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Health Care Systems Outcomes: improving
patient outcomes at same or lower total cost Future Trends LatAm 2016
12 October 2016, Panama
Jennifer Clawson
Associate Director, Madrid
Jennifer Clawson is a core member of The Boston Consulting Group’s Health Care practice and the global
coordinator for the firm's value-based health care program, working with clients across all sectors of the industry.
Jennifer also played a key role in the establishment of ICHOM (the International Consortium for Health
Outcomes Measurement), a not-for-profit organization focused on health care outcome measurement that was
cofounded by BCG with Michael Porter of Harvard Business School and the Karolinska Institute.
• The Value-Based Hospital, BCG article series, September 2014
• Procurement, the Unexpected Driver of Value-Based Health Care 2015
• Competing on Outcomes: Winning Strategies for Value-Based Health Care, BCG focus, January 2014
• Consumers Seek Hard Data on Health Care Outcomes, BCG article, September 2012
• What Value-Based Health Care Means for Pharma, BCG article, March 2012
PUBLICATIONS AND VIDEOS
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Value-based health care (VBHC) is transforming health care
1. M. Porter: Redefining Health Care, 2006 Source: "Redefining Healthcare", BCG analysis
Concept1 Initial description
Health outcomes that
matter to patients
Cost of delivering
the outcomes
Central goal in health care becomes value for the patient, not volume,
cost containment or meeting single medical parameters
Value =
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VBHC's influence is expanding very quickly
VBHC becoming increasingly important in
academics...
2014
229
# of PubMed articles on Value-based healthcare
2013
41%
2012 2011 2010 2009 2008 2007 2006
Source: PubMed, BCG Analysis
Concept of VBHC
established through
Porter's book Inaugural ICHOM
conference First BCG study
on VBHC
...as well as on macroeconomic level
across international organizations
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Defining outcomes
=
Value
Outcomes that
matter to
patients
Cost per
patient
Source: BCG
Processes Patient
experience/ engagement
Indicators
Patient
initial
conditions
Outcomes
that matter
to patients
Structure • Staff certification,
• Facilities
standards
• ... • PSA
• Gleason Score
• Surgical margin
• …
• Protocols
• Guidelines
• Survival
• Continence
• Erectile function
• Anxiety
• Adequate
information
• Expectations
agreed with
physician
• ...
• Age
• Comorbidity
• ...
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INFLAMMATOR
Y BOWEL
DISEASE
INFLAMMATORY
BOWEL DISEASE
Numbers not representing
prioritization/ likelihood
Current 21 Standard Sets
Ongoing discussions
to launch
1. Chronic kidney disease
2. Oral health
3. Inflammatory arthritis
4. Bipolar disorder
5. Congenital hand
malformations
6. Facial palsy
7. HIV/AIDS
8. Pediatrics epilepsy
9. Pediatric overall health
10. Adult overall health
11. Substance use
disorders
12. Burns
13. Head and neck cancer
ICHOM has become the standard setter for outcomes
Source: ICHOM
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INFLAMMATOR
Y BOWEL
DISEASE
INFLAMMATORY
BOWEL DISEASE
Numbers not representing
prioritization/ likelihood
Current 21 Standard Sets
Ongoing discussions
to launch
1. Chronic kidney disease
2. Oral health
3. Inflammatory arthritis
4. Bipolar disorder
5. Congenital hand
malformations
6. Facial palsy
7. HIV/AIDS
8. Pediatrics epilepsy
9. Pediatric overall health
10. Adult overall health
11. Substance use
disorders
12. Burns
13. Head and neck cancer
ICHOM has become the standard setter for outcomes
4 Years
21 Standard Sets
45% of the Disease Burden
7 Sets published in peer-reviewed journals; 2 more accepted for publication
Cleft Lip
and Palate*
Localized
Prostate Cancer
Low
Back Pain
Stroke
Coronary
Artery Disease
Cataract
Advanced
Prostate Cancer
Hip and Knee
Osteoarthritis
Macular
Degeneration*
Source: ICHOM
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Leading organizations globally adopting ICHOM standards
