SCAN Health European Procurement Summit 2018 in partnership with NHS NW Procurement Development – Ma

Please register at the registration table, help yourself to breakfast and find a seat.

The event will begin at 9:00.

SCAN Health European Procurement Summit 2018 In partnership with NHS NW Procurement Development

#SCANHEPS18

Agenda 8:30- Registration & 9:00 Breakfast

13:15- Panel Session Two: 14:30 Orthopedic Registries

9:00Opening Remarks 9:15

14:30Comfort Break 14:45

9:15- Keynote Session One: 10:15 Innovation Procurement

14:45Panel Session Three: 15:45 Value-based Procurement

10:15 - Networking Break 10:45

15:4516:15 Keynote Session Two

10:45 Panel Session One: Supply Chain Maturity 12:15

16:1516:30 Closing Remarks

Models

#SCANHEPS18

Introduction & Opening Remarks 9:00 – 9:15

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Dr. Anne Snowdon

Mr. Brian Mangan

Scientific Director & CEO, SCAN Health Academic Chair, World Health Innovation Network

Deputy Director, NHS NW Procurement Development @ NHSNWPD

#SCANHEPS18

Keynote Session 9:15 – 10:15

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Outcomes Based Procurement: a Strategy to Drive Health System Transformation Dr. Anne Snowdon Scientific Director & CEO, SCAN Health Academic Chair, World Health Innovation Network @SCAN_Health, @WIN_Health

HEALTH SYSTEM COSTS: THE CHALLENGE OF SUSTAINABILITY

#SCANHEPS18

Rising Global Healthcare Costs: 17.4%

8 %

(2014-2017)

10.7%

5.3% per year

Highest global spending

6.4% 6.6%

as a percentage of GDP is in North America 5 Deloitte, 2014

Healthcare System Performance Compared to Spending

#SCANHEPS18

6 Note: Healthcare spending as a percent of GDP. Source: Spending data are from OECD for the year 2014 and exclude spending on capital formation of healthcare providers; Commonwealth Fund analysis

Key Drivers of Health System Costs #SCANHEPS18

Medical Error is now the 3rd leading cause of death in North America. …23,000 death that is preventable annually, 68 people/day (Baker, 2014) …251,454 deaths USA, 633 people/day (Makary, 2016) ……1 in 18 hospital stays in Canada involved at least 1 harmful event

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Sources of Health System Costs: Opportunities for Procurement to Achieve Value #SCANHEPS18

Canada

Healthcare spending per capita

Denmark

UK

US

(USD, PPP; OECD, 2016)

$4,721

$5,074

$4,164

$9,832

Spending on medical goods per capita (USD, PPP; OECD, 2016)

$957

$510

$575

$1,365

$16,451

$14,105

$11,663

$21,063

19.8

-

-

12

2.5

3.7

2.8

2.6

2.58

2.6

2.6

3

Hospital Spending per Discharge (OECD, 2014; US data from 2010).

Labour Cost % of health expenditure (OECD, 2015)

# Physicians (per 1000 population; OECD, 2013/2014)

# Hospital beds (per 1000 population; OECD, 2016 or nearest year)

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Personalization and Precision: Drivers of Future Costs #SCANHEPS18

• “Omics” technologies – make personalization possible personalized to the unique genetic make-up of the individual • Information Technologies • new expectations of consumers • explosion of “apps”

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Imprecision of Precision Medicine #SCANHEPS18

Precision Medicine vs. the cost of these therapies for Drive towards

health systems

How can health systems identify Value (ex. “blue people”) if we don’t track and trace outcomes?

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Personalized medicine: Time for one-person trials Nicholas J. Schork Nature 2015. Volume 520, Issue 7549

Shifting Procurement from Procuring Products to Procuring Innovation and Value #SCANHEPS18 ‘

PRO C U R E IN NOVAT I V E S O LU TI O N S W I TH D E F I N E D O U TCO M ES

FO CU S I S O N MEA S U R A B L E O U TCO MES TH AT D EF I N E VA LU E :

SAFETY LABOUR “Never events” are not really falling — more than 1000 in the last 4 years. Indeed, in the last year of reporting we transfused the wrong type of blood into one patient, removed someone’s ovary by accident and left a surgical needle inside someone else by mistake.’

(DH and Hunt, 2017)

SUPPLIES VARIATION

ES

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Outcomes Based Procurement: System Strategy to Advance Performance #SCANHEPS18

Procurement of Solutions to Achieve Specific Outcomes o

Focuses on patient/program/system outcomes, procures solutions that achieve value

• Adheres to procurement best practice - fair, open, transparent • Engages Vendors as partners, to source or design solutions: • Vendors are engaged early in the procurement process

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Key Features of Outcomes Based Procurement #SCANHEPS18

• Focus is on measurable outcomes that define value, well beyond cost parameters •Procurement process engages:

•Physicians clinician teams: define patient priorities, clinical outcomes •Senior leaders: commit time and resources •Procurement teams to navigate the process, define criteria to 13 evaluate solutions

Innovation Procurement Models #SCANHEPS18

Innovation Partnership with Design Feature

Design Contest

Competitive Process with Negotiation and Innovative Dialogue

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Qualitative Case Study Methodology

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• Key informant interviews with members of project teams and vendors throughout the duration of innovation procurement initiatives • Document reviews, site visits • Data are coded to surface common themes within & across cases • Evidence of impact account for vendor, health system and clinician perspectives

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Case 1: A community-based organization procuring a coordinated e-services platform for the region #SCANHEPS18 Procurement Strategy: Design Competition • “Market sounding”: determined no solution existed on the market • Market Engagement: Vendor expertise needed to define possible solutions/strategies • Design phase: Vendors demonstrated proposed design strategy • Decision: consortium of vendors selected, proof of concept design stage completed, now being and RFP scaled across health organizations RFP clinical teams across the province.

Issued Decision Market Sounding

Market Engagement

Understand market, available solutions

Scope and design solution outcomes

Outcomes Based RFP

Design Phase

Proof of Concept Stage

Assess and “test drive” Partnership fit

Real world test of the design, scale across 16 region

Case 2: A hospital looking to procure a Program Solution to Improve Performance of a Cardiac Program #SCANHEPS18

Procurement: Competitive Process with Negotiation and Innovation Dialogue • Competitive Process model was used to procure improved performance outcomes, value-added services, full range of products for a 10 year contract • Phase 1: procured commodities with “value-adds” for 5 subspecialty programs.

• Phase 2 procured valueRFP for the program focused on improved RFP patient outcomes.

Issued Decision Design Procuremen t Outcomes

Pre-qualify Vendors

Phase I Competitive Dialogue

Phase II Competitive Dialogue

Program Shortlist Vendors Vendors present Dialogue with experts identify with capacity to submissions, gain vendors to fully performance meet outcome clinician feedbackevaluate proposed outcomes, requirements to strengthen finalsolution, negotiate measures of solution added features

Contract s Generated 30% cost savings for 17 program plus

Case 3: A community based organization seeking a patient and caregiver support #SCANHEPS18 solution for the home Procurement of an Innovation Partnership • Designed RFP to focus on a solution to achieve patient outcomes and caregiver support outcomes • Partnership first developed the solution, then trialed in a lab and community setting.

RFP Issued

Market Scannin g Understand current market capacity

RFP Decision

Design Solution Outcome s

Site Visits with Shortlisted Vendors

Engage patients, clinicians to scope desired outcomes

Demo of proposed solutions, evaluate potential for

Lab Trial

Field Trial

Test in Test in controlled, real world home like home like settings setting to with evaluate

Deploy Solution across System Scale and Spread18

Case 4: A Hospital looking to Procure a Smart Privacy Solution #SCANHEPS18

Procurement Model: Competitive Dialogue Model Competitive Dialogue: engaged vendor market on current solutions, outcomes defined based on vendor dialogue.

