A Real Time Lab for Pan Canadian Innovation Leveraging Canadian Blood Services Model for Better Value to Health care Systems

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1 A Real Time Lab for Pan Canadian Innovation Leveraging Canadian Blood Services Model for Better Value to Health care Systems November 14, 2014

2 Submission to the Advisory Panel on Health Care Innovation 1 1. Introduction Canadian Blood Services is an essential partner in Canada s health care systems and a leader in providing collaborative, responsive products and services supporting better patient outcomes across the country. Since 1998, it has been engaged in something much talked about today as an innovation to bring better value to health system funders and tax payers: sustainable, accountable, pan Canadian, cost shared service delivery. Canadian Blood Services was created in response to the inquiry led by Justice Horace Krever into the tainted blood tragedy the largest public health catastrophe in the country s history. In the wake of the Krever Commission, the organization was given the mandate for a national blood system that assures access to a safe, secure and affordable supply of blood, blood products and their alternatives. Since then, it has transformed a fragmented system into a pan Canadian biologics manufacturer and distributor worthy of the trust of the public, blood donors, funders, and health care providers. Today, Canadian Blood Services manages the national supply of blood, blood products, stem cells and related services for all provinces and territories (except Quebec) and is building Canada s first national public umbilical cord blood bank. It also leads an integrated, national system for organ donation and transplantation and provides essential leading practice and public awareness services for tissue donation and transplantation. Provincially and territorially funded and federally regulated, it is dedicated to improving patient outcomes through the manufacturing and delivery of safe, appropriate, and high quality products and services to Canadians. In a sense, Canadian Blood Services itself is a real time laboratory for innovation in both effective pan Canadian service delivery and interprovincial collaboration. Indeed, its success validates federal, provincial and territorial (FPT) governments ground breaking decision some 16 years ago to structure the arm s length blood system as it did, in a manner that puts patient outcomes first and facilitates organizational accountability and excellence. It is the organization s experience that where there are specific problems like a broken blood system or a chronic shortage of organs for transplant, sustained partnerships that cut across multiple sectors can and do bring much needed change in practice, structure and culture for the benefit of patients. Canadian Blood Services wishes to share some of its key experiences in the hope that they can spark innovation in other areas of healthcare that would also benefit from a sustained pan Canadian approach. 2. Pan Canadian Governance, National Service Delivery, and Sustained Public Involvement: Catalysts for Innovation Canadian Blood Services experience revolves around pan Canadian health care service delivery. Delivering products and services across the country presents a unique and complex set of challenges: jurisdictional and intergovernmental, demographic, geographic, and economic. The delivery of health care services is the purview of provincial and territorial governments and the diversity of approaches taken by them in addressing patients health needs reflects their priorities and constraints.

3 2 Innovation Panel Submission Governance: Canadian Blood Services arm s length governance model works within this challenging landscape because it balances ministerial accountability with the autonomy necessary to ensure a safe, secure and effective blood system. While the governance model itself is innovative and remains unique in the Canadian landscape it provides a catalyst for further change by creating conditions that make long term collaboration in support of a national mandate a reality. Within this model, PT ministers of health act as corporate members and appoint the organization s board of directors, approve corporate plans and provide annual budgets. Health Canada regulates Canadian Blood Services operations and provides funding for research and development activities, as well as for certain organ and tissue donation and transplantation programs while the interprovincial system is maturing. The board of directors is responsible for the overall direction of the affairs, operational activities and budget for the organization and for reporting on Canadian Blood Services performance to corporate members. The province of Quebec is not a member of Canadian Blood Services and has its own blood system. National Service Delivery: By leveraging the pan Canadian collaboration made possible by its governance model, Canadian Blood Services transformed and consolidated the fractured and dysfunctional national blood system inherited from the Canadian Red Cross Society. This involved collaborating with governments, patient groups, health authorities and clinicians across the country as each step of the transformation took place. As it did this and in light of its incremental successes government funders, stakeholders, the Board of Directors and executive management saw that its national service delivery platform could be leveraged to deliver other customized solutions for specific issues common to health systems across the country. Today, these solutions include: creating and managing three interprovincial patient registries and related programs that facilitate organ transplantation (now collectively referred to as the Canadian Transplant Registry); building Canada s first national public umbilical cord blood bank and operating the OneMatch Stem Cell and Marrow Network; and, bulk purchasing of vital plasma derived pharmaceuticals via a public tender process that balances national security of supply with product choice and cost efficiency. Within these areas of business there were (and are) many challenges to overcome, such as: how to standardize referral criteria from PT health systems when adding patients to organ transplantation waitlists and respect privacy laws across the country; achieving optimal approaches to capturing data on how blood, plasma protein products, and organs are used in order to drive evidence based improvements across the national system; how to foster ground breaking research and leading practices in transplantation and transfusion medicine (in , Canadian Blood Services undertook a major reorganization and created a Centre for Innovation focused on research and development.) Public Involvement: Over the years, to help mitigate these and other challenges and build the consensus needed for change, Canadian Blood Services has developed an extensive capacity for public involvement and consultation on local, regional, national and international bases. Public involvement was a key recommendation of the Krever Commission and one that continues to inform

