Improving Value in Chemotherapy

Transcription

1 Improving Value in Chemotherapy Nathan Hall March 2017

2 Content 1. Financial Context 2. What does Improving Value mean? 3. How can we Improve Value in Chemotherapy? 2

3 Our Context There is an ever increasing need, demand and cost for Healthcare. Demand is driven by ageing population, new technology and new diseases. There is a finite amount of resource that the UK economy can allocate to the various elements of public services, including Health. Opportunity Cost - Better access to treatment for one group of patients takes funding away from another group. Therefore it is everyone's responsibility to ensure the best use of resources available. 3

4 2015/ / / / / /21 Billion Specialised Services - 3.6bn Gap by 2020/21 Specialised Commissioning - Pressures and allocation 25.0 Underlying pressures for specialised assumed higher than for the NHS average over the next five years: FYFV pressure 7.9% Including additional pressure 9.0% 20.0 Allocation increases of 7.0% for this year and 4.8/4.5/4.5/5.0% over the next four years i.e. average 5.3% a year Additional pressure FYFV pressure Allocation Gap between allocation and FYFV expected pressure rises to 2.5bn by 2020/21. Additional pressures from new drugs expected to add an additional 1.1bn by 2020/21 In response to this financial challenge we will need to achieve more value from the resources available to each and every year by switching resources from lower value to higher value activity. 0.0 Each Specialised Commissioning Region must achieve at least 2.4% efficiency annually. In cash terms for Specialised Commissioning this is million in 2016/17

5 Specialised Commissioning Spend by Programme of Care ,500,000,000 3,000,000, billion of our commissioning spend on Cancer goes to Chemotherapy the single biggest service line within Specialised Commissioning portfolio. 2,500,000,000 2,000,000,000 1,500,000,000 1,000,000, ,000,000 - Internal Medicine Cancer Women and Children Trauma Mental Health Blood and Infection Unassigned 5

6 Chemotherapy & Specialised Commissioning Chemotherapy is Directly Commissioned by NHS England as a Specialised Service Cancer Programme of Care Board & Chemotherapy Clinical Reference Group development of national commissioning products for Commissioning Chemotherapy 4 Regions and 10 Local Hub Teams hold contractual relationship with chemotherapy providers 6

7 Section 2: What does Improving Value mean?

8 The Aim of Improving Value Improving Value in specialised commissioning aims to achieve measurable improvement in patient benefit or outcome whilst achieving a reduction in the cost of specialised services. Reducing demand for specialised services Changing how specialised services are delivered Changing how we transact for specialised services 8

9 Remember that in healthcare quality and efficiency are linked Good quality is less costly because of more accurate diagnoses, fewer treatment errors, lower complication rates, faster recovery, less invasive treatment and minimisation of the need for treatment. More broadly, better health is less expensive than illness. Michael E Porter Redefining Health Care

10 What is Value? Value in healthcare is a relationship between patient outcome and costs. (outcome = benefit - harm) Donabedian s Point of Optimality There is a best or optimum relationship between costs and benefits of healthcare, a point below which more benefits could be obtained at costs that are low relative to benefits and above which additional benefits are obtained at costs too large relative to the corresponding benefit. By reducing variation (and improving the mean) in patient benefit & outcome, harm and costs of healthcare we can improve value. 10

11 Donabedian s Point of Optimality 11

12 So where is the point of Optimal Value? 12

13 What is Low Value Health Care? Treatments that do more harm than good Treatments that have little or no evidence of effectiveness Treatments that are effective but are offered to patients for whom they are not effective Treatments offered to patients who do not understand the relative benefits and harms before accepting the offer of treatment Treatments that use resources which would produce more value if invested in some other services Treatments that cost more than the outcomes they achieve

14 Some Real Examples of Improving Value in Specialised Services BlueTeq - Clinical Decision Support Tool Spinal Surgery Pathway reform HIV Drug regimens Discharging adult patients from critical care within 4 hours of readiness for discharge Dose standardisation Chemotherapy Enhanced supportive care for people with advanced progressing cancer 14