Phase 1: high level solutions submitted, dialogue on ways to strengthen solution Phase 2: Detailed solution RFP presentation, evaluated RFP for selection of Vendor Issued Decision Market Engagemen t Engage Vendors to understand market options, informs RFP design

PreQualifi cation Survey Identify vendors who have capacity to deliver the solution

Phase I: Outline Solutio n Feedback on draft solution from health team

Phase II: Detailed Solution Evaluate submissions for ability to achieve outcomes

Pilot testing Pilot test the for value potential in real world

Contract

In Progress 19

Evidence of Impact Teams that have undertaken innovation procurement projects have, to date, seen considerable positive outcomes.

• • •

Significant financial value generated Partnerships with small or unexpected vendors Implementation of innovation solutions

“So you’re looking at dollars and cents right, it’s saving the overall program in excess of 30%.”

(Procurement Lead – Case 2) “It really allowed us to make a really good decision at the end…and I think the proof of the success of this is that in the end the vendor that we’ve chosen is different because we went through that process.” (Senior Manager – Case 3)

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What is the in Outcomes Based Procurement?

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Expands the mandate of Procurement as a Strategic Asset to drive Innovation

Integrated strategy blending Procurement expertise with clinician perspectives, patient engagement and organizational leadership Operationalizes the Outcomes so they are measurable – builds

#SCANHEPS18

Integrated Team: Procurement, Clinician, finance, patients, leadership

Vendor Expertise and Capacity for Solution Design, and Partnership

Innovative Solutions Address Priority Challenges to Achieve Value

Senior Leadership Vision, Resource Commitmen t 22

Key Conditions that Drive Value #SCANHEPS18

System Intelligence: Clinician expertise, shared risk, partnership with vendors to achieve outcomes

Solutions focus on Measurable outcomes, made possible by Vendor Partnerships

Market Intelligence: Expertise in market intelligence informs solutions, scalability to new markets

Shared Accountability 23

Health Organization Team

Vendor Community

The Value of Vendors as Partners #SCANHEPS18

Vendor Partnerships characterized by: • Equality • Transparency of expectations • Learning health system insights, priorities, evidence • “Shared” skin in the game • Engage vendors as partners as a first step, not as an outcome of winning an RFP “I find this process really, really perfect because there is no surprises on the vendor side. They can ask all the questions they want, they know what we are expecting. They can even guide us by saying, ‘well you are saying this; what about this? Did you think about that?’ And also we

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Clinician Leadership: Key Condition for Success #SCANHEPS18

• Draws on deep clinical knowledge and experience, ensures the right questions are asked • Vendor access to clinician expertise • Creates clinician “ownership” “At the end of the day, of procurement decisions working with the product to actually understand all the differences between them, so that the right questions get asked before you get to the 25

Identifying Best Practices for Innovation Procurement

#SCANHEPS18

?

What we still don’t know

• Long term Impact on value • Long Term impact on vendors or health systems

What we know matters • Early market engagement • Vendor Partnership Flexibility, collaboration • Organizational culture & 26 leadership

Key Considerations for Outcomes Procurement “There’s no road map” Resource Intensiveness: “It’s High Effort” Time and resource intensive, engaging clinicians It is important for both sides to define and understand what co-designing solutions means

#SCANHEPS18

Understanding Co-Design Managing expectations Evaluating very different solutions to determine RFP award Need to consider ways to evaluate highly varied solutions from vendors (and consider value over the life of the

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Future: Procurement as a Strategy to Achieve Performance Outcomes

Implement; measure evidence of impact and risk

Vendor RFP Partnership established to deliver solutions

Market engagement to identify possible solutions

Identify priority solutions and outcomes

es m o c Out

Pro d e s Ba

Innovation at Scale

ent m e cu r ly Supp

Clinician led, predictive analytics, quality and safety

ed grat e t n yI icall ta Flow n i l C a in D Evidence of patient outcomes, a h C product use, variation in care define RFP Outcome specifications

Inventory tracking provides performance data to inform solutions

Global standard barcodes to identify every product and care process

Performance Outcomes • Shared Risk and accountability • Measurable outcomes of performance • Accurate case costing • Transparency of variation • Evidence to inform Scalability VALUE

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Emergence of Clinically Integrated Supply Chain – Foundational to Defining Outcomes of Value

#SCANHEPS18

Example: Impact of Supply Chain on Perioperative Program - Total Knee Arthroplasty (Mercy Health System)

• Traceability of patient outcomes– informs procurement teams of best outcomes • Inventory costs – informs procurement of product demand • Reduced Labour costs–defines program outcomes of value to clinicians.

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Outcomes Based Procurement to Strengthen Health System Performance #SCANHEPS18

3 1

Thank You #SCANHEPS18

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

Website : Faceboo k: Twitter: LinkedI n: YouTube :

www.worldhealthinovationnetwork.co m @WorldHealthInnovationNetwork @WIN_Health World Health Innovation Network WIN Health

Website : Faceboo k: Twitter: LinkedI n:

www.SCANHealt h.ca @SCANHealthNC E @SCAN_Health SCAN Health

3 2

Thank You #SCANHEPS18

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

Website : Faceboo k: Twitter: LinkedI n: YouTube :

www.worldhealthinovationnetwork.co m @WorldHealthInnovationNetwork @WIN_Health World Health Innovation Network WIN Health

Website : Faceboo k: Twitter: LinkedI n:

www.SCANHealt h.ca @SCANHealthNC E @SCAN_Health SCAN Health

Networking Break

10:15 – 10:45

#SCANHEPS18

SCAN Health: Building International Collaboration to Advance Supply Chain Maturity to Inform Innovation Procurement Models in Health Systems #SCANHEPS18

Mr. Paul Broadbridge Chief Executive Officer, Digital Bridge Consulting @AU_Pbroadbridge, @Digital__Bridge

Dr. Kevin Fenton Strategic Director of Place and Wellbeing, London Borough of Southwark @ProfKevinFenton, @lb_southwark

Mr. Blain Newton Executive Vice President, HIMSS Analytics @newton_vt, @HIMSSAnalytics

Mr. David O’Toole

Dr. Hakim Yadi

President & CEO, Canadian Institute for Health Information @DOTCIHI, @CIHI_ICIS

Chief Executive Officer, Northern Health Science Alliance Ltd @hakim_yadi, @The_NHSA

Session 1 Moderated By: Dr. Anne Snowdon, Scientific Director & CEO, SCAN Health Academic Chair, WIN @SCAN_Health, @WIN_Health

Opportunities and challenges with diffusing and scaling public health and clinical interventions: Lessons for SCAN Health?

Professor Kevin Fenton Strategic Director for Place & Wellbeing

Southwark Public Health

October 2018

What can SCANH learn from Diffusion of Innovations Theory and Practice?

INTRODUCTION • Diffusion of innovations is a theory profound by Everett Rogers that seeks to explain how, why, and at what rate new ideas and technology spread.

• Rogers argues that diffusion is the process by which an innovation is communicated over time among the participants in a social system.

• For Rogers (2003), adoption is a decision of “full use of an innovation as the best course of action available” and rejection is a decision “not to adopt an innovation”.

• Rogers defines diffusion as “the process in which an innovation is communicated thorough certain channels over time among the members of a social system” . As expressed in this definition, innovation, communication channels, time, and social system are the four key components of the diffusion of innovations.

• Diffusion of Innovations seeks to explain how innovations are taken up in a population. An innovation is an idea, behaviour, or object that is perceived as new by its audience.

• Diffusion of Innovations offers three valuable insights into the process of social change: • What qualities make an innovation spread successfully.

• The importance of peer-peer conversations and peer networks.

• Understanding the needs of different user segments.

Slide 36

What qualities make innovations spread?

• Diffusion of Innovations takes a radically different approach to most other theories of change.

• Instead of focusing on persuading individuals to change, it sees change as being primarily about the evolution or “reinvention” of products and behaviours so they become better fits for the needs of individuals and groups.

• In Diffusion of Innovations it is not people who change, but the innovations themselves.

Why do certain innovations spread more quickly than others? And why do others fail? Diffusion scholars recognise five qualities that determine the success of an innovation.

THESE 5 QUALITIES DETERMINE BETWEEN 49 AND 87% OF THE VARIATION IN THE ADOPTION OF NEW PRODUCTS

Relative advantage: This is the degree to which an innovation is perceived as better than the idea it supersedes by a

particular group of users, measured in terms that matter to those users, like economic advantage, social prestige, convenience, or satisfaction. The greater the perceived relative advantage of an innovation, the more rapid its rate of adoption is likely to be.

