IVBAR. Value based reimbursement and initiatives in Sweden. Jonas Wohlin CEO, IVBAR The Institute for Value- Based Reimbursement

Transcription

1 IVBAR The Institute for Value- Based Reimbursement Value based reimbursement and initiatives in Sweden Jonas Wohlin CEO, IVBAR

2 IVBAR Agenda What is value based health care? What is value based reimbursement? Case examples from Sweden Background: Health Care landscape in Sweden 1) Value based Health Care implementation at 3 large university hospitals 2) Reimbursement model for Hip/Knee replacement in Stockholm County 3) Reimbursement model for Spine surgery in Stockholm County 4) SVEUS National collaboration for development of value based reimbursement and monitoring systems 2

3 IVBAR Background (significantly simplified) Health care constantly developing/improving Good However Cost increasing faster than GDP in most countries and Major variations in methods, health outcomes and cost between providers, health systems and countries Slow diffusion of best practice Rationing or Improved efficiency Potential for improvement 3

4 IVBAR What is Value Based Health Care? Goals Access Quality Cost containment Better Integration Patient safety Patient satisfaction Etc. Value= Health Outcomes Cost on patient level Lack of clarity? Conflicting goals? Difficult to unite around? 4

5 IVBAR Consequenses of value-based health care 1. Segment patients into groups with similar needs 2. Define patient relevant health outcomes for each group 3. Secure ability to monitor health outcomes and cost for each patient group 4. Organise care to maximize value for each group 5. Organise steering models to enable & stimulate value development 5

6 Challenges with current steering models IVBAR Care process Care Activity How much health care do we get for the money we invest DKK Care activity with Complication How much health do we get for the money we invest Productivity vs efficiency focus 6

7 Bundle payment for episode of care IVBAR Sick pat Initial visit Operation Post-op Follow-up / Rehab Healthier pat complication Bundled price = DKK 7

8 IVBAR Agenda What is value based health care? What is value based reimbursement? Case examples from Sweden Background: Health Care landscape in Sweden 1) Value based Health Care implementation at 3 large university hospitals 2) Reimbursement model for Hip/Knee replacement in Stockholm County 3) Reimbursement model for Spine surgery in Stockholm County 4) SVEUS National collaboration for development of value based reimbursement and monitoring systems 8

9 IVBAR Health Care in Sweden brief overview Overview 21 county councils inhabitants Health Care spend as % of GDP Universal coverage & tax financed Taxes levied by county councils 17% from government +17% 9,1 Public and private providers 7,8 Large variation in reimbursement models set by counties Mix of block budgets, capitation, DRG, fee-forservice, often with P4P components Source: OECD StatExtracts 9

10 IVBAR Extensive but fragmented follow-up of health system performance difficult to measure value Quality registries Medical associations Grass-roots driven Participation voluntary Varying coverage National databases Social Insurance Agency Sick leave Statistics Sweden Demographic data needed for casemix adjustment Value? County council databases Patient Administrative Systems (claims data) Production data including diagnoses and procedures Prescribed drugs Electronic Patient Records (in some cases) Municipalities Health care and nursing data 10

11 IVBAR Regional and local trends in Sweden Increased transparency around health outcomes Registry data on provider level available to the public Open comparisons published by the Increased public attention to differences in access and outcomes Public media attention and debate around Health care quality and access Tax-payers push for more quality and patientcentric Health Care Providers and payers are reorganizing to focus on patient value Steering models models critizised Focus on productivity as the measure of performance by payers being criticized Increased acceptance that present systems cause barriers to innovation due to focus on activities 11

12 CASE 1) VBHC initiatives at 3 university hospitals Traditional improvement project Process development at the organizational unit, primarily focusing on: Clinical guidelines Increased productivity IVBAR Department Process development Improvement project based on value based health care Definition of approx. 300 patient groups with similar needs Definition of relevant health outcomes and measurement methods Process development based on patient groups, across departments, primarily focusing on Improved health Low resource consumption in relation to health benefits achieved Karolinska University Hospital, Sahlgrenska Hospital and Uppsala Akademiska Hospital 12

