Healthcare Innovationfrom

absolute need to affordability

JoséFragata,MD,PhD,Agg,FETCS,FESC

Chair,DepartmentofCardiovascularandLungMedicine,SantaMarta’sHospital

Director,CardiacSurgery,CUFHospitals– Lisbon

FullProfessorofSurgery– NOVAMedicalSchool

ViceRectortoHealthNOVAUniversity

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INOVAÇÃO NA SAÚDE da

Necessidade à Acessibilidade

NoConflicts!2

background...

Despite enormous health gains over the last century – namely inlongevity and quality of life – performance of health systems is stillnot satisfactory to populations, at a point when ageing dominates

• Excessive Variation• Quality issues• Cost spiral• Affordability• Uneven Access• Unsatisfaction

Most solutions used so far,proved unsuccessful !

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WHO's director general, Tedros Adhanom Ghebreyesus, said it was "completely unacceptable that half the world still lacks coverage for the most essential health services."

Healthcare Cost Spiral

The problem…

• Healthcare (HC) spiral cost :not completely explained bydemography & innovation tolls

• No linear relation betweenexpenditure and HC gains

• Explanation has to be foundon the way HC business is run

UNECESSARY MEDICALPROCEDURES 3,8x

ADMINISTRATION &CONTROL 3,5x

INEFFICIENCY&ERRORS 2,4x

PRICESaboveCOSTS 2x

FRAUD 1,5x

POORDISEASEPREVENTION 1x

CostSpiral…

5IOM2010

• Services arecentered on medicalspecialities,instead of patientneeds

• Focus is on outcomes perceived by doctors,much less on patient(consumer)health care statusperceived by patients

• Care is provided indispersed care centres,instead of highvolume&performing specialized units

• Focus has been on volume&on paying perprocedure,not inhealth value created forpatients

asaresult.....

• EVER- GROWINGHEALTH

CAREEXPENDITURE

• HEALTHCAREWASTE+20%

• QUALITY&SAFETYISSUES

• INSATISFACTION

Traditional Healthcare Organization

MedicineEvolution...

Hartzband,NEJM2010

• AGEING• CHRONICDISEASES– newpattern• POVERTY- asymetries• INDIVIDUAL&SOCIALEXIGENCE• POTENCIALforLITIGATION

agenda...

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1. InnovationiscrucialtotheHealthCare

change

2. WhatkindofInnovation?

3. Innovationisneeded,butisitaffordable?

4. Succeedingataffordableinnovation

Innovation is crucialtoHealth Care...

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• HealthcarehasexperiencedanexplosionofinnovationsoDrugso ImagediagnosisoGenomeandpersonalisedMedicineoDigitaltransformation

• HealthcaresystemsfacesunprecedentedchallengetoChange:oReduceErrorso LowerCostsoReducewaste

COMPLEXITY:o Ageingof“babyboomers”o ChronicDiseaseso CostSpiralandFinanceConstraint

Under our present system, just doing our best, or working harder will not be enough. Healthcare industry is on the brink of a massive change: INNOVATION !

Innovation

“the design, invention, development, and or implementation of newor altered products, services, processes, systems, organizationalstructures, or business models for the purpose of creating new valuefor customers and financial returns for the firm.” John Haughom 2017

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Invention- invention isatotallyuniqueor noveldevice,method,compositionorprocess.Innovation- innovationisoftenalsoviewed astheapplicationofbettersolutions thatmeetnewrequirements,unarticulatedneeds,orexisting market needs.

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TYPESINNOVATION

Disruptiveinnovations

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© Jim Hagemann Snabe

A new Season!

“The Innovators Dilemma"

“Only the paranoid survive”, 1996 Andy Grove

• 10x change in an element of the business• What worked before doesn’t work now• The executives are the last to know

Inflection Point

1997 Clayton M. Christensen

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Yearsoflifegained,1970- 2000

Littlerelationbetweenmoney

spentinresearchandtranslatedhealth

benefits– exceptC&V

Moredisruptiveinnovationisneeded!

Areas…•PersonalizedMedicine•DigitalMedicine• Technologyenabledcare•NewBusinessModels

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Fast! •Genomics• OrganReplacement

• Imaging• Sensors

• Robotics

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• 65%transactionsinHealthcarewillbemobile2018• MobileAppstorelatewithpatients• RemoteMonitoring• BigData• ArtificialIntelligence• PrecisionMedicine

Moore’sLaw

Trangenic – Chimeric Animalorgans forHuman Transplants

Heartmate artificial heart

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• Affordabilityisthekeytoaccessibility– ex.genericdrugstotreatAfrica’sAIDS.

• Affordabilityneeds“thinkingoutofthebox”andstimulatecreativity

• Innovationshouldgohand- in-handwithitsownaffordability:

“It is only when the benefits of research reaches the person on thelowest rung of the economic ladder that it can be considered asdelivering true value”. K. Mazumdar-Shaw 2018

TheEthicsofInnovation…

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"Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr. Shetty says. "What health care needs is process innovation, not product innovation."

The Wall St JournaslThe Henry Ford of Heart SurgeryIn India, a Factory Model for Hospitals Is Cutting Costs and Yielding ProfitsBy Geeta AnandUpdated Nov. 25, 2009 12:01 a.m. ET

NarayanaHealth,Dr,DeviShetty

TECHNOLOGY&ECONOMYOFSCALE=Qualitythat’saffordable

19QUALITY– SCALEECONOMY– LOWCOST=VALUE

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Technicalandbusinessevolvedatdifferentpace

I am convinced that the great innovator solutions for surgery or medicine will come from now by changing the way we manage and organize our clinical work, namely around performance safety and quality programs

Europe2020– forahealthierEU

• Promotinggoodhealthisanintegralpartof Europe2020• Keepingpeoplehealthyandactiveforlongerhasapositiveimpactonproductivityandcompetitiveness

• Innovationcanhelpmakethehealthcaresectormoresustainableandfindnewcuresforhealthconditions

• Thehealthcaresectorhasanimportantroletoplayinimprovingskillsandcreatingjobsasitemploys1in10ofthemostqualifiedworkersintheEU

• Withaprojected45%increaseinthenumberofpeopleaged65andoverinthenext20years,financingrisinghealthcarecostsandaccesstoadignifiedandindependentlifefortheagingpopulationwillbecentraltothepoliticaldebate.

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1. Innovation Union• active and healthy ageing

2. Digitalagenda• e-HEALTHand m-HEALTH• Health records• Ambient assisted living

3. Newskils and jobs– health care workforce4. Platform against Poverty

Why is Innovation cost – effectiveWhy is it so badly needed ?

• Traditional Doctor &Hospitaltreatments:curative rather than preventive• Payed forfull bed occupation and medicalact• Noone is payed forahealthy patient – lack of disease• Technical Innovation costs lots of money – not easily translated inresults• Anew and innovative businesssolution is needed forHealthcare• What type of Innovation ?– disruptive !• Directed tochange Healthcare businessmodel

NewYorkTimes2010innovating Health Care Methods

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Payingforhealth,notdisease…

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CGulbenkian

ProfF.Fonseca

Insimpleterms,arewewillingtopayforeachtimethecargoestorepair,orforatotalyrepairedcar?

We arewilling topay foracompletely treated pt,back tohis normallife.NOTFORREPEATEDINTERVENTIONS!

And we want toknow the totalcost foreach treated pt =VALUE

MichaelPorterHarvardBusinessSchool

The new initiative !Value-based Healthcare

Monitoring,Acting and Analysing Outcomes &Costs toincrease HCVALUE...

• Improving health outcomes• Reducing health care costs• USINGBOTHINCOMBINATION

TheSolution…

Burdendiseases(47)ClinicalpathwaysOutcomeassessment&reportingStandardsetdisseminationFinalcostassessment

VALUEfor

PATIENTS

•DIAGNOSIS

•HOSPITALPHASE

•RECOVERY(intermediate term)

•SUSTAINABILITY(long term)

ICHOMmethodology

INHOSPITALSurvival

Complications

RECOVERYTimetoRecoverComplicationsMedicalErrors

HCSUSTAINABILITYPERMANENTFUNCTION

RECURRENCESSEQUELAE

REINTERVENTIONS

OUTCOMES:SurvivalPain

ComplicationsLOSReadmissions

ES

FunctionTimetoRecover

LateComplicationsInfection

ES

REPORTEDOutcomesSENSORS

TELEMONITORING

Clinical Pathway forHIP&KNEEosteoarthritisExample

CoLA

B

Posturography &electromyographyVertebralMetrics ®

Quaresma GeGamboa H- FCT

Sensor– outcome detection

Value4Health.CoLAB- FCT

Telemonitorization

DATA….• PATIENTREPORTEDOUTCOMES

ATREGULARINTERVALS• PATIENTFOLLOW-UPDATA• TREATMENTCOSTS

PRECISIONMEDICINEPREVENTIVECARE

CLINICDECISIONALGORYTHMSARTIFICIALINTELLIGENCE

Big Data

TREATMENTMODALITIES

PROSTATICCANCER

BRACHITHERAPY

PROTONBEAM

ROBOTICPROSTATECTOMY

BENCHMARKINGFORLOCALIZEDPROSTATICCANCER

“allorganizationsrequireonecorecompetency:innovation.”PETERDRUCKER

Theaggressiverateofchangefacinghealthcarecallsforleaderswhounderstandandpossessthiskeycompetency,andknowhowtoinstillitthroughouttheirrespectiveorganizations. 32

HowshallwetreatdiseasesintheFuture

qTodayweareobsessedwithfixingdiseasewithgenerictherapy.qImagineifwedon’tgetsick.qImaginewepreventdiseasebecausewedoDNAanalysis.qWecertainlywillhavesensors,sothatweseethingsandpredictthingsbeforeit’stoolate.

qIfwedohavetofixadisease,wedoitindividuallybecauseweunderstandtheindividualpatient’sindividualsituation.

qWetreateachoneaccordingtohisGenesinapersonalizedway

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• FUSEDIGITALWITHPHYSICALANDINVOLVEHUMANS• REINVENTOPERATIONS&HCLOGISTICS• INTERACTIONSWITHCUSTOMERS• CHANGETHEINTIREBUSINESSMODEL

JimSnabe 2017

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THEFUTUREOFINNOVATION…

DIGITAL• ArtificialIntelligence• Robotics• 3Dprinting

HUMAN• Sensitivity- humanity• Creativity• Recoverystrategies

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THEFUTUREOFINNOVATION…

DETAILSDREAMS

© Jim Hagemann Snabe

..and Details

”Details matter. It’s worthwaiting for to get it right”

Steve Jobs

© Jim Hagemann Snabe

Dreams…

” I believe that this nation shouldcommit itself to achieving the

goal, before this decade is out, of landing a man on the Moon and

returning him safely to the Earth.”

J. F. Kennedy

Leadership!

Keeping the right focus...• Because it had neverrealized that his businesswas not FILM, rather, itwas IMAGE…

•We will also fail if we missto incorporate AFFORDABLEINNOVATION strategies inthe Health Care Equation.

WHYDIDKODAKBROKE ?

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OBRIGADO!

jigfragata@gmail.com