Global Trends in Health System Innovation

Global Trends in Health System Innovation September 7, 2017

Dr. Anne Snowdon, BScN, MSc, PhD, FAAN Academic Chair, World Health Innovation Network (WIN) Scientific Director & CEO, Supply Chain Advancement Network in Health (SCAN Health) Professor, Strategy and Entrepreneurship 1 Odette School of Business

GLO B A L CO N T E XT IN 2 01 3

Rising Global Healthcare Costs:

5.3% per year

(2014-

2017)

17.4%

10.7% 6.4% 6.6%

8%

Highest global spending as a percentage of GDP is in North America

Deloitte, 2014

CANADIAN CONTEXT IN 2013

Total Spend:

Economy:

Growth:

$215 Billion 11% of GDP 5.5% (2011)

CIHI, 2014

CANADIAN CONTEXT IN 2013

Hospitals:

Drugs:

Physicians:

$62.6 Billion $34.5 Billion $31.4 Billion #1 Cost is Labour #2 Cost is Products

CIHI, 2014

OV E RA L L P E R F O R M A N C E RA N K I N G

AUS

CAN

FRA

GER

NETH

NZ

NOR

SWE

SWIZ

UK

USA

OVE RALL RANKIN G (2013)

4

10

9

5

5

7

7

3

2

1

11

QUALITY CARE

2

9

8

7

5

4

11

10

3

1

5

EFFECTIVE CARE

4

7

9

6

5

2

11

10

8

1

3

SAFE CARE

3

10

2

6

7

9

11

5

4

1

7

C O O R D I N AT E D CARED

4

8

9

10

5

2

7

11

3

1

6

PAT I E N T- C E N T R E D CARE

5

8

10

7

3

6

11

9

2

1

4

ACCESS

8

9

11

2

4

7

6

4

2

1

9

C O S T- R E L AT E D PROBLEM

9

5

10

4

8

6

3

1

7

1

11

TIMELINESS OF CARE

6

11

10

4

2

7

8

9

1

3

5

EFFICIENCY

4

10

8

9

7

3

4

2

6

1

11

EQUITY

5

9

7

4

8

10

6

1

2

2

11

H E A LT H Y L I V E S

4

8

1

7

5

9

6

2

3

10

11

H E A LT H EXPENDITURES/ C A P I TA , 2 0 1 3 *

$5,827 $5,718 $4,864 $5,006 $6,145 $4,063 $9,715 $5,680 $9,276 $3,598 $9,146

TOP 2

MIDDLE

BOTTOM 2

Commonwealth Fund, 2014; *World Bank, 201

e number of Canadians aged 65 or older will in the next 25 years, reaching double by 2036.

10.4 million

8.0% 1971

14.4%

24.7% 2031

1991 2011

11.5%

2051

22.8%

Employment and Social Development Canada, 2014

Chronic disease rates increasing, anadians over 20 yrs of age have a Chronic ill

Age-Adjusted Prevalence (%)

0.8

14%

per year

0.6

0.4

0.2

0

2001.0

2010.0 Cancer Diabetes

2020.0

2030.0

Cardiovascular Diseases Hypertension

2039.0

│

Population Demands on health systems?

Ontario population 1% 5% 10%

Health Expenditures

50%

On average, health care spending is highly concentrated with the top 5% of the population (ranked by cost) accounting for 66% of expenditure

Median cost for health resource use in Ontario = $181.00

70,000 Canadians experience preventable serious injury while

Every year

hospitalized‌

‌23,000 experience death , Now 3rd leading cause of death Baker, 2004

Challenges for Clinical Teams

“Clinicians become used to missing information (1:4 pts), equipment is missing or defective (1:3 pts), “cut corners” to get the work done.

