Ruud Simons Programme Manager Medication Safety and

Patient Empowerment, Nictiz, The Netherlands

Perspective from ‘the payer’

“The Payers role” !

A Nictiz - Health care insurers view

MSc Ruud Simons, MBA-MBI, pharmacist !Eurobioforum, Tallin, September, 23rd 2014

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This genomics design costed 84mlj !

!Probably the most

expensive genomics ever!

!I’m certainly not!

talking about genomics !!

Piet Mondriaan: Victory Boogie Woogie

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I still have 25 minutes left

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How can we achieve and sustain a ”decent” liberal society, one that aspires to justice and equal opportunity for all and inspires individuals to sacrifice for the common good?”!!

Political Emotions!Why love Matters for Justice!!Martha C. Nussbaum!Distinguished Service Professor of Law and Ethics!

!My opinion!!We do have this obligation also in !Personalized Medicine

Today

What is it that I didn’t hear ??

!Connect all our initiatives ?? Co-operate on them How??!!!!Money talk / Return of Investments!!Patient empowerment!!Prevention!!Co -creation!!International standards !!!

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Personalized Medicine

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“Every patient reacts differently on a disease and its treatment”. !

Our ambition lies in finding why this is so, and what it means for the development of new medical technologies (e.g. drugs or devices)

and its use !!!

Every individual is unique !

Our responsibility is not!!!

Building blocks of Personalized Medicine

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Meaningful Use!Best Practice Triple aim

Healthy Medical !Technology Assessment!

Information!Technology

International perspective

Patient registries

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Personalized !Medicine

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I still have 23 minutes left!hope i’m not boring you

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!Triple Aim !

!• Improving the patient experience of care (including

quality and satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care.

!!

Facilitate and trust doctors and nurses to realize the best care for patients

Triple aim

Together with our partners we work on personal health!! •Our higher aim (that’s why we exist) : Working together on healthcare and providing health insurance •Our ambition: Before 2020 everyone in the Netherlands can trust on the best healthcare

Our Ambition: Before 2020 everyone in the Netherlands can trust on the best care We have a duty to spend our customers money in the best possible ways 1.Quality and safety of care 2.Solidarity 3.Health care infrastructure 4.Innovation 5.Affordability of care

Achmea divisie Zorg & Gezondheid

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Achmea VISION AMBITION

Together with our partners we work

on personal health

Health care infrastructure

Affordability of care

Quality and safety of care

Innovation

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Meaningful Use!Best Practice

• Benchmark (expensive drugs)!• Treatments fitted to individual!• Shared decision proces (last slide of today)!• Better decision support systems for doctors!• Standardized ICT!• Beware of undertreatment !• Off label use!• Patient Empowerment

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Costs are raising mainly because introduction of new drugs! Costs (€) of expensive drugs and orphan drugs ! (Costs in Hospitals only, Nation wide Netherlands)

7 %*New drugs !Growth Hormones !Oncolytics (oral) !Orphan Drugs !Other expensive drugs (e.g. oncolytics i.v.)

!

*7% Raise of costs in expensive drugs vs 1% maximum rise of costs agreed upon in Hospitals

Tumor Necrose Factor inhibitors - comparison

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40

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40

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Nation wide

Region

ANALYSIS: Direct comparison of volumes (mg) per patient[2012]

Best practice; diff € 6120 pp/py!For €4mlj/year

• Benchmark (expensive drugs)

•“Half the money I

spend on advertising is wasted; the trouble is, I don't know which half.”

With permission of Ken Redekop, IMTA, Rotterdam

• Better decision support systems for doctors

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• ICT fitted on Health care processes!• Lower enter barriers for innovation!• Target om population, not on the sick!• Lower administrative burden!• Use MTA for breaking down rules !!!• Standardized ICT (information standards) !• Patient Empowerment (I’m a diabetic !)!• NICTIZ project on patient empowerment

Healthy Medical !Technology Assessment!

Information!Technology

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!• Use MTA for breaking down rules !!!

• The enormous amount of rules causes a major delay in innovation (acceptation of clinical studies, approval of market acces of drugs)!

• Informed consent should be used where it was ment to be for!!!• Patient safety or numbers needed to treat are not the holy grail!

• NICTIZ project on patient empowerment!• The patient has access to his medication records at any time at

any place (from any place)!• The patient can download, add enrich and share his actual

medication data!• The patient can share medication related experiences back to the

doctor / pharmacist; eg. Breakthrough pain (Cancer)

Healthy Medical !Technology Assessment!

