Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian:...
Transcript of Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian:...
Value in Health Care
Ghassan Hamadeh, MD, CPE
Professor & Chair, Family Medicine, American University of Beirut
Chief Medical Information Officer, AUBMC
Founding President, ISPOR Lebanon Chapter (LSPOR)
Disclosure
• American University of Beirut Medical Center
• Non Governmental Organizations: LSPOR, Majmoua, CHC
• WHO, MOH: primary health care, rational prescribing, practice guidelines, value based contracting
• Pharma: Occasional speaker on drug quality
Value in Health
• From Quality to Value:
• Interpreting Data:
• What do WE need to do:
From Quality to Value
• Donabedian: Evaluating the quality of medical care (1966)
• AHRQ (1989), NCQA (1990), VA NSQIP (1994)
• Institute of Medicine:• “the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (1996)
• Gaps, variations in care delivery (JAMA Sep 1998) • To Err is Human (1999), • Crossing the quality chasm (2001): 6 goals
• STEEEP: Safe, Timely, Effective, Efficient, Equitable, Patient Centered
• Best Care at lower cost (2013)
• Other US initiatives:• PQRS (2006), IHI Triple Aim (2008), ACO (2011), CMS Value based
payments (2012)….. Population health, Reducing costs and Improving patient experience
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st Century Committee on Quality of Health Care in America,
ed. Washington, DC: N.A. Press; 2001.
Value Definition
Given a “desired” quality, the value of a “health product” is:
• Desirability (“what matters”)• Depends on perspective
• Individual patient, politician, population, physician, pharma, production
QALYs / $$ is a very rough approximation
Value Definition
WarningQALYs / $$ is a very rough approximation
Value in Health
• From Quality to Value: Quality is not enough
• Interpreting Data: The illusion of rationalism
• What do WE need to do:
Interpreting DataHow what matters clouds facts
• People often swayed by anecdotes
• People are often “victims” of:• Biases
• Optimistic Bias: We believe we have substantial control of our lives.
• Confirmation Bias: All evidence confirms one’s belief
• Aversion to perceived loss: • we fear loss more than value gains, so we
tend to interpret evidence in that scope
Interpreting DataDecisions are made by people
https://icer-review.org/wp-content/uploads/2016/06/icer_multiple_myeloma_v4.pdf
Value in Health
• From Quality to Value: Quality is not enough
• Interpreting Data: The illusion of rationalism
• What do WE need to do:
it is about sociology
What can we doReorganize practice / service delivery
TECHNOLOGY
1. Build and enable information technology platforms
2. Identify waste
3. Measure outcomes and costs for every patient
SOCIOLOGY
4. Change behavior
5. Reorganize care around patient medical conditions
6. New forms for care payments
HBR – October 2013
Identify Health Care Waste
Tests
Imaging
Change BehaviorChoosing Wisely
What have “we” triedReorganize practice / service delivery
• Train physicians and public sector officials• LSPOR activities, World Bank projects
• Ask pharma to provide the “data” not the anecdotes• Devastating diseases committee using NICE guidelines
• VBP model tested in hospital beds• World Bank funded project
• Value Based Contracting in PHC with packages and services towards UHC
• New drug pricing models • Managed Agreements
What can “we” tryInnovative Pricing Models
• Outcomes-based pricing• If outcome not reached -> rebate is given or full payment not made
• Indication-based pricing• 2 drugs with same INN can have 2 prices for different indications
• E.g. Sildenafil for Pul HT and ED
• Drug mortgages• Pay for a short life saving course in installments over a life time
• Drug licenses• License a drug for life or a specific duration as much as you would need from it
Sachs et. al. Innovative Contracting for Pharmaceuticals and Medicaid's Best-Price Rule. J Health Polit Policy Law. 2018 Feb 1;43(1):5-18.
Value in Health
• From Quality to Value: Quality is not enough
• Interpreting Data: The illusion of rationalism
• What do WE need to do: it is about sociology and not technology
Thank you