Compatibility with existing values and practices: This is the degree to which an innovation is perceived as being consistent with the values, past experiences, and needs of potential adopters. An idea that is incompatible with their values, norms or practices will not be adopted as rapidly as an innovation that is compatible.

Simplicity and ease of use: This is the degree to which an innovation is perceived as difficult to understand and use.

New ideas that are simpler to understand are adopted more rapidly than innovations that require the adopter to develop new skills and understandings.

Trialability: This is the degree to which an innovation can be experimented with on a limited basis. An innovation that is trialable represents less uncertainty to the individual who is considering it.

Observable results: The easier it is for individuals to see the results of an innovation, the more likely they are to adopt Slide 38 it. Visible results lower uncertainty and also stimulate peer discussion of a new idea, as friends and neighbours of an adopter

Adoption of new ideas do not happen simultaneously; some people adapt to innovation more quickly than others THEORY OF DIFFUSION & INNOVATION Diffusion of innovation theory (DOI) provides a framework of how new ideas, products or ways of working are adopted, outlined in five adopter categories.  Innovators: Interested in new ideas. Little needs to be done to appeal to this group.  Early Adopters: Opinion leaders who embrace change opportunities. “How to” manuals on implementation appeal to this group.  Early Majority: Typically need to see evidence that it works before adopting change. Success stories appeal to this group.  Late Majority: Sceptical of change. Need to see how many people have adopted change that has been successful.  Laggards: Hardest to bring on board. Statistics and pressure from other groups may appeal.

Innovators (2.5%)

Early Adoptors (13.5%)

Early Majority (34%)

Late Majority (34%)

References 1. Boston University, School of Public Health. 2018. Behaviour Change Models. http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories4.html

Laggards (16%) Slide 39

Amid a world of evidence-based medicine, public health and some clinical interventions have proven more complex to extend TRANSLATIONAL GAPS Challenge

Challenge

2

3

FIRST TRANSLATIONAL GAP

SECOND TRANSLATIONAL GAP

INNOVATION

Challenge

1

TRANSLATION

WIDESPREAD ADOPTION

1. Oftentimes evaluating multifactorial interventions is complex and prone to many types of bias – when dealing with rare outcomes we often lack statistical power 2. We seek to adapt complex interventions – and do not always know the interaction and influence of external factors 3. From implementation science literature, much of the change is driven by organisational readiness gained through the development process – lift and shift tends not to work Slide 40

The success of an innovation depends on how well it evolves to meet the needs of more and more demanding and risk-averse individuals in a population (the history of the mobile phone is a perfect example).

REINVENTION IS A KEY PRINCIPLE IN DIFFUSION • A good way to achieve this is to make users into partners in a continuous process of redevelopment.

• Computer games companies, pharmaceutical corporations and rural research institutes are examples of organisations that seek to make users active partners in improving innovations by supporting user communities or by applying participative action research techniques.

• Many computer games are now built with the intention that they will be modified by enthusiastic users.

• The concept of reinvention is important because it tells us that no product or process can rest on it’s laurels: continuous improvement is the key to spreading an innovation.

Slide 41

The importance of peer-peer conversations and peer networks and diffusion of innovation CONVERSATIONS AND NETWORKS • The second important insight is that impersonal marketing methods like advertising and media stories may spread information about new innovations, but it’s conversations that spread adoption.

• Why? Because the adoption of new products or behaviours involves the management of risk and uncertainty. It’s usually only people we personally know and trust – and who we know have successfully adopted the innovation themselves – who can give us credible reassurances that our attempts to change won’t result in embarrassment, humiliation, financial loss or wasted time.

• Early adopters are the exception to this rule. They are on the lookout for advantages and tend to see the risks as low because they are financially more secure, more personally confident, and better informed about the particular product or behaviour.

• Often they will grasp at innovations on the basis of no more than a well worded news article.

The rest of the population, however, see higher risks in change, and therefore require assurance from trusted peers that an innovation is do-able and provides genuine benefits.

Slide 42

The importance of peer-peer conversations and peer networks PEER NETWORKS INCREASINGLY IMPORTANT • As an innovation spreads from early adopters to majority audiences, face-to-face communication therefore becomes more essential to the decision to adopt. This principle is embodied in the Bass Forecasting Model (below), which illustrates how face-to-face communication becomes more influential over time, and mass media less influential.

• The emphasis on peer-peer communication has led diffusion scholars to be interested in peer networks. Many diffusionstyle campaigns now consciously attempt to utilise peer networks, for instance by using Popular Opinion Leader techniques or various “viral marketing” methods.

• These methods – which are becoming increasingly popular – aim to recruit well-connected individuals to spread new Source: Mahajan, Muller and Bass (1990) as reproduced in ideas through their own social networks.

Rogers, E.M.(2003) p210.

• Opinion leader tactics have been successful in raising the standards of practice by medical doctors, promoting weatherisation of homes, and encouraging safe sex in gay communities.

Slide 43

Conclusions

IMPLICATIONS FOR SCAN HEALTH • Researchers propose that four main elements influence the spread of a new idea: the innovation itself, communication channels, time, and a social system.

• This process relies heavily on human capital. The innovation must be widely adopted in order to self-sustain. Within the rate of adoption, there is a point at which an innovation reaches critical mass.

• The information flows through networks.

• The nature of networks and the roles opinion leaders play in them determine the likelihood that the innovation will be adopted.

• Innovation diffusion research has attempted to explain the variables that influence how and why users adopt a new information medium, such as the Internet.

• Opinion leaders exert influence on audience behaviour via their personal contact, but additional intermediaries called change agents and gatekeepers are also included in the process of diffusion.

Slide 44

Opportunities and challenges with diffusing and scaling public health and clinical interventions: Lessons for SCAN Health?

Professor Kevin Fenton Strategic Director for Place & Wellbeing

Southwark Public Health

October 2018

Why can’t we get out of our own way

https://www.data61.csiro.au/en/Our-Work/Future-Cities/Planning-sustainable-infrastructure/Digital-Innovation

https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-top-10-health-care-innovations-web-friendly.pdf

Collaboration | Why can’t we get out of our way • Resources constrained (budget and people) • Setup to compete against each other • Organisational structures (domestically and globally) • Fighting for resources – capital, research, recurrent

Collaboration | So what do we need to do • Realise collaboration and teamwork are different • Continue to learn from other industries • Break down siloes • Be proactive – seek out partnerships • Identify the common strategic outcomes • Acknowledge we are the glue

#SCANHEPS18

Improving healthcare systems with innovation in procurement and supply chain practices David O’Toole President & CEO Canadian Institute for Health Information

October 4, 2018

cihi.ca

@cihi_icis

#SCANHEPS18

Oh, Canada

Pop’n: 36 million (pop. density among lowest in the world) Single-payer model 70/30 split public/private coverage 14 systems Health card number linked to jurisdiction 52

#SCANHEPS18

Canadian Institute for Health Information

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#SCANHEPS18

Data holdings PatientReported Data

Types of Care • • • • • • • •

Hospital & Emergency Clinical Registries Mental Health Home Care Long-term care Rehabilitation Pharmaceuticals More

• •

Patient-Reported Outcome Measures (PROMs) Patient-Reported Experience Measures (PREMs)

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Health Spending • • • • •

Patient costing data Case Mix & Population Grouper Hospital and regional health authority financial accounts Physician Billing System-wide health expenditures

#SCANHEPS18

Collaboration for innovative procurement Rare events

Advanced health systems

Real-world applications

Global industries

Common standards, methodology

Pooled data 55

#SCANHEPS18

CIHI Collaborations • International health data standards and performance measurement • SCANH activities: blood product use, surgical site infections, hip/knee • interRAI data standards for home & long-term care, mental health • Strong AI and genomics sectors • Value-based Health Care Network • Learn more this afternoon…