Source: ICHOM
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Localized prostate cancer: ICHOM Standard Set of outcomes
Source: ICHOM
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Localized prostate cancer: ICHOM Working Group
* Patient representative
Source: ICHOM
Adam Glaser, St James’ Institute
of Oncology; NHS
Jim Catto, University of
Sheffield, European Urology
Kim Moretti, South Australian Prostate
Cancer Clinical Outcome
Collaborative
Mark Frydenberg, Prostate Cancer
Registry of Victoria
Ian Roos*, Cancer Voices Victoria
Frank Sullivan
Prostate Cancer Institute
John Fitzpatrick,
Irish Cancer Society
Hartwig Huland and Markus Graefen, Martini Klinik
Michael Froehner,
Günter Feick*, Bundesverband Prostatakrebs
Selbsthilfe (BPS); Europa UOMO
Thomas Wiegel, University Hospital Ulm
C.H. Bangma,
Erasmus Medical Center
Anna Bill-Axelson,
Swedish Prostate
Cancer Registry
Francesco Montorsi, European Urology
Editor in Chief
Alberto Briganti, Vita-Salute San Raffaele
University Hospital, Milan
Jacob Ramon,
Sheba Medical Center
Steven Jay Frank, MD Anderson
David Swanson, MD Anderson
Andrew Vickers, MSKCC
Adam Kibel, Dana Farber/BWH
Michael O’Leary, Dana Farber/BWH
Anthony D’Amico, Dana Farber/BWH
Neil Martin, Dana Farber/BWH
Michael Blute, MGH
Howard Sandler, Cedars-Sinai
Ronald Chen, University of North
Carolina
Dan Hamstra, University of Michigan
Ash Tewari, Weill Cornell Medical
College
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Martini - Europe's leading center for Prostate cancer therapy
Source: Hospital quality reports 2010
Martini Klinik does over 2k
prostatectomies /year – largest in EU 5 year disease-specific survival
Martini Klinik 95%
Average Hospital 94%
Severe erectile dysfunction
75.5%
34.7%
Average Hospital
Martini Klinik
6.5%
43.3% Average Hospital
Incontinence
Martini Klinik
Regis
try
sta
rted
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Would you rather have a heart attack in Sweden or the UK?
59%
89%
7.6%
1.0
22%
78%
10.5%
1.37
30-day
mortality
Source: Chung et al, The Lancet, Jan 23, 2014.
Outcomes1
Primary PCI3
Treatment
β blocker at
discharge4
Standardized
mortality rate2
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Dutch payers fund physician-led registries to improve value
~30% decreased mortality in colorectal cancers 2010 – 2012
13 – 15% decrease in ALOS2 during the same time period
1. DICA: Dutch Institute for Clinical Audit 2. ALOS: average length of stay Disclaimer: Cause/effect (ie registries affect on outcomes) can never be proven 100% / Source: DICA annual report 2013; initial interviews with DICA representatives
Impact on Outcome
Impact on
Resources
0
10
2010
4.0%
2012
-31%
5.8%
30 days mortality after resection (%)
Colon cancer Rectal cancer
0
5
2010
2.7%
2012
-29%
3.8%
30 days mortality after resection (%)
Colon cancer Rectal cancer
13 110
20
2010 2012
-15%
ALOS2 (days)
16 14
0
20
2010 2012
-13% ALOS2 (days)
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Value-based health care can improve outcomes and costs Improvement often observed at the same time
Source: BCG analysis
Outcome
Cost
HC Value
=
Examples with outcomes focus and
increased HC value
Impact Organization
Patient. sat.
+20%
Costs
-25%
PE-rates1
-80%
Costs2
-1%
Complic.
-21%
Costs
-28-36%
Mortality
-53%
Costs
-€151/pat.
Survival
+3%
Costs
-6%
Patients
Cataract
CABG
All patients
Lung
transplant
Chronic
diseases
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VBHC and outcome measurement are here to stay
“We know [very little] about whether, where, and
how health services achieve the outcomes that
patients are looking for. We want health ministers
today and in the future to do something about
this.”
Value in Healthcare
"Misalignments of incentives, interests, strategies and
behaviours of parties engaged in healthcare delivery are at
the core of inefficiency.
Value-based care could be the solution to these
misalignments, by redefining how care is organized,
measured, and reimbursed."
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