Integration and-patient-power
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While most healthcare leaders believe existing models are sustainable, they expect major changes to systems in the next 5 years. There is a disconnect between perceived need for change at the organizational versus system level. Leaders see integration as critical to improved sustainability but efforts focus more on transactional than transformative changes. Many believe care is structured for organizations, not patients, and patients are not actively engaged in their care despite evidence that engaged patients have better outcomes at lower costs.
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Integration and-patient-power
- 1. Integration and patient power Dr Mark Britnell Chairman and Partner KPMG’s Global Health Practice @markbritnell
- 2. 1© 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved. Member of the World Economic Forum Global Agenda Council 60 countries, 170+ occasions.
- 3. 2© 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved. 65 senior healthcare leaders from 30 countries Vektis Mr. Herman Bennema General Director Discovery Health Dr Jonny Broomberg CEO All-Party Parliamentary Group on Global Health Lord Nigel Crisp Co-Chair Fundaçâo Antonio Prudente Mr. Irlau Machado Filho CEO Monitor Dr David Behan CEO Hospital Sirio Libanes Dr. Paulo Chapchap Strategy Director Médica Sur Mr. Antonio Crosswell CEO Institute Gustave Roussy Mr. Charles Guepratte Deputy CEO Institute for Healthcare Improvement (IHI) Ms. Maureen Bisognano President and CEO Karolinska University Hospital Dr. Soki Choi Project Leader of “Nya Karolinska” Salford Royal Hospitals Foundation Trust Sir David Dalton CEO National Voices Mr Jeremy Hughes Chair Swiss Medical Group Mr. Miguel Carlos Blanco CEO Queensland DoH, Health Services Division Dr. Michael Cleary Deputy Director-General West/North West Hospitals Group Mr. Noel Daly Chairman Virginia Mason Medical Centre Dr. Andrew Jacobs Medical Director Buurtzorg Netherlands Mr Jos de Blok Director South Metropolitan Health Service Prof. Robyn Collins Adj. Associate Professor Alberta Ministry of Health Ms. Janet Davidson Deputy Minister Wiener Krankenanstalt- enverbund Prof. Dr. med. Udo Janßen CFO Health and Social Care Northern Ireland Mr. John Compton CEO Centers for Medicare & Medicaid Services (CMS) Ms. Julie Boughn, Former Deputy Director, Center for Medicaid and CHIP Services Former CIO Nuffield Trust Mr Nigel Edwards CEO Keiju Healthcare Systems Dr. Masahiro Kanno CEO Menzis Mr. Roger van Boxtel CEO Unfallkrankenhaus Berlin Prof. Dr. Med. Axel Ekkernkamp, CEO Royal Liverpool and Broadgreen Uni. Hosp. Mr. Aidan Kehoe CEO Memorial Sloan Kettering Dr. Murray Brennan VP, International Programmes Access Health Connecticut Kevin Counihan CEO The Society for Family Health Sir Bright Ekweremadu Managing Director NHS England Mr. Tim Kelsey National Director for patients and information
- 4. 3© 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved. 65 senior healthcare leaders from 30 countries Achmea Mr. Roelof Konterman CEO United Family Healthcare Ms. Roberta Lipson Chairwoman UCL Hospitals NHS FT Sir Robert Naylor CEO The Investment Fund for Healthcare in Africa Mr. Onno Schellekens Managing Director Faculty Hospital Brno Dr. Roman Kraus CEO NHS Leadership Academy Ms. Karen Lynas Deputy Managing Director Singapore Health Services Prof. Ivy Ng Group CEO Apollo Hospitals Lt. Gen. Dr. M. Singh Director Medical Services Foundation Hospital St Joseph Mr. Jean-Patrick Lajonchere, CEO Health and Social Care Board Northern Ireland Pamela McCreedy Director NHS England Sir David Nicholson Former CEO KPJ Healthcare Berhad Siti Sa’diah Sheikh Bakir Corporate Advisor Hygeia Group Ms. Fola Laoye Chairwoman The Economist Ms. Anne McElvoy Editor Department of Health Ms Una O’Brien Permanent Secretary St Joseph’s Healthcare, Hamilton Dr. Kevin Smith President and CEO Yonsei Univ. Health System - Severance University Hospital Dr. Chul Lee President and CEO Health Service Journal Mr. Alastair McClellan Editor The Royal Marsden NHS Foundation Trust Ms Cally Palmer CEO Geisinger Health System Dr. Glenn Steele President and CEO Myong-Ji Hospital M. Wang-Jun Lee CEO and Chairman Espria