« In ancient times, medicine was a very simple thing. It was used to promote health, prevent disease, restore health when compromised and minimize suffering. In the 20th century, the idea that production would get better results was imported in the world of health, » said Ricardo Baptista Leite, Member of the Portuguese National Parliament, speaking at « Building a value-based health system on a national scale » roundtable, held during the « value-based health care « (VBHC) Health & tech for people day, organized on December 18, 2018 in Paris by Care Insight.
Also, “NHS has failed in a certain way because people who have money go to the private sector. More and more, the population is divided.” So, strong reforms are required to avoid cost-driven behaviours and a schism between the private and public sectors.
« The rise in costs led to a lack of sustainability, » he added, « so, the solution is to get rid of what has no added value and invest strongly at the base of the pyramid. »
He also said NHS has in his view « failed in a certain way because people who have money go to the private sector. More and more, the population is divided, so, strong reforms are required to avoid cost-driven behaviors and a schism between the private and public sectors. »
Healthcare expenditures: shifting from a cost-driven mindset to investment-driven mindset
« Money is not necessarily the major driver and we should drive patients, » said Peter Pitts, President, Center for Medicine in the Public Interest, Former Associate Commissioner, FDA. Besides, David Bates, Professor of Health Policy & Management, Harvard T.H. Chan School of Public Health, added that “in the US, payment is unbelievable and complex: there are thousands of different payers in our institution.”
Payment should be related to quality to generate better outcomes and not just process and should be done and measured through the electronic health record for a minimum burden to the providers.
« Tomorrow, we will focus on outcomes instead of reimbursement » (Peter Juhn, Amgen)
Peter Juhn, Global Head of Value-based Partnerships, Amgen, USA, added that we should « consider the health less as a cost and more as an investment. We have a system where we minimize costs without regards of what those costs could bring us. And if you think about the question of value, you replace the notion of cost by an investment, it takes a different flavor. »
And investments are linked to future outcomes, he said. According to him, another reason to have an investment orientation rather than a cost orientation is because of medicine innovation. « Tomorrow, we will focus on outcomes instead of reimbursement. »
Peter Juhn illustrates this with an example: 3 or 4 years ago, Sovaldi which is a curative therapy for hepatitis C challenged HC payers by changing the paradigm: “you pay once, and you actually cure the disease. Most payers are used to paying a little bit every year for many years”.
Also based on this example, Ricardo Leite explained that Portugal was the first country in the world to establish the “pay per cure” system. “Governments will only pay the pharmaceutical company after the clinical cure of hepatitis C is proven.
That was the first value-based medicine approach in Portugal. « Sadly, it is a single example, » he said. « Doing that when there is a cure is easier than when we have a chronic condition. »
Collect data at a government stage
A cornerstone shared by the panellists is that data should be collected by the government, by an agency for example. According to them, there is a huge need to shift to a bigger model, beyond the walls of hospitals and share all these data with collaborative partners.
And Ricardo Leite goes beyond: « If it is used for research or clinical trials, why not create a citizen refund which would involve patients using their data? » This data collection would give access to
This data collection would give access to innovation at a local community level.
« We need to geography data, go micro to make a real change, and if we do it properly, this would create sustainability with the cooperation of the public health, the cornerstone of the health system, » Ricardo Leite said.
He stressed the importance of collaboration between healthcare providers, hospitals, city halls and the education system “to put that public health prevention at the core of the system.”.
In addition, David Bates admitted that creating a large data set will be valuable to have large access to patients and at a minimum cost.
Partnership and transparency between stakeholders
Peter Juhn alludes to the subject of partnership by declaring that “This is inclusive for all the stakeholders including manufacturers. And manufacturers can bring some interesting expertise, interesting experience and interesting data that can be valuable.”
According to David Bates, we should consider data exchange as a public good. He pointed out that to reach this goal, we need to make more standards at a national level. And about past experience in the United States, he said that the use of Electronic Medical Record and data exchange promote collaboration and improve care.
Peter Juhn concluded by assuring that these collaborations will create a system which reduces costs but not the value.
Educate and engage the patient
Regarding the US system, Peter Pitts explained that there are some programs to educate the patient supported by the Center for Medicare and Medicaids Service (CMMS) which is a federal agency. He put forward an American concept called “Human by design” which allows the programs to keep a patient’s perspective in mind. And beyond education, some programs will involve the patient to give his inputs, for a drug development by doing trials in real life.
Predict and prevent the system
According to Peter Juhn, value-based healthcare is not enough. He took for granted that we have already moved from the fee for service system to an outcome based – value-based healthcare system. He went further by saying that “this is an intermediate level. Where we really need to go, we need to get to a predict and prevent healthcare system. This is the ultimate value.”
Coming back to the traditional model, he added that “what we have today is a “fix-it” system. We wait for people to get into trouble and we always try to fix them.” In his view, progress in medicine, science and technologies, including data sciences, data analytics offer an unprecedented ability to predict which patient would have risks, which patient will come into trouble.
Singapore and France as examples
« What is the best healthcare system? », asked to the speakers Detlev Ganten, Chairman, President et Founder, World Health Summit.
- Ricardo Leite’s opinion: Portugal was a leader at a European level for electronic prescription. « In collaboration with mayors, at a local level, it allowed to understand the state of health of citizens. » But he warned that collecting data from so many different providers costs a lot. He concluded by recommending to take what is done abroad and adapt it locally.
- Peter Pitts’ opinion: Singapore is an example but “if we consider Singapore as a country/company, you have to compare the geography, population size, political systems”.
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Peter Juhn’ opinion: “As for Singapore, they have solved a problem: not having a healthcare budget on an annual circle but a 5-year plan, 10-year plan, 20-year plan.” He pointed out the benefit of having a long-term view.
- David Bates’ opinion: « France has the best outcomes and is followed by digitalized countries such as Danemark, Sweden, Estonia. These are the leaders in Europe. » He also admitted that France needs to experiment the NHS like in England.
As a conclusion Dentlev Ganten said that “we want federal management, quality; we want reconsidered costs.”
Interview with Dentlev Ganten
What impact does the concept of health value have on the organization of the healthcare in Germany?
Is value-based health care applicable to all health systems in the world?
Find all H&T SUMMIT 2018 video on Numérique & Santé by Care Insight YouTube channel.