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Roma, 18 Dicembre 2017
NUOVI STRUMENTI DI VALORIZZAZIONE
DELL’INNOVAZIONE
E SOSTENIBILITÀ DEL SSN
GUIDO BECCAGUTTI
VBHC LEAD MEDTRONIC ITALIA
VERSO SISTEMI SANITARI VALUE-BASED
LA PROSPETTIVA DI MEDTRONIC
I costi per l’assistenza sanitaria stanno
esplodendo
1
SFIDE NEI SISTEMI SANITARI GLOBALI
1. Source: Deloitte. 2015 Global Health Care. Accessed September 8, 2015. 2. Source: ICHOM analysis, Martin Makary, How Health Care’s Successes Became Distractions”, Health Affairs August 2014 3. World Health Organization. The Impact of Chronic Disease in High Income Countries. Accessed September 1, 2015 / UNC Carolina Population Center. Mortality and Cause of Death, 1900 v. 2010. June 16, 2014. Accessed September 1, 2015., 4. Source: Michael Porter ICHOM 2016
2x variation in 30-day mortality rate from heart attack in U.S.
18x variation in reoperation rates from radical prostatectomies in the Netherlands
20x variation in mortality after colon cancer surgery in Sweden
Esiste grandissima variabilità sugli esiti
di salute erogati
2
Consumer-driven healthcare
Evidence-based medicine
Prior authorization for expensive services
Le “soluzioni” incrementali proposte hanno avuto un impatto marginale
4
I bisogni di salute sono solo destinati
a crescere
3
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
SIGNIFICANT OUTCOME VARIATION WHERE EVER DATA ARE AVAILABLE 2-36X VARIATION IN OUTCOME, DEPENDING ON PROCEDURE AND COUNTRY
• variation in 30-day in hospital mortality rate from heart attack in US (25th vs 75th perc.)
• variation in bypass surgery mortality in the UK
• variation in reoperations due to complications after knee replacement in Germany
• variation in emergency readmissions after hip surgery in the UK
• variation in complication rates from radical prostatectomies in the Netherlands
• variation in reoperation rates after hip surgery in Germany
• variation in capsule complications after cataract surgery in Sweden
2x
4x
5x
6x
9x
18x
36x
Source: National institute for cardiovascular outcomes research annual report 2010-2011, The Swedish National Cataract Registry, HSCIC, NIS and SID 2011 data, AHRQ IQI SAS Module, Dimick et al. (2009). Composite measures for surgical mortality in the hospital. Health Affairs, 28(4), 1189–98, Health at a Glance 2013, OECD Indicators; Statistisches Bundesamt (DRG_OPSvier, Stat_Bev_EA), eigene Berechnung und Darstellung (IGES 2014) https://faktencheck-gesundheit.de/die-faktenchecks/interaktive-karten-zu-regionalen-unterschieden/kniegelenk-erstimplantationen/BCG analysis
SISTEMI VOLUME-BASED: PROBLEMI GLOBALI
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
EPISODICI DISCONNESSI INCONSISTENTI CARENZA DI DATI
GLI EROGATORI
SONO FINANZIATI A
VOLUME O SERVIZIO
NON A VALORE
MANCANZA DI
CONTINUITÀ
ASSISTENZIALE
ENORME
VARIABILITÀ DI
ESITO
PATIENT-TO-PATIENT
OSPEDALE - OSPEDALE
(TALVOLTA ANCHE NELLO
STESSO EROGATORE)
I DATI DISPONIBILI
NON SONO
CONDIVISI E/O
VALORIZZATI
LA SOLUZIONE: METTERE IL PAZIENTE REALMENTE AL CENTRO DELLE CURE
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
IL PUNTO DI VISTA L’INDUSTRIA HA UN RUOLO PRIMARIO NELLO SVILUPPO DI SISTEMI VALUE-BASED
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
RESPONSABILITÀ
E
OPPORTUNITÀ
DI AGIRE COME
PARTNER/LEAD
INSOSTENIBILITÀ
DEI SISTEMI
SANITARI
ACCETTAZIONE E
SUPPORTO ALLO
SVILUPPO DI NUOVI
MODELLI DI
EROGAZIONE E
FINANZIAMENTO
PATIENT-
CENTERED MISSION
& MINDSET
SIAMO PREPARATI
PER ESPLORARE
NUOVI SISTEMI DI
PAGAMENTO
STARTS WITH A COMMON UNDERSTANDING: WHAT IS “VALUE” DEFINIZIONI
The Economist Advisory Board:
“A healthcare system that explicitly prioritizes health outcomes that matter to patients relative to their costs.”