Mr. Marco Meerdink CEO Narayana Health Dr. Ashutosh Raghuvanshi Vice Chair, Group CEO National Voices Mr. Jeremy Taylor CEO Peking University Prof. Ling Li Professor Life Healthcare South Africa Mr. Andre Meyer, CEO Public Health Foundation of India Prof. K. Srinath Reddy President Ministry of Health Prof. Josef Vymazal First Deputy Minister Department of Health of the Canton Zurich Mr. Hansjörg Lehmann Head of Health Planning and Control Humanitas Mr. Luciano Ravera CEO Assuta Medical Centres Mr. Pinhas Tsruya CEO CZ Mr. Wim van der Meeren CEO Birmingham University Hospitals NHS FT Dame Julie Moore CEO NSW Ministry of Health Mr. Ken Whelan Deputy Director General
- 5. #1 Organisations and health systems are not aligned for sustainable transformation How much change do you expect in the shape of the provider system and their business models in the next 5 years? “The current business models operated by hospitals in my system are...” Source: KPMG pre-conference surveys: Rome 2012 and London 2014 3% 16% 53% 13% 16% 11% 19% 30% 37% 4% 0% 10% 20% 30% 40% 50% 60% Extremely sustainable Very sustainable Somewhat sustainable Not very sustainable Not at all sustainable 37% 61% 3% 0%0% 52% 41% 4% 0% 4% 0% 10% 20% 30% 40% 50% 60% 70% Major changes Moderate changes Minor change No significant change Not sure Rome 2012 London 2014 72% think existing hospital business models are sustainable but 98% expect moderate or major change to their health systems Do they believe change starts with someone else?
- 6. Our crowd sourcing community revealed a major disconnect between their organisation and health system What is the scale of change required in your organisation? What is the scale of change required in the healthcare sector in your country? #1 Organisations and health systems are not aligned for sustainable transformation Sources: KPMG What Works Healthcare Insights global crowd sourcing community Twice as many thought the wider system required fundamental change 35% 36% 16% 6% 6% 0% 20% 40% 60% 80% Fundamental Moderate Incremental Very little No change is required 73% 19% 7% 1% 1% 0% 20% 40% 60% 80%
- 7. While most strategic effort is focused on transactional – not transformative – changes, integration is much more prominent. #1 Organisations and health systems are not aligned for sustainable transformation Which strategies are providers likely to adopt to respond to these changes? Source: KPMG pre-conference surveys: Rome 2012 and London 2014 85% 81% 74% 44% 56% 52% 44% 30% 22% 30% 81% 78% 85% 85% 74% 50% 52% 41% 56% 63% 33% 19% 93% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Majorcost reduction Leanorother improvement methods Developingnew workforcemodels Incomegrowthfrom existingpayers Mergers Acquisitionsof otherhospitals Acquisitionsof otherprovidertypes Verticalintegration Entryintonew markets inthecountry Expansioninto overseasmarkets Focus& specialization Investmentin healthIT %ofresponses: 'Likely'or'VeryLikely'
- 8. "My health system is planning to redesign care within the next 5 years to create more integrated delivery" #2 People believe that integration is critical for improved health system sustainability 82% of global respondents believed their health system will become more integrated over the next 5 years Sources: KPMG Global Healthcare Conference 2014, pre-conference survey 0% 7% 11% 52% 30% 0% 10% 20% 30% 40% 50% 60% Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 9. #2 People believe that integration is critical for improved health system sustainability "Fragmented patient pathways – within my organisation and across my health system – compromise clinical effectiveness and operational efficiency" 80% of global respondents agreed that fragmented care hampered clinical effectiveness and operational efficiency Sources: KPMG Global Healthcare Conference 2014, pre-conference survey 0% 0% 19% 58% 22% 0% 10% 20% 30% 40% 50% 60% 70% Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 10. "Bringing primary and secondary care together into the same organisation does not create sufficient additional value to justify the difficulty of doing so" #2 People believe that integration is critical for improved health system sustainability 71% of global respondents believed that greater primary and