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#SCANHEPS18

Opportunities

The issue

The partners

Data & analysis

Translation into action

Best outcome, best value

Advice from this group on: • Pilots vs scale projects • Leverage existing work (e.g. CAN/UK hip arthroplasty) • Tapping networks like SCANH, Int’l Society of Arthroplasty Registries • Role of strategic partnerships with industry • …

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#SCANHEPS18

@cihi_icis

cihi.ca

#SCANHEPS18

Global Learnings – Delivered Locally

October 2018

#SCANHEPS18

#SCANHEPS18

Driving Engagement for Global Learning

#SCANHEPS18

#SCANHEPS18

Well Designed Technological Solutions Can Help

JCO top performing hospitals by number of quality metrics excelling in, by EMRAM Stage

#SCANHEPS18

But Not Without Strong Processes & People

#SCANHEPS18

By Sharing Best Practices Globally, We Can Improve Locally

#SCANHEPS18

#SCANHEPS18

Session 1

รง

Dr. Hakim Yadi Chief Executive Officer, Northern Health Science Alliance Ltd @hakim_yadi, @The_NHSA

#SCANHEPS18

Building International Collaboration to Advance Supply Chain Maturity to Inform Innovation Procurement Models in Health Systems

Panel Discussion and Q&A

Networking Lunch

12:15 – 13:15

#SCANHEPS18

International Collaboration Among Global Orthopedic Registries as a Strategic Opportunity to Drive Value for Populations Leveraging Real World Evidence of Outcomes and Value #SCANHEPS18

Prof. Phil Turner

Mr. Greg Webster

Orthopaedic Consultant & President Elect, British Orthopaedic Association @BritOrthopaedic

Director, Canadian Institute for Health Information @GWebsterGreg, @CIHI_ICIS

Mr. Jitendra Prasad Chief Program Officer Contracting, Procurement and Supply Management, Alberta Health Services @AHS_media

Mr. Brian Mangan Deputy Director, NHS NW Procurement Development @NHSNWPD

Dr. Randy V. Bradley Assistant Professor of Information Systems and Supply Chain Management, University of Tennessee @randyvbradley

Session 2 Moderated By: Mr. Richard Armstrong Head of Health Solution Strategies, Northgate Public Services @NorthgatePS

National Joint Registries a clinical perspective Prof Phil Turner President BOA

History of the UK NJR #SCANHEPS18

• Failure of 3M Capital Hip • Slow to pick up problem • Need for national surveillance

Aims #SCANHEPS18

• Highlight prosthesis brands with high failure rate • Ensure patients obtain best clinical care • Evidence based purchasing • Evidence for best performing implants • Improve surgical practice • Ensure best use of resources

NJR Report 2004 #SCANHEPS18

• Hips and knees • 50% data entry • Data quality • Activity • Implant choice • Surgical technique • Anaesthetic • VTE prophylaxis

NJR 2018 #SCANHEPS18

• All major arthroplasties • Data quality and linkage • Reports • Annual • Hospital Annual Clinical • Consultant Level

• Research

#SCANHEPS18

What matters to a clinician? #SCANHEPS18

• What am I doing?

• Am I using the right implant?

• Am I an outlier?

• Revision • Mortality

• What am I costing?

Hospital level #SCANHEPS18

Surgeon level #SCANHEPS18

Outlier status #SCANHEPS18

• Appraisal • Elective Care Review • Invited Review Mechanism

Extended data use #SCANHEPS18

• GIRFT • Service reconfiguration • International variation

Generating real-world evidence of outcomes and value from arthroplasty registries Greg Webster Director, Acute and Ambulatory Care Information Services gwebster@cihi.ca Canadian Institute for Health Information

October 4, 2018

cihi.ca

@cihi_icis

CIHI’s Strategic Plan 2016 to 2021

Data holdings that support value-based healthcare PatientReported Data

Types of Care • • • • • • • •

Hospital & Emergency Clinical Registries Mental Health Home Care Long-term care Rehabilitation Pharmaceuticals More

• •

Patient-Reported Outcome Measures (PROMs) Patient-Reported Experience Measures (PREMs)

Health Spending • • • • •

Patient costing data Case Mix & Population Grouper Hospital and regional health authority financial accounts Physician Billing System-wide health expenditures

CIHI also has a number of databases on the health workforce, e.g. physicians, nurses, allied health professionals.

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Real-world evidence generated from many sources‌ Costing and Resource Use Data

Administrative and Clinical Data

Patient-Reported Experience Measures

Rehabilitation Data

Patient-Reported Outcome Measures

Medical Device Data

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Registries provide real world evidence of value • De Puy ASR entered market globally in 2003 Example: De Puy ASR • Joint Replacement Registry data (Australia and UK) showed higher revision rates • Voluntary worldwide recall by company in 2010 due to issues related to metal debris reactions in the soft tissues surrounding joint (estimated 93,000 globally) • Legal action continues

“Out of joint: The story of the ASR”

• Substantial reduction in subsequent use of this prosthesis in Canada and elsewhere

http://www.bmj.com/content/bmj/342/bmj.d2905.full.pdf

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Canadian Joint Replacement Registry Aims:  Launched in 2000 in collaboration with the Canadian Orthopaedic Association (COA)  Member of International Society of Arthroplasty Registries (ISAR)

• Improve the quality of care and the clinical outcomes of hip and knee replacement recipients • Reduce revision rates by studying the risk factors that affect outcomes (system, surgical, prosthesis, etc.)

• Support implant monitoring activities • Support procurement functions to ensure quality implants for optimum costs • > 100,000 procedures annually in Canada

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Registries can inform clinical and procurement decisions

• CJRR study: adding antibiotics to bone cement did not significantly reduce revision rates compared to using bone cement without antibiotics • Potential cost-savings of up to $5.3 million CAD (>£3 million) annually if stop using antibiotics in bone cement for this procedure in Canada (far more than cost of CJRR) • Surgeons in the largest region in Manitoba discontinued using this type of cement based on these results

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â &#x; Early Results from Canada - England Collaboration

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Focus on: Total hip arthroplasty (THA) health system outcomes Canada

Annual surgery volumes Mean length of stay (days) Inpatient cost (public facilities)

England

Primary

Revision

Primary

Revision

40,645

4,664

87,733

7,933

4.6

12.7

5.6

12.5

£5,920

£8,943

£5,888

£7,564

90

Clinical outcome: Revision risk by implant material Canada 0.0%

England/Wales

1.0%

2.0%

3.0%

1.8%

All implant materials

2.4%

1.6%

Metal on polyethylene

2.2%

1.3%

Ceramic on polyethylene

2.0%

Cumulative revision risk 1 year

3 years

0.0%

1.0%

2.0%

0.8%

All implant materials

1.6%

0.7%

Metal on polyethylene

1.3%

0.7%

Ceramic on polyethylene

1.3%

Cumulative revision risk 1 year

3 years

3.0%

Several factors may explain variations • Patient-level

- Age, sex, patient complexity (e.g. comorbidities) • Implant/prosthesis • Clinical-level - Surgical technique - Volumes by surgeon and centre • Health system-level - Delivery of services (e.g. hospital model, patient pathways) - Procurement practices 92

Opportunities for global collaboration • Leverage data globally for early warnings and surveillance

Standardize methodologies to support cost and outcome comparisons

Advance data and product labelling standards across supply chain

Accelerate use of the data to support valuebased procurement, health care delivery and better outcomes

93

@cihi_icis

cihi.ca

#SCANHEPS18

Procurement perspective on orthopaedic collaboration Brian Mangan Deputy Director NHS NW Procurement Development

Introduction #SCANHEPS18

Procurement objectives 1. Understanding of global markets, pricing and products 2. Promote engagement between clinicians, procurement and industry 3. Opportunities for cross border commercial collaboration and wider application

Understanding the “markets” #SCANHEPS18

Canada

UK

Depuy/JnJ

20.5%

30.5%

Smith&Nephew

7.0%

5.6%

Stryker

25.8%

37.8%

Zimmer Biomet

42.5%

17.4%

Others

4.2%

8.7%

In the short term yes – established companies, products, service..

• How can we work with industry to meet the current and future challenges?

If no – Stifles innovation and price competitiveness • Minimise barriers to entry, increase threats of substitute products?

