Value Based Healthcare

in NHS Wales……

Alan Brace

Director of Finance

Health and Social Services Group

Welsh Government

What’s a

Good

Outcome

Worth ?

NHS Finance - The Alligators

Jaw…..

Scenario modelling suggests a cumulative financial gap of between £1.3bn and £1.9bn over the next five years

£6.753bn

£6.385bn

£5.043bn

£4.838bn

£3.5bn

£4.0bn

£4.5bn

£5.0bn

£5.5bn

£6.0bn

£6.5bn

£7.0bn

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Annual grow th in costs (high)

Annual grow th in costs (low )

3% reduction in annual funding

4% reduction in annual funding

£1.9bn

gap

£1.3bn

gap

Esimated range of

financial challenge

Improving Healthcare Value

• The case for change has never been stronger.

• Health Spend is over 50% of the Welsh Government Budget and

growing.

• We have what is needed to achieve increased value - an

integrated system, capable of data measurement and directed

change

• Our Health system is planned, more agile and integrated, we can

effect change more easily and at scale

• University Health Board designations allow for joined up thinking,

greater ambition and working across sectors in new ways

Health and Wealth

• Health spend is also a huge lever for economic value

• Welsh Government can create an environment, for business

activity that impacts on Welsh economic growth.

• Foster closer relationships between suppliers and the NHS

• Value Based Healthcare provides a common platform to

achieve this.

So how have we gone about this ……

Our Value Journey.

Aneurin Bevan Health Board...

Achieved to date

Outcomes Collection Costing

Parkinson’s Neurology TDABC

Parkinson’s COTE TDABC

Dementia Patient level and TDABC

Primary Care Mental Health TDABC

Inflammatory Bowel Disease TDABC

Heart Failure Patient level costing

Pulmonary Rehab/COPD Programme Budgeting

Cataracts TDABC

Reviewing scope Prostate Cancer TDABC

Aneurin Bevan Health

Board...Currently Developing

Scoping Opportunities

Vascular Surgery

Dermatology Psoriasis

Endoscopy Breast Services

Diabetes Alcohol Liaison Service

Adult Autism with Social

Services Inflammatory Arthritis

NHS Wales Developments

Lung Cancer Heart Failure

Time Driven Activity Based Costing,

in progress.

All Cataract Pathways in NHS

Wales -TDABC

Outcome Measurement in Progress

Value Based Procurement

Procurement Challenges:

• A siloed-approach and

misaligned goals

• Strong pressure to reduce

Costs

• A price only approach and

• A lack of consideration for the

quality of care or longer-

term economic implications

WHY THIS APPROACH NOW?

Procurement Opportunities:

• Industry are showing signs of

readiness

• Keen to develop partnerships

• New EU Directive gives more

support to value

• Tendering is ripe for reshaping

• Growing demand to

systematically measure

outcomes and costs

System suffers from a lack of incentives, tools and expertise to consider the

complete value which products and services can offer, at different levels and

across stakeholders.

Delivering Value for Wales –

Placing Outcomes at the heart of

Procurement

Assessing Value and measuring what matters -

Placing clinical and patient reported outcomes at

the heart of the procurement decision making

process.

PARTNERING FOR VALUE

A Value Based approach to Procurement will encourage true partnership with

Academic and Industry partners, adopting a risk-sharing approach which will be

measured on the outcomes that are achieved.

We will look to:

Measure specific healthcare outcomes and assess value in the goods

and services that we pay for.

Look to agree guarantee models that tie prices to specific

predetermined outcomes.

Look to triangulate outcomes capture, patient and clinical costing

and contracting to access the opportunities to redesign services

across the whole cycle of care, driving efficiency, outcomes and

potentially significant savings.

Reducing clinical variation by ensuring that product choice is based

upon robust considered evidence.

A Joint Collaboration between –

Swansea University Medical School,

Erasmus Holland,

Cascais Portugal and

ICHOM

Value Based Health Care –

Medical Undergraduate Curriculum

Health and Social Care -

Leadership and Innovation

Academy

Diolch yn fawr.

Thank you.