Integration and patient power

Integration and patient power

Dr Mark Britnell Chairman and Partner KPMG’s Global Health Practice

@markbritnell

1 © 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?


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.


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%

Maj

or c

ost

redu

ctio

n

Lean

or o

ther

im

prov

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t m

etho

ds

Dev

elop

ing

new

w

orkf

orce

mod

els

Inco

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grow

th f

rom

ex

istin

g pa

yers

Mer

gers

Acq

uisi

tions

of

othe

r hos

pita

ls

Acq

uisi

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of

othe

r pro

vide

r typ

es

Ver

tical

inte

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ion

Ent

ry in

to n

ew

mar

kets

in

the

coun

try

Exp

ansi

on in

to

over

seas

mar

kets

Focu

s &

sp

ecia

lizat

ion

Inve

stm

ent i

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IT

% o

f res

pons

es:

'Lik

ely'

or '

Ver

y Li

kely

'

"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


"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"


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

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

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

Crohn’s & Colitis Foundation of America

Families USA

American Cancer Society

Childbirth connection

Canadian Cancer Survivor Network

Canadian Diabetes

Association

healthexperiences.ca

Canadian Breast Cancer Network / Reseau Canadien du Cancer du Sein

ABRA SUS

Nederlandse Diabetes

Vereniging

Crohn en Colitis Ulcerosa Vereniging

Nederland

European Patients Forum National Voices

National Childbirth Trust

Macmillan Cancer Support

Hong Kong Breast Cancer

Foundation Diabetes Hong Kong

Dutch Patients & Consumers Organisation

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

Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama

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

www.kpmg.com/whatworks

http://www.kpmg.com/whatworks

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 centreed 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

mat

urity

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

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© 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.

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Integration and patient power