Variance in pricing and products #SCANHEPS18

• Insufficient data - but main suppliers, similar products • Sensitivity around price • Removal of Non disclosure agreements an opportunity not a threat.

Promoting engagement and co-operation between clinicians, procurement and industry #SCANHEPS18

• Opportunities for further dialogue:

• How suppliers can share their global perspective • Application of GIRFT across territories

Opportunities for wider application and cross border commercial collaboration #SCANHEPS18

Proposed next steps #SCANHEPS18

Short term • Transparency agreement & MOU • Data from other territories • Global SRM SWOT and action plan • Procurement guidance Medium • Exploration of GIRFT approach Long term • Identify opportunities for expansion into other areas Benefits Improved outcomes, efficiency, supplier relations and opportunities for innovation

#SCANHEPS18

Thank you for listening Brian.a.mangan@wwl.nhs.uk 07525 673007

Connect Care – Contracting Procurement & Supply Management

International Collaboration Among Global Orthopaedic Registries as a Strategic Opportunity to Drive Value for Populations Leveraging Real World Evidence of Outcomes and Value Thoughts From Alberta, Canada Jitendra Prasad (JP) Chief Program Officer, Contracting, Procurement & Supply Management Alberta Health Services 4 October 2018

Alberta Health Services

AHS Foundational Strategies

105

10 Years Later…

Hips & Knees Landscape in Alberta

Number of Bi-Lateral Hip Replacements Number of Bi-Lateral Knee Replacements April 2013 - March 2018 April 2013 - March 2018 6K 5K 4,777

4,969

5,117

5,478

5,667

7K 6K5,842

5,980

6,247

6,252

6,065

398

440

487

5K

4K

4K 3K 3K 2K

2K

1K 466 K

447

428 Primary Hip

526

Hip Revision

524

1K 382 K

397 Primary Knee

Knee Revision

107

Hip & Knee Revisions and Length-of-Stay 2015/16 Average Length-of-Stay

Percentage of Revisions 9.8% 10.0%

9.6% 9.2%

9.5% 9.0%

8.6%

8.7%

Primary Knee Replacement:

8.5%

3.6 Days (Range 3.1 – 4.0 Days)

8.0% 8.0%

7.5% 7.0% 6.5% 6.5% 6.0%

Primary Hip Replacement: 3.7 Days (Range 2.9 – 4.0 Days)

7.0% 6.6%

%'age Hip Revisions

6.4% %'age Knee Revisions

Hip Revision: 14.0 Days (Range 6.9 – 15.8 Days) Knee Revision: 7.8 Days (Range 4.6– 12.0 Days)

108

Hips & Knees Landscape in Alberta

80% 60%

4.6% 5,117 29.2%

4.0% 5,478 30.1%

5,667 4.9%

6,000

90%

27.5%

5,000

80%

4,000 29.5%

28.8%

28.9%

40% 20% 0%

3,000 2,000

36.7% 447

526 37.0%

38.7% 524

2015

2016

2017

Zimmer Johnson & Johnson Smith & Nephew Stryker Number of Primary Procedures Number of Revision Procedures

1,000 0

Number of Procedures

100%

100%

Knee Implant Percentage Spend by Vendor Number of Bi-Lateral Knee Replacements & Revisions 2015-2017 8.8% 6,247

8.3% 6,252

11.8%

13.5%

8.8% 6,065 11.6%

32.0%

26.4%

25.4%

70% 60%

7,000 6,000 5,000 4,000

50% 3,000

40% 30% 20% 10% 0%

47.5% 398 2015

54.2%

2,000

Zimmer 487 Stryker 440 Johnson 2016 & Johnson 2017 Smith & Nephew Number of Primary Procedures Number of Revision Procedures

1,000

51.8%

Number of Procedures

Hip Implant Percentage Spend by Vendor Number of Bi-Lateral Hip Replacements & Revisions 2015-2017

0

109

Hips & Knees Landscape in Alberta – Procedure Costs ($1 CAD = £0.60 or €0.68) $35K $30K

$4,435

$25K

$4,590

Cost

$20K $15K

$3,553

$3,333

$2,864

$2,853

$10K $5K

$27,407 $19,073

$11,935

$11,671

$11,196

$11,068

$K

Acute Cost

Supply Cost

110

Alberta Registry Scan • • • •

Registry use and reporting is not mandatory in Alberta Initiative underway to increase reporting Alberta uses OR TECH – current reporting rate at 50% + Alberta is on a journey to implement ConnectCare which includes the implementation of a Clinical Information System (EPIC) • This will include implementation of scanning of all implants directly into the CIS which would then allow for reporting to the Registry • What does Connect Care mean?

111

10/16/18

112

Opportunities for Procurement

• Vendors – Looking for market share and to introduce new products • Physicians – Looking for the best implants with quality outcomes and lower revision rates • Administration – Improved outcomes and lower costs • Opportunity for global collaboration – Transparency: market share, costs – Global registry collaboration e.g. resurfacing failure rates (Australian Registry resulting in change in practice) • Value Based Procurement – Outcome based cost payment – Revision rates

113

Just for thought….

• If there were a 50% reduction in revision rates in Alberta, the total cost reduction would be (based on 2015/16 information):

$$$$$ (or should that be £££££ or €€€€€?)

114

Thank You! Questions?

Digital (Supply Chain) Infrastructure to Support Global Registry Collaboration Randy V. Bradley, PhD, CPHIMS, FHIMSS The University of Tennessee rbradley@utk.edu @randyvbradley linkedin.com/in/randyvbradley +1-334-354-5966

PROVEN. RESULTS. FASTER.

#SCANHEPS18

Supply Chain Digitalization Digitalization of Healthcare

117

#SCANHEPS18

Transparency and Visibility: Means, Not Ends

TRANSPARENCY

INTEGRITY

TRACEABILITY

VISIBILITY

SUPPLY CHAIN SUSTAINABILITY

SUPPLY CHAIN RISK MANAGEMENT 118

#SCANHEPS18

Top 3 Information Management Challenges Facing Organizations Different parts of our organization give different answers to the same customer

18%

There are different business processes completing the same activity across the organization

16%

A significant part of people’s jobs is to take data from one set of systems, manipulate it, and enter it into other systems

17% 119

#SCANHEPS18

When Retail Giants Like Apple, Walmart, and Amazon Invade Healthcare

#SCANHEPS18

The Always-on Digital Supply Chain

#SCANHEPS18

Your (New) Digital Supply Chain

122

#SCANHEPS18

#SCANHEPS18

From Digitization to Digitalization PROCESS DIGITIZATION PROCESS DIGITALIZATION DIGITAL BUSINESS TRANSFORMATION Digitization

1 Conversion (Data)

Digitalization

Transformation

2

3 Adaptation (Process)

Creation (Business) 124

#SCANHEPS18

125

#SCANHEPS18

Exposing The Product Journey Traceability with • Origin information along the supply chain is displayed to consumers, and enriched with pictures, videos • Visualization of the supply chain offers data analysis of origin information beyond the direct preliminary stages and customers • Provides static and dynamic data about the "conveyor belt" of the supply chain, such as certificates, seals of quality, lab results, allergens, etc.)

• In order to submit origin data to the fTRACE system, suppliers have to implement only one interface, resulting in transaction costs being reduced to a minimum.

