A partnership approach to support Value based Healthcare ... · principles of prudent healthcare through a patient-centered system.7 Dutch parliament urges move to outcome-based payments.5

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 [email protected]

PHGB/NPR/0818/0004August 2018

mailto:[email protected]

4Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.

Healthcare spending is a global problem

4


Yet there appears to be no correlation between spend and outcomes

5

2014 data


Healthcare spending with diminishing returns


R&D productivity and spending is falling


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


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


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


Institutions around the world are using ICHOM Standard Sets

32 Countries

650+ Organizations

15 National Registries

Non-exhaustive


'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


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.


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


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


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


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.


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


Outcomes collected


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


Condition

Cataracts

PROM Licensing

Free

PROM and measurement cycle for the cataract standard set

Number of data items in Set

35Catquest-9SF


PROM for the cataracts standard set: Catquest-9SF

Validated translations (open source):

• Danish• Dutch• English• French• German• Italian• Slovakian• Spanish• Swedish


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


Fishbone diagram showing parameters that might influence the patient-reported outcome as reflected by the Catquest-9SF


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





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


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

Documents

A partnership approach to support Value based Healthcare ... · principles of prudent healthcare through a patient-centered system.7 Dutch parliament urges move to outcome-based payments.5