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#ReformIntegration

#WhatWorks

Coordinated health and

social care

What would it take to really make it happen?

Tuesday 1 July 2014

08.15 – 14.00


#ReformIntegration

#WhatWorks

08.45 – 08.50 Welcome and introduction

Andrew Haldenby, Director, Reform


#ReformIntegration

#WhatWorks

08.50 – 09.20 Integration and patient power

Dr Mark Britnell, Chair and Partner,

KPMG’s Global Health Practice

Integration and

patient power

Dr Mark Britnell

Chairman and Partner

Global Health Practice KPMG

@markbritnell

5 © 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with

KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other

member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved.

Member of the World Economic Forum Global Agenda Council

60 countries, 170+ occasions.




65 senior healthcare leaders from 30 countries

Vektis Mr. Herman Bennema General Director

Discovery Health Dr Jonny Broomberg CEO

All-Party Parliamentary Group on Global Health Lord Nigel Crisp Co-Chair

Fundaçâo Antonio Prudente Mr. Irlau Machado Filho CEO

Monitor Dr David Behan CEO

Hospital Sirio Libanes Dr. Paulo Chapchap Strategy Director

Médica Sur Mr. Antonio Crosswell CEO

Institute Gustave Roussy Mr. Charles Guepratte Deputy CEO

Institute for Healthcare Improvement (IHI) Ms. Maureen Bisognano President and CEO

Karolinska University Hospital Dr. Soki Choi Project Leader of “Nya Karolinska”

Salford Royal Hospitals Foundation Trust Sir David Dalton CEO

National Voices Mr Jeremy Hughes Chair

Swiss Medical Group Mr. Miguel Carlos Blanco CEO Queensland DoH, Health Services

Division Dr. Michael Cleary Deputy Director-General

West/North West Hospitals Group Mr. Noel Daly Chairman

Virginia Mason Medical Centre Dr. Andrew Jacobs Medical Director

Buurtzorg Netherlands Mr Jos de Blok Director

South Metropolitan Health Service Prof. Robyn Collins Adj. Associate Professor

Alberta Ministry of Health Ms. Janet Davidson Deputy Minister

Wiener Krankenanstalt-enverbund Prof. Dr. med. Udo Janßen CFO

Health and Social Care Northern Ireland Mr. John Compton CEO Centers for Medicare & Medicaid

Services (CMS) Ms. Julie Boughn, Former Deputy Director, Center for Medicaid and CHIP Services Former CIO

Nuffield Trust Mr Nigel Edwards CEO

Keiju Healthcare Systems Dr. Masahiro Kanno CEO

Menzis Mr. Roger van Boxtel CEO

Unfallkrankenhaus Berlin Prof. Dr. Med. Axel Ekkernkamp, CEO

Royal Liverpool and Broadgreen Uni. Hosp. Mr. Aidan Kehoe CEO

Memorial Sloan Kettering Dr. Murray Brennan VP, International Programmes

Access Health Connecticut Kevin Counihan CEO

The Society for Family Health Sir Bright Ekweremadu Managing Director

NHS England Mr. Tim Kelsey National Director for patients and information




65 senior healthcare leaders from 30 countries

Achmea Mr. Roelof Konterman CEO

United Family Healthcare Ms. Roberta Lipson Chairwoman

UCL Hospitals NHS FT Sir Robert Naylor CEO

The Investment Fund for Healthcare in Africa Mr. Onno Schellekens Managing Director

Faculty Hospital Brno Dr. Roman Kraus CEO

NHS Leadership Academy Ms. Karen Lynas Deputy Managing Director

Singapore Health Services Prof. Ivy Ng Group CEO

Apollo Hospitals Lt. Gen. Dr. M. Singh Director Medical Services

Foundation Hospital St Joseph Mr. Jean-Patrick Lajonchere, CEO

Health and Social Care Board Northern Ireland Pamela McCreedy Director

NHS England Sir David Nicholson Former CEO

KPJ Healthcare Berhad Siti Sa’diah Sheikh Bakir Corporate Advisor

Hygeia Group Ms. Fola Laoye Chairwoman

The Economist Ms. Anne McElvoy Editor Department of Health

Ms Una O’Brien Permanent Secretary

St Joseph’s Healthcare, Hamilton Dr. Kevin Smith President and CEO

Yonsei Univ. Health System - Severance University Hospital Dr. Chul Lee President and CEO