126

#SCANHEPS18

#SCANHEPS18

Orthopedic Procedures • Door Opened: Every 1.5 min • Total case open door time: 10.75 minutes • Percentage of supply related openings: 30%

128

#SCANHEPS18

Orthopedic Procedures • 99.8% accurate usage and charge capture • Association of supplies and implants to specific patients • Accurate case cost • Item expiration alert • Automated UDI documentation 129

#SCANHEPS18

E2E Integration, Transparency, and Coordination Control S Vertical information flows

Horizontal information flows along the process

• End-to-End information flows • Transparency on all process steps • Real-time to "true-time" decision-making • Value-added services: o Tracking & tracing o Patient-device matching o Provider practice vs. Patient preference

C

#SCANHEPS18

Attributes of NexGen Supply Chains 1 Digital 2 Connected 3 Collaborative 4 Always-on 5 Forward-looking analytics

6 7 8 9 10

Transparent Secure and trusted Agile, adaptive, responsive

Effective and efficient Safe and sustainable

Thank You! Randy V. Bradley, Ph.D., CPHIMS, FHIMSS

rbradley@utk.edu @randyvbradley linkedin.com/in/randyvbradley +1-865-974-1761 +1-334-354-5966

#SCANHEPS18

International Collaboration Among Global Orthopedic Registries as a Strategic Opportunity to Drive Value for Populations Leveraging Real World Evidence of Outcomes and Value

Panel Discussion and Q&A

Comfort Break 14:30 – 14:45

#SCANHEPS18

Value Based Procurement – An Alternative Approach to Total Cost Reduction, Improved Efficiency and Enhanced Patient Outcomes in the NHS #SCANHEPS18

Mr. Robert McGough Partner, Hill Dickinson LLP @<insert twitter>

Mr. Andrew Smallwood Head of Sourcing, NHS Wales Shared Services Partnership @<insert twitter>

Mr. Yves Verboven

Mr. Alan Wain

Director Access & Economic Policies, MedTech Europe @<insert twitter>

COO, Supply Chain Coordination Limited, Management Function of the NHS Supply Chain @<insert twitter>

Session 3 Moderated by: Brian Mangan Deputy Director, NHS NW Procurement Development @NHSNWPD

Journey to date..

Theory

Practice

#SCANHEPS18

“Value based procurement” Defined as a approach that delivers: • Tangible, measurable financial benefit to the health system over and above a reduction in purchase price • and/or a tangible and measureable, improved patient outcome; derived through the process of procurement (tendering, contracting and supplier relationship management).

#SCANHEPS18

VALUE BASED PROCUREMENT

A n dy S m a llw o o d B A ( H o n s) M C I P S Head of Sourcing, NHS Wales Shared Services Partnership

07771 795513 andrew.smallwood@wales.nhs.uk

“VALUE” DEFINITION RECAP Michael Porter’s definition for “value:” “The health outcomes achieved that matter to patients relative to the cost of achieving these outcomes.”

VALUE = OUTCOMES / COSTS

Prof Sir Muir Gray’s “transforming healthcare by delivering triple value”: PERSONALISED VALUE – base decisions on the best current evidence, careful assessment of an individual’s clinical condition and an individual’s value.

TECHNICAL VALUE – improve the quality and safety of healthcare to increase the value derived from resources allocated to particular services.

ALLOCATIVE VALUE – allocate resources to different groups equitably and in a way that maximises value for the whole population.

Personal

Technical Allocative

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, is healthcare that delivers the best possible outcomes to patients for the lowest possible cost.”

WE ALL KNOW WHY WE’RE DOING THIS, DON’T WE? …

Our Challenges: • Rising costs

• Ageing population

+

Our opportunity for alignment across Wales: Wales Strategic Healthcare Policies

• Variation in care

Parliamentary Review – “Quadruple Aim” Wellbeing of Future Generations Act – “A Healthier Wales”

• Increasing demand

Prudent Healthcare 4 key Principles:

whilst trying to • Improve quality of care for our population

1.

2.

3.

4.

Public and professionals are equal partners through co-production Care for those with the greatest need first Do only what is needed and do no harm Reduce inappropriate variation through evidence-based approaches

National Improvement Programme and Efficiency Framework

So! Extending Value beyond outcome and cost collection to triangulate with Procurement services to assess Value in the way we procure goods and services

WHAT IS VALUE BASED PROCUREMENT? Delivering Value for Wales placing outcomes at the heart of Procurement

Assessing the value and measuring what matters, using outcome divided by cost and placing clinical and patient reported outcomes at the heart of the procurement decision making process.

VBP IMPLEMENTATION FRAMEWORK

The value based procurement implementation framework:

Product: Quality driven standardisation Once for Wales, allowing best price above quality threshold.

Well proven and still appropriate.

Process: Total cost of care, greater transparency

and assessment of cost beyond product, a focus on leaner processes to avoid unnecessary cost and increase efficiency.

Patient: Putting the PATIENT at the centre (where

Change of culture and reward system

possible/appropriate), using available evidence to select products to drive improved efficacy.

Ongoing management using patient reported and clinical outcomes to ensure improved patient outcomes. Challenge suppliers to risk share in the patient outcome.

AS IS

To BE

WHAT WE’RE DOING

VALUE-BASED PROCUREMENT GROUP Value based projects / activity: • POCT Anti-Coagulation monitoring • Stoma • Sacral Nerve Stimulation • ERAS • Stroke management • Spinal needles • Cataracts • Heart Failure • Cystic Fibrosis • Wound Management • Diabetes • Orthopaedics

Working with: Partnerships with Industry: • MedTech Europe

• Welsh Government • National Value Based Care Lead • Local Health Boards & Trusts • All Procurement Teams • Clinical leads • ICHOM • SMTL • Health Technology Wales • Now specifically DOFs…

WORKING WITH DIRECTORS OF FINANCE & PROCUREMENT Opportunities value can bring to Wales: • Longer term savings across the NHS Wales by investing in prevention and patient outcomes

Challenges “Value” poses:

• Allocate budget where it is needed in the whole system

• Savings targets • Budget boundaries • Financial position • Risk sharing with industry

Moving to a Value Based System…

Efficiency Framework Efficiency, Healthcare Value & Improvement group

• Financially and economically prosperous • Reward sharing with Industry leaders that can make things happen for us in Wales

This will be a transition, a new way of thinking, we appreciate it will take an adjustment in order for value to make a difference, but procurement need finance support with this change

Value Based Procurement Yves Verboven, Director access & Economic Policies

Value to guide economic sound investment …

Negative spiral, pressure increases on health systems and industry - reactive

Healthcare Systems under pressure

‘Reactive response’ from systems

Continue short-term cost containment Option

Decision Medtech industry under pressure

Short-term cost containment

1

Loose / Loose

Option

2

Win / Win / Win Virtuous loop, resolving pressure on healthcare systems and industry – pro-active

New broad industry value propositions and partnerships

STARTING POINT â&#x20AC;&#x201C; VALUE and ECONOMICS Need Efficiency gains to addresses ageing related expenditure growth and sustainability, Avoid cost of care delivery, waste, low value care, avoid health care cost to start, invest in good health

An Annual saving of 0.5% of expenditure will do the job

Procurement organizations â&#x20AC;&#x153;From administrative cost cutting work to creating value and economic most advantageous tendering â&#x20AC;?

Value a guide for economic sound investments Outcomes that matter to patients and cost of care delivery (efficiency ) at the core But also Information need to be valued as a core of performance health systems But not limited to these dimension only as European health care system are often responsible/ dependent on HC worker/ HC actors and multiple institutions (Hospitals, community, â&#x20AC;Ś )

Outcomes

Other benefits Societal impacts Costs

incl. care delivery

Their perspective are considered in 2nd layers and fosters multidisciplinary team in decision making.

Further value propositions which are of societal relevance might be valued (green, ability to remain economic, social active, remain in good health (economic value) â&#x20AC;Ś And local policy focuses (e.g. SME-Innovation friendly â&#x20AC;Ś (3rd layer)

Other benefits healthcare actors and system, Broader impact on society & economy (policy layer)

149

To be successful further challenges need to be addressed

150

MEAT VALUE BASED PROCUREMENT

Outcomes Costs

HCP

Provider

Patient

incl. care delivery

Health system Socio-economic impact What Is Value in Health Care?

Michael E. Porter, Ph.D. New England Journal Medicine 363;26 nejm.org December 23, 2010 HTAi Policy Forum, International Journal of Technology Assessment in Health Care, 00:0 (2013), 1â&#x20AC;&#x201C;7 Source: BCG

Procurement, the unexpected driver of value based health care

Best in Class : first movers

MEAT Value-based procurement 3 key questions

Introduction to VBP1 framework 1

What are we going to buy?

2

What matters to us?

3

1. Value-Based Procurement Source: MedTech Europe, BCG

Criteria selection

How much are we willing to pay?

Value assignment

Most Economic Advantageous

Quality criteria to be measured in monetary terms, (willingness to pay) and deducted from total costs Layer Outcomes

Category Outcomes & evidence Outcomes focus Purchasing

Product Costs

Maintenance Disposal

Care delivery

Operating / healthcare delivery Secondary patient benefits

Other benefits for key stakeholders

HCP benefits Provider benefits

Criteria Evidence of relevant outcomes improvement Existence of high quality outcomes data Support in measuring and reporting on outcomes Willingness to offer outcomes-dep. risk-sharing Price of purchasing / renting product Compatibility: required upgrades to infrastructure Conversion: staff training for new product Spare parts Technical staff time Service contract

...

Cost

Total costs [€]

Disposal / decommissioning Cost of consumables Medical staff time using device Infrastructure usage

...

Patient and/or relative comfort and convenience Patient flexibility & mobility Impact on treatment adherence Secure usage for care providers Ease-of-use / handling &&functionality functionality Training and access to education Maintainability & technical service Support improving efficiency alongsupport patient

Quality

Willingness to pay [€]

Alignment and support with reimburse. pathw. structure Support on admin., storage and logistics

Strategic fit for provider and support of strategy

Health system benefits Innovation

Broader impact on society

Source: BCG

Sustainability Socio-economic impact

Criteria which could be included in supplier selection

Reduced long term costs of treatment Reduction of rehospitaliz. / number of treatments Development of new and improved technologies Contribution to development of health care Environmental impact Socially responsible product value chain Impact of people not in the workforce Burden carried by non professional carers Impact on competition in MedTech sector

Criteria Criteria to to be be selected selected // detailed detailed during during tender tender definition definition

-

Bid value [€]

Value Based Contractual agreements

Our journey started !

Progressive adoption to a new method

2022-2025 2019-2021 2017-2019 2016 2015

Develop solution

Build awareness Create "pull"

Pilot deployment Learning curve

Build Community of Practice

Business cases Early adaptation

Broad adoption EU-wide recognition

Join the Community of Practice â&#x20AC;&#x201C; A joint learning through Pilots

Yves Verboven Director Market Access & Economic Policies, MedTechEurope Mail to: Y.Verboven@MedTechEurope.org Phone: +32 (479) 07 94 14

Value to guide Economic sound investment Healthcare Systems under pressure

Continued ‘reactive response’

Negative spiral

-

-

Increasing demand Post 2008 HC budget outpaced economic growth Ageing population Demographic change Multi-morbidity driven by socio-economic status Shortage of HC workers Quality gaps in care delivery Outcomes variation Major inefficiencies and waste Silo budgeting Model focused on acute not chronic disease High rate of complications, HAIs and AMR risk Expenditure focus Political focus on cost containment

Medtech industry under pressure

‘Reactive response’ from systems

• • • • •

-

Lower prices Increase barriers for reimbursement Cap budgets Cut budgets Claw-back costs Price / volume agreements Volume purchases Price regulation More costly regulatory requirements

Partnerships to address health system pressure (from supply to demand, ensuring populations are in good health and economically active) Broad Value Propositions by industry Health systems use Value to guide investments Medtech industry committed to being rewarded for value creation / enabling the good health Medtech industry committed to having investments made by systems in the most advantageous ways, ensuring the sustainability of health systems

Virtuous loop -

Price Pressures No premium for innovation Limited opportunity for business growth Europe less attractive market

Focus on supply No longer best value for money offered Most economic advantageous offers not provided Price control through competitive market dynamic lost Continuous innovation no longer offered No ability to sustain SMEs Lower tier products offered Quality not awarded

= Negative spiral / pressure points not resolved

Decision point

Option

1

Loose / Loose

2 Win / Win / Win Option

New broad industry value propositions and partnership -

Focus on demand Personalized care Informed decision making management Reduced cost of care delivery Benefits to HC workers Avoid areas of disease progression New business models / financing models Comparative evidence to support system transformation Complication minimization Intervention at right time Management of episode of care Management of care pathways

= Virtuous loop / pressure points alleviated

#SCANHEPS18

Alan Wain, Chief Operating Officer, Supply Chain Coordination Limited, Management Function of the NHS Supply Chain (UK)

#SCANHEPS18

What is value?

Establishment of a common definition for value will form a sound foundation for contracting

Quality

When we are seeking to establish value, should the perceived quality of the product be embedded into evaluation criteria?

How do brands distort our perception of value?

What about patient experience?

Should the required quality of the product be a given in the specification to eliminate this as a variable in the procurement

Value Drivers Better clinical outcomes and reduced risks should be regarded as value drivers, but how do we measure them?

Total cost of ownership is a value driver but when do we pay for the resultant lower cost?

When there is a one-to-one relationship between usage and outcome, the value delivery is easy to see but what of many-to-one usage to outcome statistical relationships?

Measurement What evidence of value creation can we rely upon?

How would we set ourselves up to measure clinical outcomes â&#x20AC;&#x201C; registries?

What administrative burden does that place on the system?

#SCANHEPS18

Procuring value?

Having identified the value, we need to have a way to contract for it

Contracting for value Indemnity models – supplier pays a rebate if outcome is not delivered Payment by results – customer only pays if the outcome is delivered Driver is included in the specification and, therefore, the cost – customer specifies that the value adding component is within the product package Outsource it – customer contracts the whole pathway and outcome to a service provider

Challenges Whose opinion counts? – the FD’s ‘acid test’, the clinician’s ‘feel test’, the patient’s preferences Value delivery down the pathway of multiple budget holders – who get’s the benefit vs who pays for it Total cost of ownership and reduced risk can span many years but targets are set annually – strategic vs tactical decisions The contracting models don’t work well for a many-to-one statistical relationships

Aligning incentives in the new operating model for NHS Supply Chain

Open book costing methods to pay service provider costs Profit line linked to delivery of value (savings) through gain share mechanism Total cost of ownership counts as savings, but apply the FD’s ‘acid test’ Where savings are not directly attributable to the product or statistical relationship (intangible), there is a KPI adjustment to profit line

#SCANHEPS18

Robert McGough, Partner, Hill Dickinson LLP (UK)

#SCANHEPS18

1.

Contracting for Value: legal perspective Clarity on scope of the pathway/equipment to be included

Has the Payer determined what contracts are impacted and a transition plan to move to a value based model How much of the contract value is tied to the required outcomes and how the rest is reimbursed Is there a draft Value Based Contract for early review in the procurement process

#SCANHEPS18

2.

Value Based Procurement can be applied in practice through a structured approach Determine your outcomes

Market Engagement

OUT COM Design/determine procurement process/award criteria

Incorporate: • Site visits

ES

Advertise

• Product testing • Existing data • Define price/quality ratio

Engage and evaluate

• Assign values to your outcomes • Total cost of delivery of care

Award

#SCANHEPS18

3.

Challenges in moving to Value Move away from inputs/cost basis â&#x20AC;&#x201C; importance of data / benchmarking

Initial costs to set up the new way of working â&#x20AC;&#x201C; changes in the finance/payment mechanisms New models of collaboration

Managing a new risk profile

#SCANHEPS18

“Value Based Procurement” An Alternative Approach to Total Cost Reduction, Improved Efficiency and Enhanced Patient Outcomes in the NHS

Panel Discussion and Q&A

#SCANHEPS18

Keynote Session 15:45 â&#x20AC;&#x201C; 16:15

Dr. Ben Bridgewater Chief Executive Officer Health Innovation Manchester @BridgewaterBen, @healthinnovmcr

Click to edit Master title

Health Innovation Manchester Creating the innovation environment

Ben Bridgewater, CEO

A perspective through a 3 sided lens Click to edit Master title

Clinical leader

Global technology

Innovation network

As a clinical leader Click to edit Master title

Unacceptable variation in outcomes

Failures of governance

Erosion of public trust

Process for Quality Improvement and Quality Assurance in UK Cardiac Surgery Click to edit Master title

Collaborate Collect Collate Wrangle Analyse Disseminate Governance

50% reduction in risk adjusted UK mortality rates over 10 years

Where were the problems? Where are the problems still?

Click to edit Master title

Systems of Engagement

Systems of Record

INNOVATION

Systems of Insight

Strategy and KPIs

Outcomes People

Process

Infrastructure Tools & Tech

Culture

Safety Efficiency Outcomes Experience

The Hippocratic Oath – 275 AD Click to edit Master title

I swear by Apollo the Healer, by Asclepius, by Hygiena, by Pancea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

Lessons from digital transformation Click to edit Master title

Banking

Retail

• The customer is already digital and will define the next moves • Digital platforms disrupt existing value chains • Platform effects create winners and losers • Its not about technology, its about digital transformation

Transport

Manufacturing

Insurance

Process & operating model

Consumer experience Digital

£

Business model

Digital transformation/Digital Disruption Click to edit Master title

Taxis, ride sharing Retail Travel Cloud computing Banking Insurance Defence Energy/utilities Aerospace Automobiles

Ref: LEF: Disruption the professions

Healthcare

Degree of regulation

Degree of digitisation

Music, books, TV Newspapers, magazines Advertising marketing Packaged software

Degree of regulation/liability/security concerns

Degree of disruption

Wellness care

Degree of digitisation Organisational models, Professional culture Challenges re Digital Trust

Perpetuate the status quo

Patient outcomes across Greater Manchester are currently below national averages against a range of disease and and the city faces significant public health challenges Click to edit Master title

Greater Manchester devolution is a catalyst for change Click to edit Master title

Why

What

Significant variation in population health outcomes, from national standards and across localities.

Delegated financial control of ÂŁ6bn health and social care budget.

Economic productivity inhibited by poor health of population.

Established governance structures and integrated commissioning at city-region and locality level.

Strong delivery track record of collaboration and delivery across the city region.

Integrated academic health science and innovation system, Health Innovation Manchester.

Our aim is to promote equality and equity across Greater Manchester health and care, drive inclusive growth and ensure that no community or group is left behind Click to edit Master title

• Transform the health and social care system to help more people stay well and take better care of those who are ill.

• Align our health and social care system to wider public services such as education, skills, work and housing.

• Create a financially balanced and sustainable system.

• Make sure our services are clinically safe throughout.

Determinants of outcomes Your genes

Your healthcare

10

10

Your environment and behaviors 80

GMâ&#x20AC;&#x2122;s academic health science innovation system Health innovation Manchester: an organisation, a system and a new way of working Click to edit Master title

Industry partnerships

Academia and research

Commissioners and providers

National agencies and government

GM assets for digital transformation Click to edit Master title

Genomics and other biomarkers Scientific and clinical research excellence

Civic leadership and strategy

Collaboration and partnership

Effective commissioners and providers

Citizen engagement and trust

ÂŁ

ÂŁ

Digital transformation

Novel business models Industry partnerships

Digital transformation in healthcare Click to edit Master title

The process by which technology is changing the way in which products and services are provided to citizens for the maintenance of wellness and the detection and treatment of disease To solve existing problems

Aging populations

Unnaceptable variation

Empowered consumers

Escalating costs

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Digital maturity model; Where are we aiming to go across GM Click to edit Master title

Level 4

Ongoing digital transformation in all aspects of business. Active horizon scanning, prioritization and utilization of emerging technology. Pivot of service provision and business models for digital age

Level 3

Digital mindset of leadership and emerging digital OD strategy. Active digital talent management. Digital transformation of key business processes.

Level 2

Digital systems of record and engagement in place. Developing insight generation.

Level 1

Some key systems digitised. Organisational digital intent and defined digital strategy

Level 0

Key systems mainly analogue. No clear digital intent or strategy

Digital transformation a persona based perspective Click to edit Master title

Clinicians

Insights and engagement to improve care

Managers

Insights for improvement and regulatory assurance

Planners

Insights for pathway and service redesign

Commissioners

Pivot towards value based care

Regulators

Insights to drive intelligent regulation

Patients

Reassurance, choice and novel systems of engagement

Academics

Substrate for research

LS/Biotech/technology

Trials, algorithms, pathway design, novel tools and business models

184

Digital transformation, driven by Industry partnership In flight Click to edit Master title

Implementati on of new GM COPD guidelines

Stroke pathway redesign

Hepatitis C Elimination Programme

Support from GSK/Pfizer:

Support from AbbVie/MSD/Gilead:

CHC driven programme

•

Secondment of from industry

•

Support for Hep C pathway mapping

•

•

Implement findings from SLS

•

Case finding solutions

Analytics and pathway redesign through ODN

•

Cohort definition and finding

•

Provision of point of care testing devices

•

•

Provision of pharmacy run and virtual MDT clinics

•

Pharmacy and prison led delivery

SME Engagement and App development & delivery

U n d e rsta n d our p o p u la tio n

D e f in e th e needs of our p o p u la tio n

£ U n d e rsta n d our p o p u la tio n

D e f in e th e needs of our p o p u la tio n

U n d e rsta n d our p o p u la tio n

D e fin e th e needs of our p o p u la tio n

Mental Health pricing Support from Janssen: •

Implementation of outcomes based pricing for schizophrenia

•

Refunds on drug costs informed

by RWE of efficacy

185

185 U n d e rsta n d our p o p u la tio n

D e f in e th e needs of our p o p u la tio n

£

Digital transformation, driven by Industry partnership In preparation Click to edit Master title

Adding value to NICE NICE Analyses of real world data to add value to NICE and their KPIs a) statin adherence b) antibiotic resistance modeling

U n d e rs t a n d our p o p u la t io n

D e f in e th e needs of our p o p u la tio n

Improving outcomes in severe asthma

Transformin g heart failure care

PPIE after heart attack

MedTech

Pharma

Pharma

Increased understanding of heart failure population with implementation of new operating model for community HF care

Analysis of severe asthma population in Greater Manchester to inform operating model and business model transformation

Implementation of digital AMI APP with use of RWE to measure efficacy

£ U n d e rs t a n d our p o p u la t io n

D e f in e th e needs of our p o p u la tio n

£ U n d e rs ta n d our p o p u la t io n

D e f in e t h e needs of our p o p u la tio n

£ 186

186 U n d e rs t a n d our p o p u la t io n

D e f in e th e needs of our p o p u la tio n

£

Digital infrastructure to support innovation Click to edit Master title

Regional and national interoperability

Pharma

Technology

Digital transformation

Interoperability Hub (Local Health Care Record Exemplar)

Single instance of Interoperable Health and social care record for 2.8 M citizens

Digital Innovation Hub infrastructure for RWE trials, data science digital transformation

Med Tech Technology Academia

Embedded governance at city region level

Direct care

Performance management and payment reform

Service planning and reform

Population health/wellness 187

Digital Innovation: a phased approach Click to edit Master title

3 years

1 year HDRUK designated status

LS trials -partial coverage Trusted research environment

GM wide technology engagement strategy

Technology engagement strategy organisational Clinically led analytics and pathway redesign

Emerging citizen conversation

Next generation citizen-led consent

LS trials full GM coverage and national connectivitiy

Effective Dev-ops transformation pipeline into H&SC delivery

GM wide H&SC computer science strategy

GM HC&LS digital transformation centre

Comprehensive biopsycho-social system of record

Embedded digital PPIE strategy

Enhanced SoR for key cohorts Single instance H&SCR record

5 yrs +

Pivot towards public health

Routine evaluation of RWE for QI/QA

GM gives a unique digital transformation opportunity Click to edit Master title

LHCRE

+ GM health and social care devolution

= Partnership

Transformation

Click to edit Master title

https://www.healthinnovationmanchester.com/

#SCANHEPS18

Closing Remarks 16:15 – 16:30

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Dr. Anne Snowdon

Dr. Allan Conway

Scientific Director & CEO, SCAN Health Academic Chair, World Health Innovation Network

President of Board of Directors, SCAN Health @ SCAN_Health

Launches October 18, 2018

SCAN Health Knowledge Mobilization Platform

GOAL: @SCAN_Health

Enabling partners to come together on key priorities and learning opportunities to profile best practice achievements in healthcare supply chain.

#SCANHEPS18

Thank you for attending SCAN Health European Procurement Summit 2018!

SCAN Health gratefully acknowledges the generous support of our sponsors and partners.

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