Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian:...

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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)

Transcript of Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian:...

Page 1: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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)

Page 2: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 3: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Value in Health

• From Quality to Value:

• Interpreting Data:

• What do WE need to do:

Page 4: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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.

Page 5: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 6: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Value Definition

WarningQALYs / $$ is a very rough approximation

Page 7: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Value in Health

• From Quality to Value: Quality is not enough

• Interpreting Data: The illusion of rationalism

• What do WE need to do:

Page 8: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 9: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Interpreting DataDecisions are made by people

https://icer-review.org/wp-content/uploads/2016/06/icer_multiple_myeloma_v4.pdf

Page 10: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 11: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 12: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Identify Health Care Waste

Tests

Imaging

Page 13: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Change BehaviorChoosing Wisely

Page 14: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 15: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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.

Page 16: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

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

Page 17: Value in Health Care - Health Insight Forum in Healthcare.pdfFrom Quality to Value •Donabedian: Evaluating the quality of medical care (1966) •AHRQ (1989), NCQA (1990), VA NSQIP

Thank you