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Presentation unovate 19 10-11-dia

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Presentation unovate 19 10-11-dia

  1. 1. Driver of healthcare sustainability: system vs. process innovation? Jan Vos van Marken Director UNOVATE a holding company of UNOVATE, Hospital Management conference, 19/10/2011 1
  2. 2. Concentration and decentralization: the ‘unravelling’ of (dutch) healthcare UNOVATE, Hospital Management conference, 19/10/2011 2
  3. 3. /wEPDwU A combination of the international collective thinking of… UNOVATE, Hospital Management conference, 19/10/2011 3
  4. 4. … and the local collective thinking of… BCG, may 2010 ‘chosing for quality’ KPMG Advisory, Sept. 2011 ‘Health Country’Boer & Croon, August 2010:‘From institutes to networks’ UNOVATE, Hospital Management conference, 19/10/2011 4
  5. 5. Overview:1. Introducing Dutch healthcare2. Exploding cost of healthcare3. Sustainability of healthcare: do we ask the right question?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’ (healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 5
  6. 6. Situation per region very different … UNOVATE, Hospital Management conference, 19/10/2011 6
  7. 7. … and demographics rapidly changing… UNOVATE, Hospital Management conference, 19/10/2011 7
  8. 8. … and demographics rapidly change (2) UNOVATE, Hospital Management conference, 19/10/2011 8
  9. 9. … but can healthcare keep pace? UNOVATE, Hospital Management conference, 19/10/2011 9
  10. 10. Structure of dutch healthcare Primary General Top Clinical care hospitals Hospitals Duration of diagnosis/treatment Patient 1 2 3 UNOVATE, Hospital Management conference, 19/10/2011 10
  11. 11. Design of the Dutch cure sector Insurance companies Government al) Level playing field: Co ion • base insurance ntr dit • Pricing structure ac /ad € € • Quality institute t se (qu • Competition law (b a an tity cy oli /qu .P ali Ins ty) Patients Providers Services UNOVATE, Hospital Management conference, 19/10/2011 11
  12. 12. Overview:1. Introducing Dutch healthcare2. Exploding cost of healthcare3. Sustainability of healthcare: do we ask the right question’?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’(healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 12
  13. 13. Dutch healtcare system best in class…. UNOVATE, Hospital Management conference, 19/10/2011 13
  14. 14. … but increasing costs are not sustainable UNOVATE, Hospital Management conference, 19/10/2011 14
  15. 15. …because expenditure is exploding(KPMG Plexus) UNOVATE, Hospital Management conference, 19/10/2011 15
  16. 16. Overview:1. Introducing Dutch healthcare2. Exploding cost of healthcare3. Sustainability of healthcare: do we ask the right question’?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’(healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 16
  17. 17. Sinek’s golden circle….. Why How What UNOVATE, Hospital Management conference, 19/10/2011 17
  18. 18. What is the ultimate sustainability question?• Can we keep healthcare affordable and conveniently accesible to everyone?• Is that really your ‘why question’?• Do you work in healthcare to help solve that question?• Is that about efficiency or effectiveness?• Or both? UNOVATE, Hospital Management conference, 19/10/2011 18
  19. 19. Meeting my daily challenges…• How can we optimize OR occupation?• How do we increase outpatient efficiency?• How do I reduce length of stay in my wards?• How do I reduce complications?• How do I increase planning stability?• How do I negotiate a higher price for the ever higher cost per procedure?• How do I prevent unnecessary/costly diagnostics? UNOVATE, Hospital Management conference, 19/10/2011 19
  20. 20. Overview:1. Exploding cost of healthcare2. The Dutch situation: short overview3. Sustainability of healthcare: do we ask the right question’?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’(healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 20
  21. 21. Lessons from Clayton ChristensenDisruptive Innovation is the only solution to sustainable healthcare:1. Business model innovation2. Unraveling of healthcare (pathways) UNOVATE, Hospital Management conference, 19/10/2011 21
  22. 22. Do not mingle different business models…• Solution Shops Fee for service model. ‘Intuitive medicine’: All diagnostics: we search until we find. Some treatments: we try until something works.• Value Adding Process Fee for outcome. Once treatment is clear a standardized way leads to best results: focus clinics.• Facilitated Networks Annual fee. Size and composition of the customer base creates value. Chronic diseases that need behavioural changes need a ‘patient like me’ approach. UNOVATE, Hospital Management conference, 19/10/2011 22
  23. 23. … but we (are forced to) do so all the time…• Diagnostics (CT, MRI, PET, Genetics) are intuitive medicine and therefor Solution Shops with fee for service business model.• Once the diagnose is conclusive, a ‘value adding process’ business model is optimal and a fee for outcome model is used.• In the Netherlands a model based on fee for outcome (DRG like system) also includes the diagnostics. This does not work for top clinical hospitals that operate in the ‘intuitive area’.• Concentration of treatment and concentration of diagnostics should in this theory happen in different organizations because their business models differ. UNOVATE, Hospital Management conference, 19/10/2011 23
  24. 24. Reducing complexity and increasing volume UNOVATE, Hospital Management conference, 19/10/2011 24
  25. 25. TU Delft just found productivity surge: 2003 – 2009 • productivity per fte has improved (34,9% nursing!!!) • +1% revenues: + 1,23% cost • Concentration ‘might be’ solution. UNOVATE, Hospital Management conference, 19/10/2011 25