Health Service Journal Mr. Alastair McClellan Editor

The Royal Marsden NHS Foundation Trust Ms Cally Palmer CEO

Geisinger Health System Dr. Glenn Steele President and CEO

Myong-Ji Hospital M. Wang-Jun Lee CEO and Chairman

Espria Mr. Marco Meerdink CEO

Narayana Health Dr. Ashutosh Raghuvanshi Vice Chair, Group CEO

National Voices Mr. Jeremy Taylor CEO

Peking University Prof. Ling Li Professor

Life Healthcare South Africa Mr. Andre Meyer, CEO

Public Health Foundation of India Prof. K. Srinath Reddy President

Ministry of Health Prof. Josef Vymazal First Deputy Minister

Department of Health of the Canton Zurich Mr. Hansjörg Lehmann Head of Health Planning and Control

Humanitas Mr. Luciano Ravera CEO

Assuta Medical Centres Mr. Pinhas Tsruya CEO

CZ Mr. Wim van der Meeren CEO

Birmingham University Hospitals NHS FT Dame Julie Moore CEO

NSW Ministry of Health Mr. Ken Whelan Deputy Director General

#1 Organisations and health systems are not aligned for sustainable

transformation

How much change do you expect in the

shape of the provider system and their

business models in the next 5 years?

“The current business models operated

by hospitals in my system are...”

Source: KPMG pre-conference surveys: Rome 2012 and London 2014

3%

16%

53%

13%16%

11%

19%

30%

37%

4%

0%

10%

20%

30%

40%

50%

60%

Extremely sustainable

Very sustainable

Somewhat sustainable

Not very sustainable

Not at all sustainable

37%

61%

3%0%0%

52%

41%

4%0%

4%

0%

10%

20%

30%

40%

50%

60%

70%

Major changes

Moderate changes

Minor change

No signif icant

change

Not sure

Rome 2012

London 2014

72% think existing hospital business models are sustainable

but 98% expect moderate or major change to their health systems

Do they believe change starts with someone else?

Our crowd sourcing community revealed a major disconnect

between their organisation and health system

What is the scale of change required

in your organisation?

What is the scale of change required in

the healthcare sector in your country?


transformation

Sources: KPMG What Works Healthcare Insights global crowd sourcing community

Twice as many thought the wider system required fundamental

change

35%

36%

16%

6%

6%

0% 20% 40% 60% 80%

Fundamental

Moderate

Incremental

Very little

No change isrequired

73%

19%

7%

1%

1%

0% 20% 40% 60% 80%

While most strategic effort is focused on

transactional – not transformative – changes,

integration is much more prominent.


transformation

Which strategies are providers likely to adopt to respond to these changes?

Source: KPMG pre-conference surveys: Rome 2012 and London 2014

85%81%

74%

44%

56%52%

44%

30%22%

30%

81%78%

85% 85%

74%

50% 52%

41%

56%63%

33%

19%

93%85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Majo

r co

st

red

uctio

n

Lean o

r o

ther

imp

rovem

ent

meth

od

s

Develo

pin

g n

ew

w

ork

forc

e m

od

els

Inco

me g

row

th f

rom

exis

ting

payers

Merg

ers

Acq

uis

itio

ns o

f o

ther ho

sp

itals

Acq

uis

itio

ns o

f o

ther p

rovid

er ty

pes

Vert

ical i

nte

gra

tio

n

Entr

y in

to n

ew

m

ark

ets

in

the c

ountr

y

Exp

ansio

n in

to

overs

eas m

ark

ets

Fo

cus &

sp

ecia

lizatio

n

Investm

ent

in

health IT

% o

f re

sp

onses:

'Lik

ely

' or 'V

ery

Lik

ely

'

"My health system is planning to redesign care within the next

5 years to create more integrated delivery"

#2 People believe that integration is critical for improved health system

sustainability

82% of global respondents believed their health system will

become more integrated over the next 5 years

Sources: KPMG Global Healthcare Conference 2014, pre-conference survey

0%

7%

11%

52%

30%

0%

10%

20%

30%

40%

50%

60%

Strongly disagree

Disagree Neither agree nor disagree

Agree Strongly agree


sustainability

"Fragmented patient pathways – within my organisation and

across my health system – compromise clinical effectiveness

and operational efficiency"

80% of global respondents agreed that fragmented care

hampered clinical effectiveness and operational efficiency


0% 0%

19%

58%

22%

0%

10%

20%

30%

40%

50%

60%

70%

Strongly disagree



"Bringing primary and secondary care together into the same

organisation does not create sufficient additional value to

justify the difficulty of doing so"


sustainability

71% of global respondents believed that greater primary and

secondary care integration was beneficial


15%

56%

19%

11%

0%0%

10%

20%

30%

40%

50%

60%

Strongly disagree



"With the right support and empowerment patients actively

managing their own care creates better value care"

#3 Patients, when empowered, will create more value

72% of global leaders believe empowered patients

create better value care


0%

11%

17%

28%

44%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Strongly disagree



Source: KPMG Global Healthcare Conference 2014, pre-conference survey


“The delivery of healthcare is currently

structured more according to

organisational structures and boundaries

than the needs of the patient"

How satisfied are you that your

organisation is truly meeting the

aspirations of your patients?

However, 89% of leaders believe their health systems are designed

around organisations’ – not patients’ – priorities and they are not very

satisfied they are meeting patients’ needs

8%4%

0%

58%

31%

0%

10%

20%

30%

40%

50%

60%

70%

Strongly disagree

Disagree Neither agree

nor disagree


7%

70%

19%

4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Very satisfied

Somewhat satisfied

Somewhat dissatisfied

Very dissatisfied


KPMG What Works Healthcare Insights global crowd sourcing community


Is patient experience a key performance

indicator for your organisation?

“In my organisation patients actively

participate in managing their own care”

79% of our crowd sourcing community believed patient

experience indicators are being more widely used; only 14% of global leaders thought their patients were becoming ‘active’

79%

17%

4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes No Don't know

3%

29%

46%

14%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Strongly disagree



Source: KPMG-commissioned global survey of patient representative and advocacy groups

#4 There is some distance between what patients want and what they get

HONG KONG

ALLIANCE OF PATIENTS'

ORGANIZATIONS

ABCD: Associacao

Brasileira de Colite

Ulcerativa e Doenca

de Crohn

Unique global insights from patient support and

advocacy groups, representing millions of

patients across 6 countries

Dutch Patients

and Consumers

Organisation

Source: KPMG-commissioned global survey of patient representative and advocacy groups


Our global research suggests 5 dominant themes:

“See me – and support me – as a person, not

a condition or an intervention site”

1

Patients want to be informed partners in care 2

Fragmented care is harmful and wasteful care. Patients

can feel “abandoned” (especially after discharge) 3

Patients want to be empowered partners in care 4

In some countries securing responsive access to care is

a fundamental priority

5


"Measurements of patient experience

impact on how my organisation delivers

care"

Are patient experience measures used in

the performance appraisal of clinical staff

and managers within your organisation?

Clinical staff

Managers

While our crowd sourcing community overwhelmingly believed

that patient experience is now a key performance indicator,

more needs to be done on activation and empowerment

Sources: KPMG What Works Healthcare Insights global crowd sourcing community

46%

37%

17%

46%42%

12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No Don't know

62%

26%

6% 5%

0%

10%

20%

30%

40%

50%

60%

70%

Strongly agree

/ Agree

Somewhat agree

Somewhat disagree

Strongly disagree

/ Disagree

Source: Hibbard J H, Greene J, Overton V (2013) ‘Patients with lower activation associated with higher costs; delivery systems

should know their patients’ “scores”.’ Health Affairs, 32, no (2013): 216-22. (Quoted in KPMG, ‘Creating new value with patients,

carers and communities’)

Many studies show that

activated’ patients have better

health outcomes at lower costs.

Patients with lower activation scores

cost 8% to 21% more.

2010 patient

activation level

Predicted per

capita billed

costs ($)

Ratio of predicted costs

relative to level 4 Patient

Activation Measure (PAM)

Level 1 (lowest) 966 1.21

Level 2 840 1.05

Level 3 783 0.97

Level 4 (highest) 799 1.00

#5 What Works. There is an evidence base for patients creating value

We have developed a 9-point maturity

matrix to help assess

progress:

#5 There is an evidence base for patients creating value

3. Systems to

support shared

decision making

4. Models

support self-

care and

help

professionals

adapt

6. Can patients get and use

information?

5. Are

patients’

assets

mobilized?

8. Are the

assets that

communities can

contribute

mobilized?

7. Are patients involved in

teaching and research?

1. Work to create a

new culture

centred

on the patient

culture

2. Patient input into

service design

Are there measurement

systems to support this?

Patient experience and outcome

data embedded in all performance

management & governance

Patient experience and outcome

data embedded in performance

management of medical staff

Real time collection data used at

front line for improvement

Systematic collection of data

reported to boards

Recognition that the collection of

data on patient experience and

outcomes will provide a basis for

understanding progress and analysis

No data on patient experience or

outcome data collected

1

2

3

4

5 9. Are there

measurement

systems to

support this?