13 Case 2) Bundle payment for Total hip/knee replacement in Stockholm IVBAR Context and approach Experienced effects after 3 years Before 2009 THR & TKR Waiting up to two years for surgery No systematic quality control from county Providers changed how they worked to improve efficiency Benchmarking, process mapping and standardisation New manuals and checklists 2009 Introduction of bundle payment Accreditation of providers and patient free choice of provider Package price for episode of care up to five years post surgery Including complication warranty SEK per procedure Certification of personnel Extra post-op visits to Waiting times significantly reduced 26% reduced complication risk Reduced resource utilization 20% reduced cost for county Initiative created positive momentum to expand the concept of Value-based reimbursement and monitoring to other areas of Swedish healthcare Satisfied patients and providers The Complication Warranty has increased our focus on reducing complications. I have to say that it increases the quality. - Provider GM in interview 13

14 IVBAR Case 3) New reimbursement system tied to patient reported outcomes developed for spine surgery Context of development Value based bundle payment for spine surgery developed in collaboration between Stockholm county Swedish Association of Spine Surgeons IVBAR Implemented October data sources, 11 years of patient data, used as input for model VAL Care consumption, 7500 patients SWESPINE outcomes, 7500 patients Stockholm Spine Center cost per patient data, patients Concept of model Si ck p a t SEK SEK SEK / n i g h t SEK I n i t i a l vi si t O p e ra t i o n Po st -o p F o l l o w -u p / Rehab Package price incl complication warranty Outcome based reimbursement Case-mix adjustment Monitoring system IT-support system co mp l i ca t i o n Bu n d l e d p ri ce + o u t co me b a se d re i mb u rse me n t Hip/Kn ee ( ) H e a l t h i e r p a t Spine surgery 14

15 Praktisk exempel/demo Vårdepisod (valbar) Patient karakteristika (input) Faktiskt hälsoutfall (output) Förväntat hälsoutfall (predikterad fördeling) Ersättning: ersättning för varje element (bas, komplikationsgaranti, prestation) och summa

16 Nationell samverkan för värdebaserad ersättning och uppföljning i hälso- och sjukvården Swedish National collaboration for value-based reimbursement and monitoring of health care

17 CASE 4) SVEUS Development of value based reimbursement and monitoring systems for 8 disease areas Patient groups Arthrosis: hip- and knee replacement Back pain: spine surgery Obstetric care Bariatric surgery Stroke Diabetes Osteoporosis Breast cancer Deliverables I Baseline analysis of value II (Including benchmarking) Value based monitoring systems III Value based reimbursement system Involved stakeholders (>50 organisations) County councils Stockholm Västra Götaland Skåne Östergötland Uppsala Dalarna Jämtland Other collaboration partners Ministry of Health and Social Affairs National Medical associations Quality registries Patient associations SALAR IVBAR Karolinska Institutet And others. ~70% of Swedish population

18 CASE 3) What does SVEUS enable? Combining data sources PAS PAS PAS Quality Quality registries Quality registries registries Försäkringskassan Socialstyrelsen SCB SVEUS Rulebooks enables features such as Continuous monitoring and feedback of Baseline patient characteristics Process measures/ cost measures Outcome measures Benchmarking between providers and counties (countries?) With case-mix adjustment Deviation reports Reimbursement management.

19 Case 3) SVEUS adress a significant proportion of Swedish burden of disease Patientgroup/ Therapy area Yearly burden of disease SEK Billions ROUGH ESTIMATE Spine ~35 Stroke ~18 Diabetes ~16 Osteoporosis Obesity ~15 ~15 Yearly burden of disease in range of ~12-14 EUR Billion Arthrosis ~12 Obstetrics ~3 Breast cancer ~2 Total ~ Källa: SVEUS Förstudie; SBU (Statens beredning för medicinsk utvärdering) 1995 (översikt ryggsmärtor omräknat till 2014 år penningvärde); SBU 2003 för Obesitas; Schmidt A, Husberg M och Berntfors L. Samhällsekonomiska kostnader för reumatiska sjukdomar

20 Main take-aways Value in health care is patient relevant health outcomes in relation to cost of achieving those outcomes Value based steering means Monitoring systems that focus on outcomes and cost of achieving those outcomes Reimbursement systems that enables & stimulates improved outcomes and reduced cost Three of Sweden s university hospitals are running major VBHCprojects Sveus is an initiative to develop value based steering models Source: 20

21 Conference on value based healthcare in Copenhagen November 24 Teaching on Value Based Health care by Professor Michael Porter, Harvard Business School Arranged by Danish Regions and IVBAR Tickets available at Source: 21

22 IVBAR Thank you!