H&T SUMMIT 2018: review the healthcare system by improving quality (roundtable)
Paris - Published Saturday, February 2, 2019 - 16:25 - #8133 The "what value means for health systems" roundtable, moderated by David BatesDavid Bates, physician, biomedical informatician and professor at Harvard (health policy and management), launched the debate of the Health & Tech For People day. The event, centered on "value-based health care" (VBHC), was held in Paris on December 18, 2018 and was organized by Care InsightCare Insight .For all speakers - Francesca ColomboFrancesca Colombo, Head of the OECD Health Division, Vanessa CandeiasVanessa Candeias, Head of System Initiative on Shaping the Future of Health and Healthcare and a Member of the Executive Committee at the World Economic Forum, and David BlumenthalDavid Blumenthal , president of The Commonwealth FundThe Commonwealth FundThe Commonwealth Fund - the current pressures on the industry - aging, chronic diseases, costs - require rethinking of health systems. According to them, this evolution should not be done solely by seeking savings but also by improving the quality of the supply of care, especially that felt by the patient.
This approach is becoming international, even in universal coverage health systems, David Blumenthal said, adding that it is complex, including in countries with a centralized governance of the system.
This evolution towards a quest for quality involves addressing the following challenges:
- to collect outcome indicators, particularly on primary care, among older patients with chronic conditions who are primarily seen in the city, with 70% of costs external to the hospital according to David Bates, and patients in general (quality seen by the patient ). These types of data collection are complex. Few indicators exist and the information is difficult to capture;
- to establish a coherence of the collected information, a difficult task because it exists:
- a fragmentation of the pathways (primary, hospital but also social);
- differences in processes and pathways, with the indicators being different in different countries;
- patient evaluation differences according to the context (country, social ...) of well-being or good health conditions (pure clinical indicators are more convergent);
- to change the habits of health professionals: reluctant to collect indicators, they may be encouraged to collect information but not obliged, David Blumenthal said. They have not been trained for this (autonomy, management practices ...);
- to evaluate practices, with 20% of waste identified in practices and treatments, Francesca Colombo, OECD, said;
- to try to understand and to make disappear the big differences between countries. The costs can be very different from one country to another, as is the case for example between Germany and France (OECD);
- to identify who the expert is (voice and choice), which implies different management of the indicators:
- Is it the health professional who proposes a collection of information?;
- Is it the patient who knows his pathology and expresses his needs?
Indicators must be relevant and measurable according to David Blumenthal
David Blumenthal insisted on the importance of the right choice of indicators: they must not be too numerous, be relevant and measurable. In his view, it is necessary to set up a real task force to validate these indicators without this being too complex a burden for professionals.
This VBHC evolution can not be done without financial tools: bundled payment (per patient, per pathology, per episode of care), capitation, population-based analyzes, for performance.
Examples of initiatives by the OECD and the World Economic Forum
During the roundtable, the OECD and the World Economic Forum described ongoing actions to support the establishment of such health organizations:
- OECD: PaRISPaRISPatient Reported indicators survey study, conducted in 19 countries, covers ambulatory care and the following pathologies: breast cancer, hip and knee surgery, mental health. A complex and long investigation, Francesca Colombo said.
David Blumenthal stressed the difficulty of getting the voice of patients. We have not yet reached the stage in a system co-managed by patients, he insists.
- The World Economic Forum wants to work with all stakeholders around key issues identified: IT (broadly defined), health financing models and policy measures.
- He launched two pilots to move from theory to practice. The first, conducted in Atlanta, focuses on heart failure, the second in Ontario focuses on diabetes.
In both cases, the pilots have started well, with strong political support (mayors) and actors quickly mobilized, Vanessa Candeias explained. However, there was a slowdown in the project after a change of mayor in both cases. The promoters of the initiative want more people and countries to be involved in the process for the coming years.
- He launched two pilots to move from theory to practice. The first, conducted in Atlanta, focuses on heart failure, the second in Ontario focuses on diabetes.
Interview with David Blumenthal (The Commonwealth Fund)
What does value means for health systems?
What indicators does the Commonwealth Fund use to assess the performance of a health system?
Find all H&T SUMMIT 2018 videos on Numérique & Santé by Care Insight YouTube channel.
The Commonwealth Fund
Profile n° 1996, created on 17/07/17 at 12:22
The Commonwealth Fund