15 5 th Key Ingredient: Effective Improvement Processes 15

16 Improving Value in Chemotherapy?

17 Key Facts Chemotherapy Commissioning 1.6 Billion 12% of Spec Com Budget 80% Drugs 20% Delivery 70% of Drug Spend NICE Approved 147 NHS Providers High Annual Growth?8% SACT Data - 170,000+ patients 1,200 Different drug regimens in use across England 1 7

18 Chemotherapy: Total Spend per Population Similar 10 CCGs 13Y G N E X D C 13R F V Difference (rate per 1000 population) Lowest 5 CCGs 13Y G N E X D 14C R F V Difference (rate per 1000 population) CCG Distribution Within Hub 13V 14F 13R 14C 14D 13X 14E 13N 14G 13Y Minimum rate per 1000 population Maximum rate per 1000 population Region Hub Code Hub Name Region Hub Code Hub Name London 13R London 13V Yorks and Humber 14C West Midlands North 13X North East Mids & East 14D East Midlands 13Y North West 14E East of England 13N South Central South 14F South West 14G South East Source: Aggregate Contract Monitoring (ACM). Rate shown is total spend per 1000 population Please use these figures with caution as further work is required to include NHSE full spend on Chemotherapy (Service Line = 'NCBPS01C ). The current analysis relates to a total spend of xxxxxxxx Period: 2015/16 18

19 Opportunities for Improving Value in Chemotherapy (PHE Report Specialised Commissioning Programme Report) Screening and early detection Minimise Late Presentation Targeted local prevention campaigns Review Data by Stage/Tumour Site and CCG Review locally Reduce variation in screening coverage rates The Treatment Pathway Identify Unwarranted Variation in Outcomes and Costs SACT Data? MDT Review of treatment plan for patients with poor performance status receiving palliative chemotherapy Reviewing compliance with NICE recommendations Commission Defined Treatment Algorithms Review of tariff for Uncomplicated Chemotherapy delivery End of treatment Consider mechanisms to ensure that all patients with cancer have the option to use dedicated palliative care services. Consider a CQUIN incentivising trusts to review all deaths within 30 and 60 days of chemotherapy and implement identified changes required in patient management. Review of SACT data on deaths within 30 and 60 days of chemotherapy Improve Earlier Access to Supportive and Palliative Care 19

20 Enhanced Supportive Care ESC is a new initiative that promotes integration of supportive care within oncology Developed at Christie NHS Foundation Trust NHS England encouraging adoption to other Cancer Centres from CQUIN Scheme Supportive care in cancer is the prevention and management of the adverse effects of cancer and its treatment 20

21 Early involvement of supportive and palliative care Improves patients quality of life Reduces the need for aggressive interventions in the last days / weeks of life Can help to optimise the use of chemotherapy in advanced cancer Has the potential to improve survival Lower Overall healthcare costs 1. Early Palliative Care for Patients with Metastatic Non Small-Cell Lung Cancer, Temel JS et al, N Engl J Med 2010; 363: August 19, Palliative and Supportive Care: Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial - Marie A. Bakitas, Journal of Clinical Oncology May 1, 2015: ; published online on March 23, 2015; DOI: /JCO Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non Small-Cell Lung Cancer; Joseph A. Greer, JCO; Feb , vol 30, no 4, )

22 Dose Standardisation in Chemotherapy - Benefits For Patient For Commissioner For Provider Fewer dose calculation errors Reduced patient waiting times chemo is ready to give Facilitation of Administration of chemotherapy on any chosen day Supports treatment of patients closer to home Same doses used across every provider in England Reduced cost through: Reduced Wastage (by re-use of cancelled doses and avoidance of incomplete vial usage during production) Allows outsourcing of standardised chemotherapy products. Reduced bespoke pharmacy preparation workload. Maximises opportunities for financial efficiency through outsourcing of standardised chemotherapy product. Fewer dose calculation errors. Reduction in prescription alterations. Quicker dispensing through use of pre-prepared doses. 22

23 Improving Value in Chemotherapy What Ideas do you 23

24 Resources to Help You /rightcare 24