0

ma

turity

leve

l

Source: KPMG, ‘Creating new value with patients, carers and communities’ 2014

1 2 3 4 5

#5 There is an evidence base for patients creating value

Source: All-Party Parliamentary Group on Global Health, ‘Patient empowerment: for better quality, more sustainable health services globally’ 2014

#6 The activist payer is emerging and pursuing value (but has some way to go)

“I expect to see...”

Global leaders expect payment systems to become more bundled

and focused on value (with downward pressure on prices)


93%85%

7%15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Payment systems more bundled and

focussed on value

Price reductions and capping of volumes

Agree

Disagree

#6 The activist payer is emerging and pursuing value (but has some way to go)

“The pursuit of short-term cost

reductions compromises clinical and

operational effectiveness:”

“My negotiations with my main payer /

provider are focussed (mainly) on ...”

But a majority agree that a short-term focus on costs is

too transactional and not consistent with value and

sustainable care

Source: KPMG Global Healthcare Conference 2014, pre-conference survey

3%

28%

17%

42%

11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Strongly disagree



41%38%

9%13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Immediate concernsfor financial

sustainability

Short-to-medium-termimprovements to

patient care

Long-term considerationsof higher-value

Sustainablepatient care

Conclusions

Organisations and health systems are not aligned for

sustainable transformation 1

People believe that integration is critical for improved

health system sustainability 2

There is some distance between what patients want and

what they get 4

The activist payer is emerging and pursuing value (but

has some way to go) 6

There is an evidence base for patients creating value 5

Patients, when empowered, will create more value 3

Workforce is a worry. Optimism around leadership and technology. 7

Launched at

Davos...

Necessity, the mother

of innovation:

Low-cost, high-quality

healthcare

kpmg.com/socialmedia

© 2014 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms

of the KPMG network of independent firms are affiliated with KPMG International. KPMG

International provides no client services.

The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG

International.

The information contained herein is of a general nature and is not intended to address the circumstances of

any particular individual or entity. Although we endeavour to provide accurate and timely information, there

can be no guarantee that such information is accurate as of the date it is received or that it will continue to be

accurate in the future. No one should act on such information without appropriate professional advice after a

thorough examination of the particular situation.

http://kpmg.com/socialmedia


#ReformIntegration

#WhatWorks

09.20 – 10.00

Keynote speech, followed by Q&A

Norman Lamb MP

Minister of State for Care and Support

Chair: Andrew Haldenby, Director, Reform


#ReformIntegration

#WhatWorks

10.00 – 10.45

Panel session: Commissioners as enablers Tamara Finkelstein, Director of Public Services, HM Treasury

Dr Martin McShane, Director for Long Term Conditions, NHS England

Jan Ledward, Chief Officer, NHS Chorley and South Ribble CCG and Chief Officer,

NHS Greater Preston CCG

Dr Andrew Webster, Director for Integrated Care, Local Government Association

Chair: Richard Harries, Deputy Director, Reform


#ReformIntegration

#WhatWorks

10.45 – 11.15 Refreshments


#ReformIntegration

#WhatWorks

11.15 – 12.00

Panel session: Providers as enablers Toby Lambert, Director of Strategy and Policy, Monitor

Professor Sir Robert Lechler, Executive Director, King’s Health Partners

Claire Murdoch, Chief Executive, Central and North West London NHS Foundation

Trust

Dr Massoud Fouladi, Co-Founder and Medical Director, Circle Partnership

Chair: Thomas Cawston, Research Director, Reform

CNWL

- Central to

Integration

- Enabling

Solutions

Claire Murdoch

Chief Executive,

Registered Nurse

Who am I?

CNWL is an Integrated Community Trust

• 1000 beds

• 250,000 patients

• Wide geography: Milton Keynes, North West

London, Camden, Winchester, Sussex, Kent

• 6,500 staff

• Prisons, street homeless, GP practices, A&Es,

major acutes, detention/immigration centres,

schools, people’s homes

Spectrum

Cradle to grave –

School nurses, midwives, end of life care, including for

children, specialist children's services, residential,

complex psychological conditions.

Head to toe –

Psychology, specialist dentistry, specialist podiatry,

sexual health, learning disability, addiction.

Spectrum cont

Social care, primary care, self help

Intensive inpatient care eCBT packages on

line and telehealth

Peer lead specialist clinicians

Major provider small specialist partner

Block contact PBR

How do we integrate as a provider?