secondary care integration was beneficial Sources: KPMG Global Healthcare Conference 2014, pre-conference survey 15% 56% 19% 11% 0% 0% 10% 20% 30% 40% 50% 60% Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 11. "With the right support and empowerment patients actively managing their own care creates better value care" #3 Patients, when empowered, will create more value 72% of global leaders believe empowered patients create better value care Sources: KPMG Global Healthcare Conference 2014, pre-conference survey 0% 11% 17% 28% 44% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 12. Source: KPMG Global Healthcare Conference 2014, pre-conference survey #3 Patients, when empowered, will create more value “The delivery of healthcare is currently structured more according to organisational structures and boundaries than the needs of the patient" How satisfied are you that your organisation is truly meeting the aspirations of your patients? However, 89% of leaders believe their health systems are designed around organisations’ – not patients’ – priorities and they are not very satisfied they are meeting patients’ needs 8% 4% 0% 58% 31% 0% 10% 20% 30% 40% 50% 60% 70% Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 7% 70% 19% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
- 13. Sources: KPMG Global Healthcare Conference 2014, pre-conference survey KPMG What Works Healthcare Insights global crowd sourcing community #3 Patients, when empowered, will create more value Is patient experience a key performance indicator for your organisation? “In my organisation patients actively participate in managing their own care” 79% of our crowd sourcing community believed patient experience indicators are being more widely used; only 14% of global leaders thought their patients were becoming ‘active’ 79% 17% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Yes No Don't know 3% 29% 46% 14% 0% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Strongly disagree Disagree Neither agreenor disagree Agree Strongly agree
- 14. Source: KPMG-commissioned global survey of patient representative and advocacy groups Hong Kong Alliance of Patients’ Organizations ABCD: Associacao Brasileira de Colite Ulcerativa e Doenca de Crohn Unique global insights from patient support and advocacy groups, representing millions of patients across 6 countries Crohn’s & Colitis Foundation of America Families USA American Cancer Society Childbirth connection Canadian Cancer Survivor Network Canadian Diabetes Association healthexperiences.ca Canadian Breast Cancer Network / Reseau Canadien du Cancer du Sein ABRA SUS Nederlandse Diabetes Vereniging Crohn en Colitis Ulcerosa Vereniging Nederland European Patients Forum National Voices National Childbirth Trust Macmillan Cancer Support Hong Kong Breast Cancer FoundationDiabetes Hong Kong Dutch Patients & Consumers Organisation #4 There is some distance between what patients want and what they get Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama
- 15. Source: KPMG-commissioned global survey of patient representative and advocacy groups #4 There is some distance between what patients want and what they get Our global research suggests 5 dominant themes: “See me – and support me – as a person, not a condition or an intervention site” 1 Patients want to be informed partners in care2 Fragmented care is harmful and wasteful care. Patients can feel “abandoned” (especially after discharge)3 Patients want to be empowered partners in care4 In some countries securing responsive access to care is a fundamental priority 5
- 16. #4 There is some distance between what patients want and what they get "Measurements of patient experience impact on how my organisation delivers care" Are patient experience measures used in the performance appraisal of clinical staff and managers within your organisation? Clinical staff Managers While our crowd sourcing community overwhelmingly believed that patient experience is now a key performance indicator, more needs to be done on activation and empowerment Sources: KPMG What Works Healthcare Insights global crowd sourcing community 46% 37% 17% 46% 42% 12% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Yes No Don't know 62% 26% 6% 5% 0% 10% 20% 30% 40% 50% 60% 70% Strongly agree / Agree Somewhat agree Somewhat disagree Strongly disagree / Disagree