  26. 26. Reducing complexity and increasing volume UNOVATE, Hospital Management conference, 19/10/2011 26
  27. 27. Overview:1. Exploding cost of healthcare2. The Dutch situation: short overview3. Sustainability of healthcare: do we ask the right question’?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’(healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 27
  28. 28. Concentration leads to higher quality ANDlower cost… Lower cost through higher quality Better Higher quality volumeLower cost throughhigher volume UNOVATE, Hospital Management conference, 19/10/2011 28
  29. 29. …all studies prove thisStudies (green) that prove positive correlationbetween quality naar[aantal positief aantal geen verband] Studies andrelatie volume en kwaliteit per (orange) volume or no relation orgaan/ziekte 8 9 23 7 7 4 6 2 4 21 20 2 6 18 15 15 4 3 7 12 12 11 0 2 0 9 9 7 1 1 3 3 6 5 5 5 5 4 4 4 0 0 4 3 3 3 3 0 1 0 1 1 1 0 0 0 UNOVATE, Hospital Management conference, 19/10/2011 29
  30. 30. For example Breast Cancer (BCG study)% patients with tumor tissue left behind % Spread in outcomes also highly correlatedNumber of breast cancer patients per hospital Number of breast cancer patients per hospital UNOVATE, Hospital Management conference, 19/10/2011 30
  31. 31. …but concentration means decentralization Mono disciplinary care • Primary Care • “Low-tech infrastructure” • Care close to the patient • Cheaper and small scale • Together with GP’s • Independent locations and scattered • Functions • Focus on process optimization • Diagnostics • Prevention & information • Chronic Care • Follow-up and light rehabilitation Current Cure Sector that does Concentrated Care everything Close Care everywhere • Thematic (multidisciplinairy) Care • Acute Care • Heavily focussed in a small number of • Diminished to smaller number locations per theme • Ten Trauma + 30 acute care centers • Complex and/or multidisciplinary • Availability function interventions; High-tech infrastructure • Seperately financed • Research & Education • Disconnected from other themes • Seperately financed UNOVATE, Hospital Management conference, 19/10/2011 31
  32. 32. Current hospitals do everything for everyone…. Distribution of care in different hospital (in euro’s) UNOVATE, Hospital Management conference, 19/10/2011 32
  33. 33. … thematic focussing lowers burden rate Top clinical / thematic Care in Euro’s UNOVATE, Hospital Management conference, 19/10/2011 33
  34. 34. ‘Next generation’ dutch healthcare Duration of diagnosis/treatment Primary/ Mono disciplinairy Diagnostic/ care Chronic Solution Shop: Care Fee for outcome Patient Accessibility Facilitated network/24-7: Annual fee / Lump sum Value Added Process: Fee for service / Lump sum Simple Acute Thematic care Multidisciplinaire complex/acute care UNOVATE, Hospital Management conference, 19/10/2011 34
  35. 35. Overview:1. Exploding cost of healthcare2. The dutch situation: short overview3. Sustainability of healthcare: the same and right question?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralisation (BCG/B&C)6. ‘Betterland’(healthy country): quant. approach (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 35
  36. 36. Concentration and decentralisation (cure) KPMG Advisory developed a hypothetical ‘healthy country’: ‘Betterland’The outcome is just a possible scenario, notnecessarily what should happen. UNOVATE, Hospital Management conference, 19/10/2011 36
  37. 37. ‘Betterland’ in revenues per region UNOVATE, Hospital Management conference, 19/10/2011 37
  38. 38. Concentration vs decentralization (acute) Number of locations acute diagnoses UNOVATE, Hospital Management conference, 19/10/2011 38
  39. 39. Concentration vs. Decentralization (elective) Number of locations elective diagnoses UNOVATE, Hospital Management conference, 19/10/2011 39
  40. 40. Travel time emergency, acute, elective, chronic Traveltime patients per category Percentage of patients Traveltime in minutes UNOVATE, Hospital Management conference, 19/10/2011 40
  41. 41. Concentration vs decentralization (hart faillure) r s pe s nt ie nt at ie t p pa 0 00 1 10 .0 n 42) 4 o ut n 00) ut cati 2.8 o o o Ab cati – 21Ab r lo – 1 lo 40 pe 045 (5 (1 UNOVATE, Hospital Management conference, 19/10/2011 41
  42. 42. Concentration study results for Breast Cancer(BCG) Number of locations from 97 to 23 within 30 min. drive = 150 pat. = 400 pat. = 1350 pat. UNOVATE, Hospital Management conference, 19/10/2011 42
  43. 43. KPMG: revenues vs # Diagnose groups UNOVATE, Hospital Management conference, 19/10/2011 43
  44. 44. Overview:1. Exploding cost of healthcare2. The Dutch situation: short overview3. Sustainability of healthcare: do we ask the right question’?4. Lessons from Clayton Christensen’s Innovators Prescription5. Concentration and decentralization (BCG/B&C)6. ‘Betterland’(healthy country): interesting model (KPMG Advisory)7. UNOVATE: position, role and examples. UNOVATE, Hospital Management conference, 19/10/2011 44
  45. 45. UNOVATE is a 100% holding company of the UMC Utrechtfocussed on service innovation (non-IP) UMC Utrecht 100% 100% UMC Utrecht UNOVATE Holding B.V. ≤ 100% < 100% Alant Comp Comp JCR Vrouw A Z BV Utrecht Product innovation service innovation (IP- driven) (non-IP) UNOVATE, Hospital Management conference, 19/10/2011 45
  46. 46. Reducing complexity and increasing volume UNOVATE, Hospital Management conference, 19/10/2011 46
  47. 47. Most projects combine burden rate and scaleeffects UNOVATE Projects 1 Surgical (H)ear Clinic 2 Outpatient Eye Clinic 3 Clinical genetics lab 4 PCR Service lab for GP lab 5 Limb reconstruction center 6 Shared Production Pharmacy UNOVATE, Hospital Management conference, 19/10/2011 47
  48. 48. My mission: unravelling healthcare! Yours? UNOVATE, Hospital Management conference, 19/10/2011 48

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