redefining health systems · industry leaders stress impact potential of vbhc michael mahony ceo,...

Redefining health systems "Stop looking for the keys under the street light"

Netherlands March17, 2017

Santeon - Larsson March 17 2017 - distribute.pptx 1

Draft—for discussion only

Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Concerned or optimistic about the future ?

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj-vLTbnbbMAhVsDZoKHVllAsAQjRwIBw&url=http://evolutionchantelle09.weebly.com/charles-darwin--alfred-wallace.html&bvm=bv.121070826,d.bGs&psig=AFQjCNEox7W6ccn60AJxywqdcYI5c5qYzQ&ust=1462101160408187

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi_04-SnrbMAhVpGZoKHTysD6UQjRwIBw&url=http://www.roman-emperors.org/conniei.htm&psig=AFQjCNHesMZiVwz3S03VEu0dUsKWIU41eQ&ust=1462101300458166



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Agenda

Starting point

From activity volume to patient value

The train has left the station

Conclusion



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Health-adjusted life expectancy globally

35

40

45

50

55

60

65

70

6’000 7’000 8’000 0 1’000 2’000 3’000 5’000 4’000

Outcome: Health-adjusted life expectancy (years, 2010)

Input: Health expenditure per capita (PPP US$, 2010)

Emerging economies

Developed economies

Health expenditure

as % of GDP

Ideal path

Path to avoid

Health-adjusted life expectancy: Estimates the number of years in full health an individual is expected to live at birth by subtracting the years of ill health (weighted according to severity) from overall life expectancy

Sources: World Bank, WHO, The Lancet, BCG



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

100

200

300

400

1995 2005 2000 2015 2010

HC Spend

GDP

Income

Index

(1995=100)

HC expenditure 2015:

9.3% of GDP


17.1% of GDP


11.1% of GDP Index

(1995=100)


12.9% of GDP Index

(1995=100)

Index

(1995=100)


9.7% of GDP Index

(1995=100)

100

200

300

400

HC Spend

Income

GDP

2000 2005 2010 2015 1995

100

200

HC Spend

Income

GDP

2015 2010 2005 2000 1995

100

200

300

400

HC Spend

1995 2000 2005 2010 2015

GDP

Income

100

150

200

250

Income

HC Spend

1995 2000 2005 2010 2015

GDP

100

200

300

Income

2015 2010 1995 2000 2005

HC Spend

GDP


11.8% of GDP Index

(1995=100)

Notes: Indexes based on local currencies; Income = Personal Disposable Income; HC expenditures as % of GDP are OECD calculation/estimates. Source: Economist Intelligence Unit April 2016, BCG analysis

With an unsustainable cost increase in developed nations

http://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svg

//upload.wikimedia.org/wikipedia/commons/a/a4/Flag_of_the_United_States.svg



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Medicine is developing exponentially

Exponential increase

in medical knowledge

# of new MEDLINE publications per year

1947 1980 2013

Number of human

genomes sequenced

doubles every

12 months

1M

0

Exponential growth in

the complexity of

medical practice

1950

2010 # of US MD Subspecialties

2005 2010

2.0

2015

0.0

1990 2000 1995

# of sequenced human genomes (M)

A dramatic increase in complexity in healthcare system



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

6

Cost increases

brought strong

focus on

process opti-

mization to

increase

efficiency

Healthcare system

Source: Joint Economic Committee, Republican Staff; Congressman Kevin Brady, Ranking House Republican Member

https://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=https://prezi.com/_nqvyfabmbpe/assembly-line/&ei=chdrVYi4KIK6sQGdj4GwCA&bvm=bv.94455598,d.bGg&psig=AFQjCNHPho788KeHORlw59XP4ewl3-AwJg&ust=1433168075649203

https://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCPuJmPmEuMgCFaGPcgod0boANQ&url=https://conservativist.wordpress.com/2010/10/09/your-new-healthcare-system-chart/&bvm=bv.104819420,d.bGQ&psig=AFQjCNFI2t-tfJHcXgO6tRrbfiY7TfBPig&ust=1444570594379996



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Growing pressure and dissatisfaction across Health care

Nurse turnover up to 20%. Doctors

increasingly unhappy with choice of

profession.

Economic provider crisis: wards

closing, reductions in staff, growing

pressure on price and productivity

Fewer medical doctors are

interested in becoming hospital

leaders

Clinical research often deprioritized

Increasing price pressure and

access limitations to innovative

suppliers



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Agenda

Starting point



Conclusion



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

=

Value

Outcomes

that matter to

patients

Cost per

patient

Defining Health care value

Processes Patient

experience/ engagement

Indicators

Patient

initial

conditions

Outcomes

that matter

to patients

Structure e.g., Staff certification, facilities standards

• PSA

• Gleason Score

• Surgical margin

• (…)

Protocols/ guidelines

• Survival

• Continence

• Erectile function

• Anxiety

• Adequate

information

• Expectations

agreed with

physician

• (...)

• Age

• Comorbidity

• (...)

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=xg3QGN7eUqubYM&tbnid=OHFtV8ZhF-yFqM:&ved=0CAUQjRw&url=http://www.mmsgrouponline.com/2013/01/10/write-down-goals-to-accelerate-your-career/&ei=6X4pUrPaH6Sm0QXnkoDoDA&bvm=bv.51773540,d.ZG4&psig=AFQjCNHfbFJnbE-SOxz_74eD1ROgGzSYcA&ust=1378537528201593



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Starting point is high quality outcomes measurement

by patient group...

Feedback

and learning

Transparent outcomes data

Analyze

variation

Identify

current best

practices Change

behavior

Value created at every stage of

process

Outcomes transparency supports continuoius improvement

Better outcomes Reduced variation Lower cost of care Continous improvement

Improved patient value

...which brings improvement

Value



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Large Intl variation in PE/blindness after cataract surgery

Incidence of PE (%)

0.5

0.4

0.3

0.2

0.1

0.0

2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994

Sweden

Bascom-Palmer (US)2

India (Aravind Eye Hospital)

Univ. Eye Center (US)1

Australia1

Saskatoon (Can)1

Netherlands1 Germany1

Ireland1

ESCRS3

ESCRS3

Japan1

UK1

Bascom-Palmer (US)2

Ontario (Can)

US Medicare

1. Multicenter study over several years. Figures in above diagram shows last year of study (and not year of publication). 2. Bascom Palmer Eye Institute is rated the nation's best ophthalmic hospital by board-certified ophthalmologists from across the United States for seven consecutive years (U.S. News & World Report's America's Best Hospitals issue). 3. The ESCRS study gives values for patients now receiving cefuroxime and patients who don't (lower value are patients receiving cefuroxime). Source: ESCRS, The Incidence of Endophthalmitis after Cataract Surgery among the U.S. Medicare Population Increased between 1994, Emely West et al, Ophthalmology 2005, Post cataract endophthalmitis in South India incidence and outcome, Lalitha P, Ophthalmology 2005.



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Transparency with dramatic effect on patient outcomes Example: Swedish myocardial infarction registry

1. Percutaneous coronary intervention 2. on angiography and PCI 3. Riks-HIA Source: SVT.se; Aftonbladet 2007-03-08; DN 2009-05-06; Dagens Medicin 2008-08-26; Läkartidningen nr 44 vol. 104, 2007; Värmlands Folkblad 10 Oct 2007

Care cycle redone

PCI1 - unit established

Emergency care expanded

to 24/7 coverage

Care aligned with national

treatment guidelines2

New specialist departments

for specific coronary

conditions started

Staffing improved

Ka

rls

tad

ce

ntr

al h

os

pit

al

Ha

lms

tad

ho

sp

ita

l

1 year mortality

20%, ranked

#68 of 73 hospitals

Ranked #43 of 73

hospitals

Before

Quality index

raised from 1 to 4

Mortality reduced

by 50%

Ranked #45

Quality index3

raised from 1 to

8,

30-day mortality

reduced by 50%

Ranked #22

After



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Data made public

2

3

4

5

6

2005 2006 2007 2008 2009

RIKS-HIA

Quality index

+13%

+22%

Bottom half 2007 (n=34) All hospitals (n=69)

+7%

+40%

Transparency increasing compliance to guidelines Example: Swedish myocardial infarction registry



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

UK mortality for AMI significantly higher than in Sweden

59%

89%

7.6%

1.0

22%

78%

10.5%

1.37

30-day

mortality

1. Acute Myocardial Infarction 2. Mortality rate adjusted for 17 casemix characteristics. 3. Primary PCI (Percutaneous Coronary Intervention) is recommended in guidelines in the USA since 2004 and in Europe since 2005 but did not become UK national policy until October 2008. β blocker at discharge has been recommended in guidelines in the USA and Europe since 1996 and in the UK since 2001, but statin therapy and ACE inhibitors or ARBs are still more commonly prescribed in the UK. Note: The study period was 2004-2010. Source: Chung et al, The Lancet, Jan 23, 2014.

Outcomes1

Primary PCI3

Treatment

β blocker at

discharge4

Standardized

mortality

rate2



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

qA

The world's leading prostate cancer center

Source: Hospital quality reports 2010

Martini Klinik does over 2k

prostatectomies /year – largest in EU 5 year disease-specific survival

Martini Klinik 95%

Average Hospital 94%

Severe erectile dysfunction

75.5%

34.7%

Average Hospital

Martini Klinik

6.5%

43.3% Average Hospital

Incontinence

Martini Klinik



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Developing team excellence in clinical practice

Institutional learning curve for urinary continence after

radical prostatectomy

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=Ep5UkyWqi_bpUM&tbnid=94SZ2dIvxQR4dM:&ved=0CAUQjRw&url=http://www.youtube.com/watch?v=dC_fYxztF14&ei=tPFJUqP5DYTTswaHuoC4BQ&bvm=bv.53371865,d.Yms&psig=AFQjCNGRuB6QjpkfB5f_7qg9d8s6Uh-JZg&ust=1380664110832545



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Agenda

Starting point



Conclusion



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

ICHOM Developing global outcomes standards

A physician-patient partnership

ICHOM facilitates a process with

physician leaders and patient

representatives to develop the

Outcomes Minimum Standard Set

ICHOM is an independent not-for-profit organization,

main funding of work from patient associations

Source: ICHOM, the International Consortium for Health Outcomes Measurement



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

* Accepted for publication 1. In the U.S. referred to as Frail Elderly Source: www.ICHOM.org

Burden of

Disease

Covered

Standard sets rapidly published in peer reviewed papers

1. Localized Prostate

Cancer

2. Lower Back Pain

3. Coronary Artery

Disease

4. Cataracts

5. Parkinson’s Disease*

6. Cleft Lip and Palate

7. Stroke

8. Hip and Knee

Osteoarthritis*

9. Macular Degeneration*

10. Lung Cancer*

11. Depression and Anxiety*

12. Advanced Prostate

Cancer

13. Breast Cancer

14. Dementia

15. Older Persons1

16. Heart Failure

17. Pregnancy and Childbirth

18. Colorectal Cancer

19. Overactive Bladder

20. Craniofacial Microsomia

21. Inflammatory Bowel

Disease

18% 35% 45%

22. End Stage Renal Failure

23. Oral Health

24. Brain Tumors

25. Drug and Alcohol

Addiction

26. Bipolar Disorder

27. Burns

28. Melanoma

29. Head and Neck Cancer

30. Pediatric Oncology

(Condition(s) TBD)

31. Rheumatoid Arthritis

32. Liver Transplantation

33. Congenital Hand

Malformations

34. Chronic Rhinosinusitis

35. Congenital Hemolytic

Anemia

36. Rotator Cuff Disease

37. Malaria

Standard Sets

Complete

(2013)

Conditions in

Year Three

(2015)

Standard Sets

Complete

(2014)

Under Consideration

for 2016

Macular

Degeneration*

Cleft Lip and

Palate*

Localized

Prostate Cancer

Low Back

Pain

Stroke

Coronary

Artery Disease

Cataract

Advanced

Prostate Cancer

Hip and Knee

Osteoarthritis



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

PLATINUM

GOLD

SILVER

BRONZE

*As of September 10, 2015

STRATEGIC PARTNERS

ICHOM globally funded by patients, payers and providers ICHOM’s Strategic and Sponsoring Partners*



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Care providers around the globe adopting ICHOM standards

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjovfWluovSAhWHFywKHVwRCL4QjRwIBw&url=http://philanthropyadvisors.org/&psig=AFQjCNF0ew5ZWOSrCRRD-nd31jSXIGLpnw&ust=1487019689460181



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Innovative companies seeking closer clinical partnerships

Recent increase in

M&A with VBHC rationale

Medtronic acquired

Covidien

''...enormous ability to

identify and create further

value-based solutions...''

Becton Dickinson

acquired Carefusion

''better positioned

to...provide safer, more

economical and improved

care.”

Danaher acquired

Nobel Biocare

''...will lead to better

clinical outcomes [and]

shorter treatment times to

the benefit of patients

and dental practitioners.''

Source: Press release, BCG Commercial Excellence Benchmarking Study in MedTech 2015 , BCG analysis

Industry leaders stress

impact potential of VBHC

Michael Mahony

CEO, Boston Scientific

''Our market today is evolving

in the direction of value-based

healthcare”

''Moving to a value-based

healthcare system is the only

thing that can keep MedTech

from being commoditized''

Omar Ishrak

Chairman and

CEO, Medtronic

Frans van Houten

CEO, Phillips

''...pressures on health

systems to shift to value-based

business models in relation to

rising costs of care''



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Future Health system defined by population needs

Policy Payments

Delivery organization

Benchmarking research & tools

Informatics

Outcomes

Costs



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

People is our most critical asset

Discipline

Motivation

Demand compliance with

clinical practice

guidelines

Manage health care on

production volume and

process efficiency

Stimulate competition on

outcomes, enable

cooperation and

innovation

Facilitate sharing of

good clinical practice

and peer recognition

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=P8ex6YTuZrBtcM&tbnid=CV1sVHBS18jDkM:&ved=0CAUQjRw&url=http://www.thenervousbreakdown.com/ajohnson/2009/07/the-case-for-disbelief/&ei=DaOMUt-aMoi4rgfq4YCIDA&bvm=bv.56643336,d.aGc&psig=AFQjCNH8iuQbvHSQLh5TL9hPdrMWIPsTyw&ust=1385034840460219

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=39r78xyBtOSNTM&tbnid=Hl9wG9hEUIznjM:&ved=0CAUQjRw&url=http://www.gru.edu/jobs/ppg/&ei=I1ZyUqntLsmOrgeb-YCACQ&bvm=bv.55819444,d.bmk&psig=AFQjCNEC8ZKuY1Fd2Ut8Tb15buSEElqFlw&ust=1383311181563019



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

Opportunities for Santeon and the Netherlands

Adopt international quality standards

Be willing to share results, build trust

Learn from each other, best practice

Compete with others on outcomes, and

reap financial benefits

Increase focus and patient volume –

reallocate patientgroups between units

Broaden collaboration across borders

Become the first European hospital

network focussing on value

improvement – serve European patients

New innovative corporate partnerships



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi7v82gsNTSAhUCDSwKHWVGBgsQjRwIBw&url=http://www.sayamausehat.com/health/7-mitos-dan-fakta-protein/&bvm=bv.149397726,d.bGg&psig=AFQjCNHZ3mIWi7vOPm9Y7kFM7eTmjkZQVQ&ust=1489525226269953

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj-vLTbnbbMAhVsDZoKHVllAsAQjRwIBw&url=http://evolutionchantelle09.weebly.com/charles-darwin--alfred-wallace.html&bvm=bv.121070826,d.bGs&psig=AFQjCNEox7W6ccn60AJxywqdcYI5c5qYzQ&ust=1462101160408187



Copyr

ight

© 2

016 b

y T

he B

osto

n C

onsultin

g G

roup,

Inc.

All

rights

reserv

ed.

The services and materials provided by The Boston Consulting Group (BCG) are subject to BCG's Standard Terms

(a copy of which is available upon request) or such other agreement as may have been previously executed by BCG. BCG does

not provide legal, accounting, or tax advice. The Client is responsible for obtaining independent advice concerning these matters.

This advice may affect the guidance given by BCG. Further, BCG has made no undertaking to update these materials after the

date hereof, notwithstanding that such information may become outdated or inaccurate.

The materials contained in this presentation are designed for the sole use by the board of directors or senior management of the

Client and solely for the limited purposes described in the presentation. The materials shall not be copied or given to any person

or entity other than the Client ("Third Party") without the prior written consent of BCG. These materials serve only as the focus for

discussion; they are incomplete without the accompanying oral commentary and may not be relied on as a stand-alone

document. Further, Third Parties may not, and it is unreasonable for any Third Party to, rely on these materials for any purpose

whatsoever. To the fullest extent permitted by law (and except to the extent otherwise agreed in a signed writing by BCG), BCG

shall have no liability whatsoever to any Third Party, and any Third Party hereby waives any rights and claims it may have at any

time against BCG with regard to the services, this presentation, or other materials, including the accuracy or completeness

thereof. Receipt and review of this document shall be deemed agreement with and consideration for the foregoing.

BCG does not provide fairness opinions or valuations of market transactions, and these materials should not be relied on or

construed as such. Further, the financial evaluations, projected market and financial information, and conclusions contained in

these materials are based upon standard valuation methodologies, are not definitive forecasts, and are not guaranteed by BCG.

BCG has used public and/or confidential data and assumptions provided to BCG by the Client. BCG has not independently

verified the data and assumptions used in these analyses. Changes in the underlying data or operating assumptions will clearly

impact the analyses and conclusions.

Disclaimer

Thank you

bcg.com | bcgperspectives.com

redefining health systems · industry leaders stress impact potential of vbhc michael mahony ceo,...

Documents