- 17. Source: Hibbard J H, Greene J, Overton V (2013) ‘Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”.’ Health Affairs, 32, no (2013): 216-22. (Quoted in KPMG, ‘Creating new value with patients, carers and communities’) Many studies show that activated’ patients have better health outcomes at lower costs. Patients with lower activation scores cost 8% to 21% more. 2010 patient activation level Predicted per capita billed costs ($) Ratio of predicted costs relative to level 4 Patient Activation Measure (PAM) Level 1 (lowest) 966 1.21 Level 2 840 1.05 Level 3 783 0.97 Level 4 (highest) 799 1.00 #5 What Works. There is an evidence base for patients creating value www.kpmg.com/whatworks
- 18. We have developed a 9-point maturity matrix to help assess progress: #5 There is an evidence base for patients creating value 3. Systems to support shared decision making 4. Models support self- care and help professionals adapt 6. Can patients get and use information? 5. Are patients’ assets mobilized? 8. Are the assets that communities can contribute mobilized? 7. Are patients involved in teaching and research? 1. Work to create a new culture centreed on the patient culture 2. Patient input into service design Are there measurement systems to support this? Patient experience and outcome data embedded in all performance management & governance Patient experience and outcome data embedded in performance management of medical staff Real time collection data used at front line for improvement Systematic collection of data reported to boards Recognition that the collection of data on patient experience and outcomes will provide a basis for understanding progress and analysis No data on patient experience or outcome data collected 1 2 3 4 5 9. Are there measurement systems to support this? 0 maturitylevel Source: KPMG, ‘Creating new value with patients, carers and communities’ 2014 12345
- 19. #5 There is an evidence base for patients creating value Source: All-Party Parliamentary Group on Global Health, ‘Patient empowerment: for better quality, more sustainable health services globally’ 2014
- 20. #6 The activist payer is emerging and pursuing value (but has some way to go) “I expect to see...” Global leaders expect payment systems to become more bundled and focused on value (with downward pressure on prices) Sources: KPMG Global Healthcare Conference 2014, pre-conference survey 93% 85% 7% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Payment systems more bundled and focussed on value Price reductions and capping of volumes Agree Disagree
- 21. #6 The activist payer is emerging and pursuing value (but has some way to go) “The pursuit of short-term cost reductions compromises clinical and operational effectiveness:” “My negotiations with my main payer / provider are focussed (mainly) on ...” But a majority agree that a short-term focus on costs is too transactional and not consistent with value and sustainable care Source: KPMG Global Healthcare Conference 2014, pre-conference survey 3% 28% 17% 42% 11% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Strongly disagree Disagree Neither agreenor disagree Agree Strongly agree 41% 38% 9% 13% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Immediate concerns for financial sustainability Short-to-medium-term improvements to patient care Long-term considerations of higher-value Sustainable patient care
- 22. Conclusions Organisations and health systems are not aligned for sustainable transformation 1 People believe that integration is critical for improved health system sustainability 2 There is some distance between what patients want and what they get4 The activist payer is emerging and pursuing value (but has some way to go)6 There is an evidence base for patients creating value5 Patients, when empowered, will create more value3 Workforce is a worry. Optimism around leadership and technology.7
- 23. Launched at Davos... Necessity, the mother of innovation:: Low-cost, high-quality healthcare
- 24. kpmg.com/socialmedia © 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International. The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation.