According to Francesca Colombo, Head of the OECD Health Division, accelerating the pace of health system transformation is a « complex problem« , saying that « the challenge is not just to optimize clinical care but also to take into consideration disease surveillance, research, system matching and waste reduction. » The expert spoke at « Accelerating the Process of Health System Transformation » roundtable during the Health & Tech for people event, which was organized at Paris, December 18, 2018 by Care Insight on the theme « value-based health care » (VBHC).
In total, five international interlocutors expressed themselves on the subject, highlighting the following 4 topics, at the center of the issues related to the acceleration of the transformation of the system:
• governance and confidentiality of data ;
• interoperability ;
• the shift from a hospital-centric to a patient-centric system ;
• health professionals cultural change.
The discussions were moderated by Vanessa Candeias, Head, Shaping the Future of Health and Healthcare, Member of the Executive Committee, World Economic Forum.
Data governance rights and privacy (F. Colombo)
The first step in speeding up the transformation process is to focus on governance and data confidentiality, said Francesca Colombo, Head of the OECD Health Division, who has a deep experience comparing the systems in different countries.
She said there is still a lot of work to do to reach this standard of privacy.
The expert recommends dealing with the data on both issues: privacy and data governance rights.
Interoperability for better performance
To accelerate the pace of health system transformation, Francesca Colombo also believes that interoperability between systems and hospitals is a fundamental technological improvement.
She took examples of hospitals which face a lack of communication between one another and practical barriers to share experience on patients. Interoperability should allow to reach this potential value from the data by having a better conversation, a stimulating communication with different stakeholders, said Francesca Colombo.
Having good standards to have the same terminology and data collection (Mr. Lamiaux)
And for that, having good standards is necessary to have the same terminology and data collection. Matthieu Lamiaux, Senior Partner & Managing Director, Boston Consulting Group (France), also insisted on having platforms which should have the same semantic when they want to compare the data. « Wires and pipes should be connected » as a single base to measure outcomes, he explained. He illustrated this point with the example of France where data is fragmented so it is difficult to compare data from hospitals and city providers.
He added, moreover, that EMR should circulate more easily between different Healthcare professionals.
Matthieu Lamiaux proposes a roadmap
« The more data you get, the better you measure outcomes, » said Matthieu Lamiaux. He pointed out the example of rare diseases which health professionals get so few data about that they require to have a global scale to compare.
« How how to collect the data, how to optimize and store them? », asked the expert. Looking at the increase of the players such as IBM, Google or Apple, there are many solutions and we have the complexity in mind and at the same time the innovation on AI, blockchain ».
He proposes to have a road map to:
- « have a global vision and keep the key principle as patient centric: there are numerous initiatives and we should match them;
- collect all these decisions, define them, spot the data you want, with the same language and the same standards;
- collect use cases which are very important for primary uses, secondary uses. For primary uses, physicians can make the decision that is right for the patient. For secondary uses, extracting a large amount of data from a large group of patients allows to have learning. »
New processes to shift from hospital-centric to patient-centric
Every panelist agrees that to shift from a paradigm to another, everybody needs to be at the table. But what is the recipe?
Anne-Sophie Viard, Government Affairs and Policy Manager, Novo Nordisk (Canada), said that her company « is also working on implementing Value-based healthcare, » adding this is not « a priority but a shared sensibility to be part of the change. »
« By allowing the manufacturers to deliver outcomes, this allows us to be collectively with the other stakeholders of the HC system and improve it, » she said. « All the actors will find a fulfilment of his own interest. »
And she added that « by really combining the outcomes, for payers, it will create a positive competition mindset, and lead the industry to make research in the good direction. » In her view, it will help to have a systemic approach to reinvest in innovation. And for patients and providers, it will empower them to make the right decision for the treatment of the patients, she said.
« By working together, you can raise more budget and also reduce costs and the healthcare burden » but it needs to be implemented step by step, says Henk Veeze, Chairman of the Board & coFounder of Diabeter (Netherlands).
A good infrastructure to better measure potential drugs side effects (AS, Viard)
Anne-Sophie Viard also pointed out that a good infrastructure of data on a value-based healthcare system will allow outcomes in real life. This would avoid major drugs crisis, known in the past, in France and in the US. In other words, it means that evaluating drugs in real conditions allows to measure their potential side effects.
Discussions are not only about costs but also about business strategy (V. Candeias)
Vanessa Candeias, concludes by saying that these discussions are not only about costs and technique but also about business strategy.
According to her, the more viable business strategy is for companies in this place, the more scale we will be able to bring this effort collectively. « Processes have to be aligned with the business objectives to accelerate the transition and leapfrog the system, » she said.
Cultural change and incentives
To tackle interoperability, AI, new processes and to be outcome-orientated, a deep cultural change is required. Joshua Tepper, President and Chief Executive Officer of Health Quality Ontario, who has a deep experience in managing hospitals says that it is an ongoing process.
The culture of change also means the culture of transparency. Matthieu Lamiaux emphasized that transparency is linked to reputation. The more transparent a structure is, the better its reputation becomes. « Thanks to outcomes based on big data, what is interesting is to compare the evolution disease after disease, year after year, based on real facts, » he said. « And it nourishes transparency and reputation. This is a virtuous circle. »
In addition, Henk Veeze said that regarding data, we must add “context data otherwise people will think it is meaningless.” In his view, it will allow the healthcare providers to have the full picture of each patient and, thanks to AI and machine learning, deliver the right treatment.
But how can we encourage the culture of change? What could motivate healthcare professionals to change their behaviors?
Francesca Columbo, who admitted that getting incentives is difficult, analyses that in traditional models, salary was raised as a motivation. But she says that we did not get the results we wanted.
Experimentation in France and other countries has been conducted about new mechanisms with population based, pay for performance, package payment and the conclusion is that it leads to reporting.
And by this, “another idea is to change what we measure; so, step by step, behaviors will change. healthcare professionals adapt to the incentives and change their behaviors to make sure they will maximize their refunds so, keep on changing what we measure and what we base their incentives on, they will adapt, and they will start to have behaviors that might be what you want in the short term and in the longer term”. She concluded that “it is a continuing adaptation”.