0
Value Based Health Care
Quality care pays out
How does benchmarking create more value in healthcare?
Outcome
Costs
Value =
Michael Porter PhD, Professor, Harvard Busine...
About the costs
Porter et al (2013): Calculate the full patient cycle costs
Measure activities per patient
Measure resourc...
Status of costing in Ireland
Costing requires local hospital knowledge, feedback and actions
National costing project impo...
Cost benchmarking possibilities
Purchase prices
European market for high costs elements, devices.
Are prices too high?
Res...
Outcome
Costs
Value =
Now about the outcome
The outcome
Indicators set per disease/treatment in collaboration with doctors, for example:
Complications (Intensive Care...
About DICA/DSCA
DSCA means Dutch Surgical Colorectal Audit. The DSCA records the results of cancer surgeries.
This gives t...
Benchmark - quality
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
100 150 200 250 300 350 400 450 500 550 600
Percentagepaënte...
Making choices
Jointly with you we create high value healthcare for Europe
Outcome
Costs
Value =
Value chart, colorectal surgery
Less complications (case mix corrected)
Lowercosts/case
86
113
187
178
132
164
141
78
177
...
Focus: making choices
Lesscosts/casethanpeers
Less complications than peers
Observed/expected outcome compared to costs
Or...
Results DICA 2010-2012
2010
2011
2012
-23%
2010
2011
2012
-18%
Mortality Complications
2010 2011 2012
Patients 2553 2555 2...
How to make it happen?
Hospital
Patient and
activity data
Costing data
Hospital
Patient and
activity data
Costing data
Hospital
Patient and
activ...
Easy to understand and easy to utilise reporting
The Dutch perspective
Experiences in the Netherlands
UHI introduced 1998
MFTP introduced 2007-2012
Freedom of choice in insurer, hospital
Safety...
Outside – in observations
MFTP/UHI is the way to go
In Ireland, administrative data is widely available, however data is n...
Summary
Summary
Value = Outcome / Costs (Porter)
Benchmarking is an essential driving force
Benchmarking on efficiency requires co...
Sweelincklaan 1 Baggot Street Upper 9-11
3712 JA Bilthoven Dublin 4
The Netherlands Ireland
+31 30 233 3872 +353 1 662 828...
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Steven Lugard, CEO, Performation

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Value Based Healthcare

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  • Value based healthcare – PorterCombinatie van kosten en kwaliteitinformatie is eerste stap2012: Proof of Concept2013: Promotie Johannes GovaertSwitch naar presentatie/agendaJohannes gaat de eerste resultaten van het onderzoek toelichtenHubert Prins (Jeroen Bosch ziekenhuis ) over het sturen met behulp van deze cijfers
  • Gecompliceerd beloop:Overlijden tijdens opname of <30dagenHer-operatie of re-interventie tijdens opname of < 30dagenComplicatie met opnameduur >14 dagen
  • Transcript of "Steven Lugard, CEO, Performation"

    1. 1. Value Based Health Care
    2. 2. Quality care pays out
    3. 3. How does benchmarking create more value in healthcare? Outcome Costs Value = Michael Porter PhD, Professor, Harvard Business School, “What is Value in Health Care“ New England Journal of Medicine, December 23, 2010 “The Strategy that will fix healthcare”, September 2013
    4. 4. About the costs Porter et al (2013): Calculate the full patient cycle costs Measure activities per patient Measure resources per activity Requires a well defined uniform costing methodology
    5. 5. Status of costing in Ireland Costing requires local hospital knowledge, feedback and actions National costing project important Access to data needs to be improved Galway/WNWHG first public group to deploy costing properly, with departments’ input Bon Secours System first private group to deploy costing on a group-wide basis
    6. 6. Cost benchmarking possibilities Purchase prices European market for high costs elements, devices. Are prices too high? Resource utilisation We all have doctors, nurses, administrative staff. How much should they produce? Activities per patient Same patient diagnoses How many activities are expected? (LOS, theatre, laboratories) Treatment mix Treatment possibilities are global. Which options do we choose? (PCI, CABG)
    7. 7. Outcome Costs Value = Now about the outcome
    8. 8. The outcome Indicators set per disease/treatment in collaboration with doctors, for example: Complications (Intensive Care/infections/re-operations) Mortality Volume New indicator sets define quality of life Hospital mortality is getting very low High differences in functional results For example after prostate surgery Indicators supported by professionals
    9. 9. About DICA/DSCA DSCA means Dutch Surgical Colorectal Audit. The DSCA records the results of cancer surgeries. This gives the professional insight into the quality of their own care and that of colleagues. This so-called benchmark information can demonstrably improve their work. The DSCA was created by: The Dutch Society of Surgical Oncology, the Dutch Society for Gastrointestinal Surgery and the Dutch Colorectal Cancer Group. DSCA is part of the Dutch Institute for Clinical Auditing (DICA). Performation and DICA team up in measuring value of healthcare A PhD study is focusing on relation of costs and clinical quality
    10. 10. Benchmark - quality 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 100 150 200 250 300 350 400 450 500 550 600 Percentagepaëntenmetgecompliceerdbeloop 95% BI Gemiddelde Ongecorrigeerd Gecorrigeerd 95% BI Funnel plot complicated clinical pathway vs. volume (2010-2012)
    11. 11. Making choices Jointly with you we create high value healthcare for Europe Outcome Costs Value =
    12. 12. Value chart, colorectal surgery Less complications (case mix corrected) Lowercosts/case 86 113 187 178 132 164 141 78 177 96 51 75 74 92 85 82 112 81 153 61 € 6.000 € 8.000 € 10.000 € 12.000 € 14.000 € 16.000 € 18.000 0 0,5 1 1,5 2 2,5 Volume of interventions : <85 per year : 85-140 per year : >140 per year € 18,000 € 16,000 € 14,000 € 12,000 € 10,000 € 8,000 € 6,000 20% 30% 40% 50%10%0% This team saves 7 complications/year and saves € 3,300 per patient = € 270k/year (compared to average hospital)
    13. 13. Focus: making choices Lesscosts/casethanpeers Less complications than peers Observed/expected outcome compared to costs Orthopaedics HeartOncology Obstetrics FOCUS Good & efficient STOP Expensive and sub-standard IMPROVE Cheap & sub-standard ‘LEAN’ Expensive but good
    14. 14. Results DICA 2010-2012 2010 2011 2012 -23% 2010 2011 2012 -18% Mortality Complications 2010 2011 2012 Patients 2553 2555 2939 Died 102 95 91 Mortality 4,0% 3,7% 3,1% 2010 2011 2012 Patients 2553 2555 2939 X-Patients 625 563 593 X-Rate 24,5% 22,0% 20,2% 2010 2011 2012 -10% 2010 2011 2012 Patients 2553 2555 2939 Costs/case € 11.487 € 10.647 € 10.368 Costs € 0 € 2.000 € 4.000 € 6.000 € 8.000 € 10.000 € 12.000 Kosten Hoofdopname + Q1 MEASURE FEEDBACK COMPARE IMPROVE
    15. 15. How to make it happen?
    16. 16. Hospital Patient and activity data Costing data Hospital Patient and activity data Costing data Hospital Patient and activity data Costing data The key: reliable data Patient and activity data (Hipe/PAS) Costing data Central ‘cloud’ data warehouse Benchmark database Reporting…. > 200 hospitals in NL/UK/IE Clinical data
    17. 17. Easy to understand and easy to utilise reporting
    18. 18. The Dutch perspective
    19. 19. Experiences in the Netherlands UHI introduced 1998 MFTP introduced 2007-2012 Freedom of choice in insurer, hospital Safety nets along the route Hospitals were already foundation trusts Autonomous seeking for best information systems Management information has improved dramatically Waiting lists have reduced, quality has improved Acute hospital costs are now going down Efficiency Quality Better purchasing
    20. 20. Outside – in observations MFTP/UHI is the way to go In Ireland, administrative data is widely available, however data is not structured Most key players are still in the dark on essential information! Major backlog on ICT investments (expenditures are only 0.3%!) Need for wall-to-wall HIS Need for Business Intelligence, DWH, dashboards High investment per hospital, or innovative, cloud solutions…. Cultural / regulations aspect make it very hard to innovate at local level Hospital managers need to empowered to take a risk Clinical data needs to be collected, monitored and actioned  DICA? Connect the doctors stronger to the hospitals
    21. 21. Summary
    22. 22. Summary Value = Outcome / Costs (Porter) Benchmarking is an essential driving force Benchmarking on efficiency requires costing models Benchmarking on outcome requires clinician involvement Value charts allow strategic choices With benchmarking, value increases WNWHG and Bon Secours System are frontrunners in financial transparency Data is a challenge in Ireland Cloud Data Warehouse is a viable route, comparing UK/NL/IE
    23. 23. Sweelincklaan 1 Baggot Street Upper 9-11 3712 JA Bilthoven Dublin 4 The Netherlands Ireland +31 30 233 3872 +353 1 662 8280 www.performation.com Steven.Lugard@performation.com
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