Information!Technology

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• International Standardized governance!!

• Exchange health care data, best practices!!

• Speak the same language!• Enough talk. Make decisions and commit to them!!!• Patient Empowerment

International!perspective

Patient RegistriesWill be necessary to combine triple aim, meaningful use, medical technology assessment and international context !

Will be necessary to Integrate data to support Clinical Decision Support

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The DMTR (Dutch Melanoma Treatment register) registers the results of the treatment of metastasized melanoma within the Netherlands. With the introduction of ipilimumab and B-RAF inhibitors, with their own indication area and specific toxic profile, is registering experiencing and outcome of treatment a major issue for good quality of care.!The main objective of the DMTR is to collect information of the quality of the melanoma treatment , as well as to provide the 14 selected dutch hospitals with the necessary efficacy outcomes.!The registry will monitor effects and adverse effects of the therapy.

Pharma Achmea

Government Policy makers Researchers

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!CE!CE!

ZIS IS

!ZAIS

!HIS

!AIS MelanAlzhei

merHemobasePompe & FabrisPharosMultiple Sclerose

Population Based

Registers

Patienten Participatie; Input Output

Web Based Layer; Input and extraction of data (standard interface)

Safety servers

Registry Servers

ReportsReports

Planning layer (business proces engineering, efficacy,

Learning layer (best practice introduction, transparency, international, meaningful)

OUTCOME MANAGEMENT Stakeholders!Reports

Basic layer ( Identification, genomics, lifestyle, client input )

Business Intelligence

Health care IS

Patient Participitation!Patient portal - PHR solutions

Patient registries give return on investment

A very cautious calculation shows that for a feeing of €2-4 per individual / per year there is a Return on Investment within 2 years

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Core%Dataseset%

Oncology Dataset

Cardiology Dataset

Surgery Dataset

Pulmonology Dataset

Dermatology Dataset

Urology Dataset

Neurology Dataset

Colon Cancer

Mamma Cancer

Lung Cancer

Prostate Cancer

1.  Core Data 2.  Field/specialism Data 3.  Problem/disease Data

Data$Defini)on$Model$

…

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Interoperability-levels-

Alignment-of-care-processes,-shared-Use-Cases-

Collabora:on-agreements-between-organisa:ons-

Integra:on-in-healthcare-applica:ons-

Communica:on-protocols-

Compa:ble-legisla:on-and-regula:ons-

Data-defini:on,-terminology,-transfer-format-

Care-Process-

Policy-

IT-Infrastructure-

Legal-and-regulatory-

Informa:on-

Applica:ons-

Standards--and-Profi

les,-Cer:fi

ca:o

n-

Security,-Governance-

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Interoperability-on-all-levels-

Loca2on-A- Loca2on-B-

Compa2ble-infrastructure-

Linked-interfaces-

Common-data-modelling-

Shared-workflow-

Aligned-policies-

Care-Process-

Policy-

IT-Infrastructure-

Legal-and-regulatory-

Informa2on-

Applica2ons-

Care-Process-

Policy-

IT-Infrastructure-

Legal-and-regulatory-

Informa2on-

Applica2ons-

Compa2ble-legisla2on-

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Personalized Medicine is about individuals !

Personalized Medicine is a shared decision proces between doctor and client or patiënt

!Changing Playing Field requires trustfully cooperation of doctors,

pharma and health care insurers !

Triple Aim is a transparent shared decision proces between health insurer, doctor and client

!Let’s do this together in an international perspective where the

bridge over Death Valley is build by us !!

Stay healthy and happy

Behind the scenes This is what top influencers do!

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• We did not discuss Hazards, Risks, Issues • We should focus on ambitions and ‚ ”let’s do it” !

• So how are we going to be top influencers ?? • What will be our business plan?? • Friends

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How can we achieve and sustain a ”decent” liberal society, one that aspires to justice and equal opportunity for all and inspires individuals to sacrifice for the common good?”!!

Political Emotions!Why love Matters for Justice!!Martha C. Nussbaum!Distinguished Service Professor of Law and Ethics!

!My opinion!!We do have this obligation also in !Personalized Medicine

Today

🌸

Shared decision process

Questions / Discussion

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MSc RHAM Simons, MBA-MBI, pharmacist Senior Project Manager E simons@nictiz.nl M +31 6 1899 5398 / +31 6 53220270 http://nl.linkedin.com/in/ruudsimonsmbambi/ @ruudsimons2020 www.nictiz.nl