Value Based Healthcare: Working in partnership to improve care and deliver greater value. WelshConfed18

Transcription

1 Value Based Healthcare: Working in partnership to improve care and deliver greater value WelshConfed18

2 Dr Chris Jones Deputy Chief Medical Officer Welsh Government WelshConfed18

3 Dr Paul Buss Medical Director/ Deputy Chief Executive Aneurin Bevan UHB WelshConfed18

4 More with Less Cost Variation the Clinical Leadership Challenge Dr Paul Buss: Executive Medical Director/Deputy CEO Aneurin Bevan University Health Board ABUHB VBHC

5 The Clinical Value Gap Rising demands/pressures Supply driven demand Older demographics Integration in practice Productivity/Efficiency clinical effectiveness Modern Clinicians: MUST DISCUSS RESOURCE MUST MEASURE OUTCOMES MUST CONSIDER VALUE A SHARED VBHC MODEL ABUHB VBHC Aneurin Bevan: the cost of looking after the visitor who falls ill cannot amount to more than a neglible fraction of 400m the total cost of the NHS A free health service In Place of Fear -1952

6 Doing the right things with resource? ABUHB VB Aneurin Bevan: too many drugs are consumed in too large quantities whilst few doctors would disagree with this statement the fault lies primarily with them Note 20 Chapter 5 In Place of Fear -1952

7 Resource and Clinical Engagement PRESENT DATA REGULARLY OVERCOME PROFESSIONAL FEAR ENGAGEMENT FOR CLINICAL VALUE

8 Informal organisation: Do we understand our Costs? The COSTING CHALLENGE Costing that influences clinical behaviour Costs - as an economic signal RIGHT Clinical Decisions GOOD clinical Behaviours INFLUENCE of Clinical Leaders Costing to close the Value Gap. Costing mechanism that accurately portrays clinical behaviour ABUHB VBHC Richard Thaler: Prospect theory broke from the traditional theory that human behaviour can be normative and descriptive Misbehaving Making Behavioural Economics 2015

9 Costing discussions for VB design Caroline Hobbs/Simon Barrell (Plics) Dr Kath Williamson. Mike FisherABUHB Costing in Mental Health Same condition different history of development Costing highlighting clinical differences Costing questions - showing opportunities Early redesign potential Challenge to clinical behaviours and habits Prep for ICHOM dataset:

10 Costing discussions for VB design Caroline Hobbs/Simon Barrell (Plics) Dr Phillip Campbell ABUHB Costing in Cardiology Pacing clinical approach in two sites Changes through costing to procurement, staffing and decisions. Challenge to clinical practice. Heart Failure Variance in various sub-cohorts Prep for ICHOM dataset:

11 LOS (DAYS) Elective Major Knee Replacements 2015/16: DIFFERENCE BETWEEN HB AND PEER LOS/DISCHARGE Sunday Monday Tuesday Wednesday Thursday Friday Saturday DAY OF ADMISSION Admission Day Discharges in Year Total difference between HB and Peer LOS Difference between HB and Peer LOS/ Discharge Total difference between HB and Peer Cost Difference between HB and Peer Cost/ Discharge Sunday , Monday , Tuesday , Wednesday ,165 1,032 Thursday , Friday , Saturday , Grand Total , Consultant 1 Consultant 2 Consultant 3 Site 1 Site 2 Site 3 Site 1 Site 2 2.Cardiology, Coronary Stents 2016/17: NUMBER OF STENTS USED PER PROCEDURE % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 3.Poisoning Toxic Effects Special Examinations Screening: 4. Elective Colectomies 2015/16: TOTAL DIFFERENCE BETWEEN HB AND PEER COST ( ) 0 50, , , , , , ,000 VARIATION AGAINST PEERS ( ) Proportion of total activity by Consultant Number of stents per procedure or more Consultant 1 66% 24% 9% 1% Consultant 2 49% 37% 9% 5% Consultant 3 61% 28% 8% 3% Total difference between HB and Peer LOS Difference between HB and Peer LOS/ Discharge Total difference between HB and Peer Cost Difference between HB and Peer Cost/ Discharge Site Discharges in Year Site 1 1,852 2, , Site , Site , ,349 1,369 Grand Total 2,814 4, , Total Discharges in Total Difference between HB Difference between HB and Total Difference between HB Difference between HB and Peer Site Year and Peer LOS Peer LOS/ Discharge and Peer Cost ( ) Cost ( )/ Discharge Site , Site ,916 4,246 Grand Total ,206 2,059