“Accept poor reliability as the norm, and stop reporting problems” “Reporting is voluntary – fear of being blamed, receive no feedback, view reporting as unlikely to lead to change” (Baker, 2014)

F O R E I G N BO DY L E FT I N D U R I N G S U R G I C A L PROCEDURE

OECD, 2013

13.5% Adverse Events, nearly double the rate in hospitals (7.5%)

Canada’s track record on Patient Safety (OECD)

(source: http://www.cihi.ca/en/health-systemperformance/performance -reporting/international/oecdinteractive-tool-patient-safety)

Estimated Cost of Preventable Adverse Events

$17-$29 billion

billion £1- £2.5 billion

billion $397 million

“It is estimated that preventable errors cost the United States $17-$29 billion per year in healthcare expenses, lost worker productivity and disability” (National Quality Forum) “This report suggests a cost of preventable adverse events that is likely to be more than £1 billion but could be up to £2.5 billion annually to the NHS” (Exploring the costs of unsafe care in the NHS, 2014).

“The economic burden of adverse events in Canada in 2009-2010 was $1.1 billion, including $397 million for preventable adverse events.” (The economics of patient safety, 2015).

│

Leading the Future of Health Care?

“If I had asked people what they wanted, they would have said faster horses”

W H E R E A R E H E A LT H S Y S T E M S G O I N G ?

G LO B A L T R E N DS Empowered Consumer Shift Towards Wellness Emergence of Digital Tools Single illness to Multicomorbidities Accountability and Value Traceability and Transparency

T H E F U T U R E H E A LT H S Y S T E M ? T H E E M P O W E R E D C O N S U M E R A B L E T O S E L F M A N A G E T H E I R H E A LT H

SHIFTING CONSUMER CULTURE MY CHILDREN Impatient Super Connected Loyalty to Value Health as a Right Researches, asks for data, negotiates

MY PARENTS Patient, used to waiting Values Stable relationship Loyalty to Brand Health as a service Defers to the expertise of the provider

CO N S U M E R D E MO GRAP H I C

Women, ave. 48 years old, make majority of health decisions for families 7 million women in Canada provide care for both children and aging parents

Boomers: wealthy (47x net worth), Values: agelessness, independence and personalization (“My Way�) .

The Digital World: Canadians spend approximately month online and

45 hours per

7 days a year on Facebook

CIRA, 2013; Gov. Can., 2010

In 2012,

44 million unique healthcare apps downloaded

Searching for health information is now the third most popular online activity for all internet users 18 and older.

There are over

97,000 health applications

Deloitte, 2014

71

of seniors download % apps, fastest growing market

Global Revenues

Mobile Healthcare Application Market:

ďƒ‡360

%

$27 Billion Revenues 2016

Deloitte, 2014; CBC 2014

Our society increasingly relies o transparent, real time informatio at a glance, from everywhere E.g. Uber, FedEx, etc.

Except in Health care‌..the same consumers are seeking online tools and Health information, unfortunately not connected to health systems E.g. Fitbit, MapMyRun

FROM “TRIPLE AIM” TO “TRIPLE VA L U E

Convenien ce

Value Choice

System Focused

Cost

Consumer Focused

FUTURE OF H E A LT H S Y S T E M S ? mG E T C O N N E C T E D A N D A C H I E V E VA L U E F O R C O N S U M E R S

We use digital technologies every day to to shop, study, do banking, travel. ‌except for health care Facebook connected people to the world around them, health systems need to do the same E.g. Bluetooth Pacemaker

H E A LT H S Y S T E M S

FIT WITH CONSUMERS?

