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TRANSCRIPT
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FROM VOLUME TO VALUE DRIVEN CARE
2016 NSW Health Innovation Symposium Elizabeth Koff, Secretary, NSW Health
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WORLD WIDE, ALL HEALTH SYSTEMS ARE ON JOURNEYS OF REFORM
• Population growth and ageing
• Increasing chronic disease
• Rapidly evolving technologies and new medical knowledge
• Rising expectations
• Uneven quality
• Increasing costs
“Health spending has risen faster than economic growth in all OECD countries over the past 20 years.” OECD, Better Policies for Better Lives
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SINCE 2011, NSW HEALTH HAS BEEN PUTTING IN PLACE THE BUILDING BLOCKS FOR TRANSFORMATION
• Putting decision making closer to the patient
• Supporting strong clinician engagement and leadership
• Making healthcare funding transparent
• Implementing new models of evidence-based care
• Looking at ways to better integrate care
• Lifting system performance
• Investing in partnerships
• Supporting connectivity through investments in eHealth
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5,000
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0 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Current public and private healthcare expenditure per capita (AU$) adjusted for cost of living
Pote
ntia
l yea
rs o
f life
lost
(<70
yea
rs) p
er 1
00,0
00 p
opul
atio
n
NSW
Higher spending and poorer health
than NSW
Higher spending and better health
than NSW
Lower spending and poorer health than NSW
Lower spending and better health than NSW
NO OTHER COUNTRY HAS BETTER HEALTH OUTCOMES PER CAPITA EXPENDITURE THAN NSW
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5,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Current public and private healthcare expenditure per capita (AU$) adjusted for cost of living
Pote
ntia
l yea
rs o
f life
lost
(<70
yea
rs) p
er 1
00,0
00 p
opul
atio
n Higher spending and poorer health
than NSW
Higher spending and better health
than NSW
Lower spending and poorer health than NSW
Lower spending and better health than NSW
NSW
US
NZ
AUS
UK GER
FRA CAN
NOR
SWE NED SUI
NO OTHER COUNTRY HAS BETTER HEALTH OUTCOMES PER CAPITA EXPENDITURE THAN NSW
-
5,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Current public and private healthcare expenditure per capita (AU$) adjusted for cost of living
Pote
ntia
l yea
rs o
f life
lost
(<70
yea
rs) p
er 1
00,0
00 p
opul
atio
n
NSW
US
NZ
AUS
UK GER
FRA CAN
NOR
SWE NED SUI
Higher spending and poorer health
than NSW
Higher spending and better health
than NSW
Lower spending and poorer health than NSW
Lower spending and better health than NSW
NO OTHER COUNTRY HAS BETTER HEALTH OUTCOMES PER CAPITA EXPENDITURE THAN NSW
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SHIFTING THE PARADIGM FROM VOLUME TO VALUE DRIVEN CARE – THE NEXT STEP IN OUR REFORM JOURNEY
“Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent. ...If value improves, patients, payers, providers,…all benefit while the economic sustainability of the health care system increases” M Porter, What is value in health care? NEJM, 2010
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FROM VOLUME TO VALUE – FOCUSSING ON PATIENT OUTCOMES
THE SYSTEM MANAGER
• New payment models
• Statewide service planning
• NSW Health enabling IT program
• New models of care
• Quality and safety capacity building
• Translational research
DISTRICTS AND NETWORKS
• Patient-centred care
• Quality and safety led governance
• Measuring and reporting
• Culture of continuous improvement
• Care integration
• Collaboration
ENABLERS Listening, Learning,
Measuring, Reporting, Data Analytics, Evidence,
Education, Research, Evaluation, Innovation,
Partnering
References: I Scott, Ten clinician-driven strategies for maximising value of Australian health care, Australian Health Review, 2014, 38; Institute of Medicine of the National Academies. Round Table on Evidence Based Medicine, Value in Health Care, March 2009; ME Porter and TH Lee, The Strategy that Will Fix Health Care, Harvard Business Review, October 2013.
BETTER OUTCOMES FOR PATIENTS Improved alignment of patient expectations with the care delivered
BETTER VALUE FOR THE SYSTEM Cost savings delivered by reducing variation,
errors, duplication and fragmentation
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FROM VOLUME TO VALUE: KEY PRIORITIES AND ACTIONS FOR NSW HEALTH
SAFETY & QUALITY PATIENTS FIRST • safe, patient-centred care
• incident management
• accountability
• measurement and reporting
• compliance
NEW MODELS OF CARE LESS VARIATION • chronic conditions (diabetes, COPD, CCF)
• timely access to care (hip fracture surgery)
• variation in rates of procedures (hysterectomy)
• community based care (palliative care)
• specialised services (stroke)
SYSTEM REDESIGN BETTER VALUE • process improvement (OR efficiency)
• statewide service planning (Level 4 ICUs and Observation Units)
• partnerships
• procurement models (tendering processes)
PEOPLE AND CULTURE SKILLS MATCH • rostering improvements
• new workforce models
• building capability of boards
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DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
Identified areas where there is an opportunity to
improve our models of care to deliver better outcomes and better
value
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OVERALL, CARE IS RATED HIGHLY BY PATIENTS IN NSW, BUT THERE’S ROOM FOR IMPROVEMENT
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“While challenges remain, it is becoming clearer every day that shifting from volume-based toward value-based payment and delivery systems in health care has great potential. But it is also clear that it will take all of us in the health care system working together to achieve its full potential of providing the best quality of care.” D Leonard. The Health Care Paradigm Shift: Moving from Volume to Value, March 31 2015
SHIFTING FROM VOLUME TO VALUE IS A LEADERSHIP IMPERATIVE
HOW WE NEED TO BE • Listen • Learn • Challenge
At all levels of the system, from the bedside to the boardroom and insetting policy:
WHAT WE NEED TO DO • Measure • Innovate • Reward
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
Between 2006 and 2009, 47% of patients who died from cancer visited an Emergency Department in the last 30 days of their life.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
Of all patients admitted to a NSW
hospital for CHF between 2006 and 2009, 15% were readmitted within 30 days of discharge – 32% for a
potentially avoidable complication.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
In 2014-15, there were
around 10,000 patient falls in NSW public
hospitals that caused harm.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
FALLS Text to come
NSW has one of the highest rates of
hospitalisation for patients with COPD.
Compared to 11 other countries, only New
Zealand had a higher rate.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
In 2014-15, admission for treatment of
diabetes accounted for 11% of all public hospital admissions, with an average stay
of 6 days.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
Compared to 11 other countries, NSW is mid
range for diabetes-related lower extremity
amputation rates (9/100.000 people).
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
In 2013, only 70% of patients with a hip fracture received surgery within the
recommended timeframe of two days from time of
admission.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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Falls End of life Osteoarthritis
Hip Fracture Diabetic foot
Diabetes
Chronic obstructive pulmonary disease
Congestive heart failure
FALLS Text to come
In NSW in 2013, 11,377 patients aged
over 50 years underwent a knee
arthroscopy, which has been found to have little or no benefit for
people in this age group.
DEVELOPING NEW MODELS OF CARE – KEY AREAS OF FOCUS TO IMPROVE CARE
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