Set Implementation
• Informatics support for the centres
• Apr 18- Mar 19
Real World Data (RWD)
Validation of Service offering
by JJV
• Publication of RWD from Feb 19 and beyond
• Value Based Healthcare pilot delivered through a JJV program
So we will be ready and at the forefront for Value Based Healthcare and performance based outcomes!
• Most Economically Advantageous Tender (MEAT)
• Looking beyond the products and having a product + service based contract
New tendering requirements
• A shift by Ministry of Health’s towards performance based payment due ageing populations and demand on healthcare coverage
• Patient and Clinical outcomes measures in the real world setting.
Performance based payments
Thank you
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