Michael Porter’s definition for “value:”
“The health outcomes achieved that matter to patients relative to the cost of achieving these outcomes.”
International Consortium for Health Outcomes Measurement (ICHOM):
“Value is defined as the outcomes that patients experience relative to the cost of delivering those outcomes. Value-based Healthcare, or VBHC, is healthcare that delivers the best possible outcomes to patients for the lowest possible cost. ”
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
We are actively partnering to drive meaningful dialogue from thought-leaders across healthcare about how we can transform the incentives in healthcare today to focus on outcomes.
“
” Omar Ishrak Chairman & CEO, Medtronic
CHRONIC CARE MANAGEMENT
OUR FOCUS:
EPISODIC CARE BUNDLES
THERAPY OPTIMIZATION
Routine treatment delivered typically includes our product
Impacting care over a more sustained period of time (beyond the product sale)
Products/ technologies that by design impact outcomes and cost
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
13
CHRONIC CARE MANAGEMENT TRATTAMENTE DEL DIABETE DI TIPO1 (DT1) IN BAMBINI O ADOLESCENTI
La sfida: IL DIABETE DI TIPO
1 RICHIEDE CURE
COSTANTI E
SPESSO CONDUCE
A COMPLICANZE
CLINICHE GRAVI E
INGENTE
CONSUMO DI
RISORSE
Globalmente il 10% di
tutti I pazienti con
diabete ha un DT1
70,000 nuove
diagnosi/anno di
bambini/adolescenti
Circa 500,000
bambini nel mondo
convivono con DT1
Curare un bambino
DT1 is 6 volte più
costoso di uno senza
diabete
1
1 Diabetes Voice, International Diabetes Federation. https://www.idf.org/sites/default/files/attachments/DV_56-SI2.pdf
2
2 Medical Costs for Youth with Diabetes More than $9,000 a Year, CDC. https://www.cdc.gov/media/releases/2011/p0427_youthdiabetes.html
3 Diabetes Voice, International Diabetes Federation. https://www.idf.org/sites/default/files/attachments/DV_56-SI2.pdf
3 4
4 Diabetes Daily, ADA. https://www.diabetesdaily.com/forum/diabetes-news-studies/89393-type-1-diabetes-type-2-diabetes-historical-trends-theories-about-cause/
14
CHRONIC CARE MANAGEMENT DIABETES CLINIC NETWORKS
Le cliniche Diabeter utilizzano un
approccio di cura integrato in cui il rimborso
è per l’itero ciclo di presa in carico in
relazione al valore clinico ed economico
creato e non al volume dei servizi generato.
Ciò che rende Diabeter all’avanguardia non
è solo il miglior livello di cure, ma la
capacità di seguire il paziente dentro e fuori
le cliniche.
L’APPROCCIO.
L’
EVIDENZA.
Più di 2,000
pazienti
seguiti cin
approccio di cura
integrato
50% dei bambini
raggiunge il target
di HbA1c target, il
miglio risultato
clinic in Olanda5
8.6% di
risparmio sul
percorso di cura,
principalmente
dovuto alla
diminuzione dei
rates
ospedalizzazione
5 Zorg instituut, 2014
SHARED ACCOUNTABILITY
CONCLUSIONI
• Trend globale di sviluppo di sistemi outcome-based anziché volume-based
• Necessità di visione olistica e di politiche coordinate
• Necessità di esperienze pilota
• Necessità di vedere le innovazioni dentro un percorso di cura
«orizzontale» del paziente
WHERE TO LEARN MORE PARTNERING TO LEAD THE TRANSFORMATION
The Economist Intelligence Unit Report, “Value-based Healthcare:
A Global Assessment” http://vbhcglobalassessment.eiu.com/
Harvard Business Review Insight Center,
“Measuring Costs and Outcomes in Health Care” https://hbr.org/insight-center/measuring-costs-
and-outcomes-in-health-care
©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.
medtronic.com
Position papers and case studies can be found on the “Transforming Healthcare”
section on our website: http://www.medtronic.com/us-en/transforming-
healthcare.html/