“It’s complicated”

Everyone’s integrating

Frailty, LTC’s, older adults

Commissioners who want providers to drive

innovation want to control

Factors for success

Appetite for risk and innovation

Clear goals and outcomes

ICT

Strong patient voice in design and delivery

Factors for success cont

Obsessive interest in the gaps and joins

Involvement of provision from 3rd Sector

Strong clinical/staff engagement

Clarity about £ and accountability

Pushing boundaries of self help and life style

Factors for success cont

Relationships, trust

Values-based healthcare

Honesty about blocks and limitations

Robust business model

Long term contracts

Example

One man’s death


#ReformIntegration

#WhatWorks

11.15 – 12.00

Panel session: Providers as enablers Toby Lambert, Director of Strategy and Policy, Monitor

Professor Sir Robert Lechler, Executive Director, King’s Health Partners

Claire Murdoch, Chief Executive, Central and North West London NHS Foundation

Trust

Dr Massoud Fouladi, Co-Founder and Medical Director, Circle Partnership

Chair: Thomas Cawston, Research Director, Reform


#ReformIntegration

#WhatWorks

12.00 – 12.45

Panel session: Consumers as enablers

Anna Bradley, Chair, Healthwatch England

Ciarán Devane, Chief Executive, Macmillan Cancer Support

Jeremy Taylor, Chief Executive, National Voices

Sonia Sodha, Head of Public Services and Consumer Rights, Which?

Chair: Cathy Corrie, Senior Researcher, Reform

22

Professional Manager

23

Professional Manager

Patient

Individual patient engagement at service level

Individual patient engagement at national level

Collective patient voice at national level Collective patient voice at service level

Better picture – mac brand?/supportive etc

Our Brand


#ReformIntegration

#WhatWorks

12.00 – 12.45







“Few bodies have done more than National

Voices to promote person centred care” Health

Service Journal , June 2014

What matters?

• Involvement in decisions and respect for preferences

• Clear, comprehensible information and support for self-care

• Emotional support, empathy and respect

• Involvement of, and support for, family and carers

• Continuity of care and smooth transitions

http://www.nationalvoices.org.uk/evidence - from 779 systematic reviews

http://www.nationalvoices.org.uk/evidence


What works? • Information is therapy

• Patient involvement leads to better clinical decisions

• Self management education and support helps people with LTCs lead better lives

• Communication training for professionals improves care

• Health behaviours can be changed. Well designed public health interventions work.

• (National Voices distilled evidence from 779 systematic reviews and turned into 5 simple guides)


Out-of-

hours

doctors

GP

District

nurses

Social

worker

Malcolm &

Barbara

Consultant Continence

adviser

Speech &

language adviser

Dietician

Community

dentist

Occupational

therapist

Equipment

service

Physiotherapist Alternating

mattress technician

Wheelchair

service

Oxygen

service Direct

payments

team;

Rowan

org.

Alzheimer’s

soc outreach

worker

Care team

2 live-in carers

(alternating weekly)

Replacement carer

[Some night nursing

– Health]

Emergency carers

& Barbara

The web of

care

(Last 7 yrs)

Dementia

Advisory

Nurse?

Person centred coordinated care: a

narrative “I can plan my care with people who

work together to understand me and my

carer(s), give me control,

and bring together services

to achieve the outcomes important to

me.”

Information

My goals/outcomes

Communication Decision making

Care planning

Transitions

The house of care

“Consumers as enablers”

• Work with me to plan my care

• Inform me

• Equip me and support me to self-manage

• Let go: trust me

• Involve my loved ones

• Work together

• Make my priorities your priorities

The customer is always right

• Thanks for listening

• www.nationalvoices.org.uk

• Follow us on Twitter

• @NVTweeting

• @JeremyTaylorNV

http://www.nationalvoices.org.uk/


#ReformIntegration

#WhatWorks

12.00 – 12.45








#ReformIntegration

#WhatWorks

12.45 – 13.15

Keynote speech, followed by Q&A

Rt Hon Stephen Dorrell MP

Former Secretary of State for Health

Chair: Andrew Haldenby, Director, Reform


#ReformIntegration

#WhatWorks

13.15 – 13.30 Closing remarks

Professor Paul Corrigan CBE, former Health Adviser to

Tony Blair and current adviser to KPMG’s Global Health

Practice

Andrew Haldenby, Director, Reform


#ReformIntegration

#WhatWorks

13.30 Lunch

coordinated health and social care - reform · coordinated health and social care ... apollo...

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