Health systems focus on the disease or diagnosis, very good at curative illness, not as focused on prevention, wellness, quality of life - what matters to the person

R E D E F I N I N G H E A LT H C A R E : S H I F T T O WA R D S P E R S O N A L I Z AT I O N of PAT I E N T & FA M I LY G O A L S – Wellness, Prevention, Quality of Life, Self Management

Empowered Consumers want the flexibility to determine what the need most, disease management is just not enough Population Health will need to be focused on population segmen And outcomes achieved

Ex. Dementia Strategy UK, Pain app

Meet Jim: COPD, Stroke, 24 medications, 8 providers visiting weekly, 8 admissions to hospital in last 14 weeks, multiple ED visits & Wife struggling to cope

It is no longer "One Size Fits All Families assuming increasing caregiver burde need the flexibility to tailor their care plan to their unique and evolving situatio

C O M P L E X I T Y O F M U LT I - C O M O R B I D I T Y PAT I E N T S R E Q U I R E I N T E G RAT E D , T RA N S PA R E N T C O L L A B O RAT I V E C A R E

Improve Transparency between primary care providers, hospital and community care providers who hold each other accountable for executing the plan to achieve outcomes.

E.g. MED GPS, “Single Source of Truth

│

Digital Technologies: Opportunity for Personalization, Moving Care Upstream, closer to Patient

• Personal Health Records empower consumers to manage health and wellness • Hand-held, point-of-care devices for information entry, sharing, transmission of health information – eMoCA project

Hand-held, point-of-care devices for information entry, sharing, transmission of data, Coaching, partnering with patients

opportunity to improve patient outcomes and achieve value by rethinking our approach to supply chain

Approximately 50% of U.S. acute care facilities report bar code assisted medication administration (BCMA) Of the 78 hospital respondents in Canada, only 6% report scanning patients’ ID at the bedside (2014)

H O S P I TA L S U P P LY C H A I N : O P P O RT U N I T Y F O R S Y S T E M I N N O V AT I O N

“The constant hunt for supplies and equipment on clinical units is the challenge of supply-chain management in health care…”

Supply Chain accounts for 25% drug costs, and 40% of devices Costs (McKinsey, 2013)

Reframing the challenge of patient safety and care quality as a system infrastructure opportunity

“Adverse events and medical error are an outcome of a lack of well-developed supply chain infrastructure that would make it nearly impossible for errors to happen�

Where is Supply Chain well developed?: Grocery: tracks and traces every food item Airlines: trace every passenger Retail: track every retail item

Transparency in Supply Chain Processes:

"You know everything in "Real Time”, measuring exactly what we do and what outcomes are achieved --- evidence to assess value to procure the right products” (NHS) Estimated Return on Investment of Traceability?

- 4:1 (NHS, considered “conservative”) - on inventory savings alone (20%

Shifting Accountability: Leadership that "levels the playing field"

PAT I E N T E X P E R I E N C E : P U T T H E P O P U L AT I O N I N C H A R G E O F D E F I N I N G VA L U E , T H E Y W I L L A N Y W AY !

“How many stars would you give this resort?

-Trip Advis

M E A S U R E W H AT M AT T E R S : B R I D G E T H E D I S C O N N E C T BETWEEN THE SYSTEM AND THE CONSUMER

Consumers measure progress towards their goals Health Systems Measure: Survival, Infections, Readmissions, Adverse Events, etc.

SYSTEM REFORM?

Building the Evidence for Innovation Adoption to Innovation at Scale to Achieve System Build the Evidence for Innovation Transformation

│Adoption

Innovation to Achieve Health System Reform

Clinical Innovation

Research Innovation • New technology • New therapies

Proof of of Proof Concept Concept

• Patient care implementation • Clinician adoption • Integration into service delivery

Proof of Relevance

• IT decision support • Service delivery model redesign • Performance metrics support adoption • Financial model for reimbursement • Leadership to drive innovation • Clinical guidelines Integration • Consumer uptake

Proof of Value and Reimbursement

WHY INNOVATE? WHY NOW?

Thank You C o n t a c t D r. A n n e S n o w d o n a t : A n n e . S n o w d o n @ u w i n d s o r. c a

Website: www.worldhealthinovationnetwork.com Facebook @WorldHealthInnovationNetwork : @WIN_Health Twitter: World Health Innovation Network LinkedIn: WIN Health YouTube:

Website: www.SCANHealth.

Facebook ca : @SCANHealthNCE Twitter: @SCAN_Health LinkedIn: SCAN Health