12 Shared Decisions with QOL/Cost Dr Gareth Roberts clinical Business lead ABUHB Renal disease and EQ5D: Real-Life Costs of Care Anxiety mobility self care Pain activities 6 months post 6 months post ABUHB VBHC No Better change Worse No Better change Worse

13 Allocative/Technical Value COPD Inpatients 3.1M 1,200 people 1,600 episodes Prescribed COPD drugs 6.9M Population unknown REAL-LIFE AB Pulmonary Rehabilitation Cost est M Current offer 429 places Home Oxygen service 0.3M 490 COPD patients Smoking Cessation Pharmacy scheme 0.1M (all conditions) NRT 0.5M (all conditions) Population unknown Flu Immunisation 9,800 COPD population Immunisation fee 7.80 x 9,800 = 0.07M IDEAL - EBM 8,487 General COPD Risk Register 4, 280 > MRC3 Risk Register 12, 867 pop n GP QOF Payment for management in primary care 0.5M Evidence based assessment of the effective interventions for COPD. Source: London Respiratory Team ABUHB VBHC Evidence based assessment of the effective interventions for COPD. Source: London Respiratory Team Rebecca Richards Senior finance lead / Dr Flood-Page ABUHB

14 1. Collecting Outcomes in Parkinson s Dr Sally Lewis/Adele Cahill ABUHB VBHC Team Condition: Incurable, progressive chronic disease of the nervous system caused by the degeneration of specific nerve cells in the brain Challenge: Feasibility Study of collecting outcomes in a clinic environment (St Woolos) Clinical Fears: Short-term project, no sustainability, no mechanism for trouble shooting Additional work: Burden of data collection, troublesome IT data collection, limited support resulting in negative impact on clinic operations and quality of care. Outcomes would this data itself be useful? 3 Main phases of implementation: Personnel & Team formation Process Mapping Informatics Lessons Learnt: IT Platform and ability to grow and scale with programme crucial Out of the box IT solutions are less burdensome Front load support systems and manage expectations Need to provide real-time data that clinicians can use immediately Top-Level commitment to both arms of the value equation No special team it should transcend all teams, business as usual Small, incremental improvements rather than mass overhauling Early benefits, Integrate costing using TDABc and scale to 5 other sites Patient information immediately available at the clinicians fingertips Streamlined history taking and focussing on What matters most to the patient Limited delays in clinic, stimulating patient-patient conversation, structuring appointments Future Opportunities Re-design, cohorting of clinics, more specialist attention Development of additional data sets Transition between IT Platforms fatigue dizzynes s 4 sleep pain urinary 01/01/ /06/20 16 Value Based Health Care Team; Aneurin Bevan University Health Board constipa tion

15 Change Catquest-9SF score Change Catquest-9SF score Challenge: To manually collect both patient and clinical outcomes 500 patient Lack of resources No single source for clinical data collection Duplication of effort for PROM collection 2.Participation in GLOBAL Benchmarking Mr Chris Blyth, VBHC Team ABUHB Aim: Systematic collection of patient and clinical outcomes using the ICHOM dataset HOW Output = 534 procedures Pre-Op Manually presenting patient with paper copy on day of surgery Intra-Op admission documents and operation in case notes Post-Op Manually sent in SAE or in Discharge pack. Re-pull notes, review optician CAT2 Data Captured: Visual Acuity, PROM, Refraction, Risk Factors, Surgeon, Target refraction, Complications 4 Operating on first eye Change in visual acuity and Catquest-9SF % 3.7% 6 4 Operating on second eye Change in visual acuity and Catquest-9SF 12.3% 2.3% Findings (Await formal output from ICHOM/ICON) Questions What from the dataset? Insufficient data to draw true analysis How can we support further collection? How do we work with Optician, reduce duplication? How do we feed PCB and RCO? % 2.5% % 5.4% Change visual acuity (logmar) Value Based Health Care Team; Aneurin Bevan University Health Board Change visual acuity (logmar)

16 Medical Director as Chief Value Officer 1 MD/CVO - every NHS Organisation - To address Value Gap Clinical Costing Outcome measures Clinical Value Analysis To Explain Value Creation: Value Based Management: Coordinating a Value Based approach Clinical Cost Leadership: Educating for Clinical Value Clinical Value Delivery: Value weighting/indices for costing ABUHB VBHC Elinor Ostrom: Local appropriators of resource have too little motivation to contribute to sustainability Governing the Commons

17 Thank you for listening : Paul.Buss2@wales.nhs.uk

18 Chris Wood MD Medical Executive Intermountain icentra Development VP Cerner WelshConfed18

19 Any Questions? WelshConfed18

20 Exhibition and Lunch Available in the lower hall. Please remember to visit the exhibition stands WelshConfed18