Mobilizing cooperation for health system transformation

As the theme at this week’s World Economic Forum Davos meeting highlights, we live in an increaslingly fractured world. Just as communities at large are fragmenting, healthcare systems, too, have become siloed due to an accelerating increase in complexity. It is too easy to lose focus on the patient as we optimize the parts of the system.

 However, there is a paradigm shift underway. Value-based healthcare puts the sustainable delivery of health outcomes of patient or population groups at the very centre of care delivery.

 This shift requires measuring health outcomes that matter to patients and the resources required to deliver those outcomes across the full cycle of care. These measurements need to be done systematically across different population segments – for example, all patients suffering from heart attack or the frail elderly. We can then compare results between organizations, regions or nations to identify clinical or operational best practices, motivate outcomes improvement, and develop increasingly precise treatments. This ongoing cycle of continuous improvement ultimately leads to what some clinical experts term precision medicine.

Four enablers support the development of health systems focussing on patient value:

·        Integrated health informatics that permit the routine capture, sharing and analysis of health outcomes and other relevant data while securing full integrity of patient data

·        New analytical tools for benchmarking and research, including sophisticated decision-support tools for clinical teams and patients

·        New payment models that reward prevention, coordination along the care chain and continuous improvement in patient value

·        New roles and organizational models that allow networks of providers and suppliers to deliver better access to appropriate care, engage clinicians in continuous improvement, and adapt to new opportunities and innovations.

 The value-based system requires coherent public policies with a legal and regulatory environment that supports and accelerates the transformation.

 Although leading stakeholders around the world are embracing elements of this value-based model, the challenge, and the opportunity, lie in unlocking its potential at the level of entire health systems – regionally, nationally and internationally. It requires significantly higher levels of cooperation and alignment among stakeholders than is the rule today.

 The second World Economic Forum report from the Value in Healthcare project, “Mobilizing cooperation for health system transformation”, was released at the January 2018 Davos meeting. The report outlines three critical mechanisms for accelerating the required stakeholder alignment.

·        New models for multi-stakeholder cooperation. Improving healthcare value requires system-wide transformation. To begin this transformation, we have initiated a series of pilots around the world, working with local stakeholders to transform their abilities to jointly deliver improved healthcare value. Our report describes one such pilot in detail: the Atlanta Heart Failure Pilot. Launched under the leadership of former Atlanta Mayor Kasim Reed, the pilot brings together approximately 40 healthcare stakeholders operating in the Atlanta metropolitan area – providers, payers, patient advocacy groups, public-sector organizations, academic institutions and pharmaceutical and medical device companies – to focus on congestive heart failure (CHF) patients. Nearly 6 million people in the United States suffer from CHF – about half of whom die within five years of the initial diagnosis. The pilot has an ambitious goal: “to create a continuously improving value-based healthcare system that positions Atlanta as a national leader in heart failure patient survival rate by 2022 while significantly improving quality of life and reducing the average cost per patient”. We draw lessons from the Atlanta pilot for organizing similar initiatives in other parts of the world.

·        New standards for health informatics. Transformation to a value-based health system demands an integrated approach to the capture and use of health data. If we are to realize the promise of value-based healthcare and precision medicine, we need comprehensive and interoperable data from large numbers of individuals. This requires defining global standards for data capture, mapping and access. Global standards will make it possible to access disparate sources of health-related information from systems around the world so that providers, payers, researchers and policy-makers can learn from each other about what works and what does not. Standard-setting may sound like a technical topic, but it is also a critical mechanism for encouraging cooperation across healthcare.

·        New directions for leadership. System transformation requires transformative leadership. Healthcare leaders need to actively inspire their own organizations to focus on what matters to patients. This, however, is only the first step. They also need to articulate a vision that looks beyond the walls of their individual organizations and take a system perspective. Politicians and policy makers similarly need to have a long-term view, bring stakeholders together, and create the policy, regulatory and legal environments to make it easier for stakeholders to cooperate. Global leadership can create public-private partnerships and ultimately a healthcare community committed to continuous improvement and innovation.

There is no doubt that better health and healthcare creates a shared future for us all. Many are stepping up to the opportunities offered by value-based healthcare. Let us all continue to do more. Cooperation enables us to overcome the barriers and challenges of a fractured world to benefit not just the health of individual organizations, but the health of patients, customers, and citizens around the world.

Find below a Link to the recording of our public session at Davos 2018 "The new health paradigm". The panel was moderated by Clifton Leaf, Editor-in-Chief of Fortune Magazine and included in order of image on top of page:

• Laurie Glimcher – President and CEO, Dana-Farber Cancer Institute
• Frans van Houten – Chairman and CEO, Philips
• Omar Ishrak – Chairman and CEO, Medtronic
• Bruce Broussard – President and CEO, Humana
• Christophe Weber – President and CEO, Takeda Pharmaceutical  

https://www.weforum.org/events/world-economic-forum-annual-meeting-2018/sessions/the-new-health-paradigm