4 Submission to the Advisory Panel on Health Care Innovation 3 decision making at Canadian Blood Services. 1 This has been a major success factor in establishing and maintaining a cohesive and responsive national system for blood, and is essential in continuing to mature the pan Canadian programs for stem cells and organ and tissue donation and transplantation. 3. Evidence of Value The following are only two examples of the value the Canadian Blood Services model brings to healthcare systems: a) Pan Canadian Bulk Purchasing of Plasma derived Drugs While Canadian Blood Services role in collecting and distributing blood components is relatively well known, few are aware that it also manages a drug portfolio valued at $500 million per year on behalf of PT governments and has sole responsibility for tendering and procuring over 35 biological drugs (plasma protein products). In fact, PT governments are benefiting from the organization s recent success in negotiating $600 million in savings over five years ( to ) through bulk purchasing plasma derived drugs a testament to the value of its pan Canadian buying power. Moreover, it has been able to maintain both product diversity and security of supply. For many patients, plasma protein products are crucial, lifesaving therapies with no alternatives. b) Canadian Transplant Registry In 2008, FPT governments (except Quebec) recognized the need for improvements in the country s organ and tissue donation and transplantation systems. Together, they affirmed Canadian Blood Services as an exemplar of collaboration and innovation by giving the organization a mandate to conduct activities related to developing a strategic plan for a nationally coordinated system; leading practices, professional education and knowledge translation, and public education; and, system performance improvement. The mandate also involved developing and maintaining three interprovincial patient registries for organ transplantation: the Living Donor Paired Exchange, the National Organ Waitlist, and the Highly Sensitized Patient program. Today, the three registries are now more accurately described as a single Canadian Transplant Registry that serves three interprovincial programs for organ listing and sharing: the Living Donor Paired Exchange (now renamed the Kidney Paired Donation program), the National Organ Waitlist, and the Highly Sensitized Patient program. These programs are guided by interprovincial policy and informed by evidence based leading practices developed collaboratively across the country. Point ofservice data from program activity is exchanged with the web based Canadian Transplant Registry, which will ensure that system reporting is timely and available going forward. The Quebec government also participates through a separate agreement with Canadian Blood Services, making this a truly national endeavour. Today, more than 100 leading transplant practitioners across Canada with support from Canadian Blood Services experts, as well as from organ procurement 1 According to Krever, The public must have access to information about the policy, management and operations of the blood supply system and be represented in the decision making. Justice Horace Krever, Commission of Inquiry on the Blood System in Canada Final Report Volume Three, November, 1997, p

5 4 Innovation Panel Submission organizations and PT health ministries work together to bring greater transparency and traceability to the interprovincial processes for managing waitlists and sharing organs. Kidney Paired Donation program: Extends the transplant possibilities for prospective kidney recipients who have willing but incompatible donors. The program enables matches among multiple donor recipient pairs, as well as anonymous non paired donors, making possible domino chains of kidney exchanges. By the end of September 2014, the program has facilitated more than 300 kidney transplants across the country. In addition to saving lives, each of those transplants avoids about $50,000/year per patient net related to dialysis and ancillary costs. 4. A Federal Role in Innovation In addition to health care transfers to PT governments to help fund essential services like the national blood system, there are other significant roles the federal government can play in health care innovation, such as a national policy role or by making targeted investments. In 1997, the federal government and PT ministries of health signed a Memorandum of Understanding that created a National Blood Authority, which a year later became Canadian Blood Services. This was a major pan Canadian policy decision involving substantial federal leadership. Over the past 16 years, it has resulted in ongoing value to jurisdictional health systems by providing standardized, lifesaving blood products for Canadian patients, no matter where in the country they live. Health Canada has provided similar leadership on organ and tissue donation and transplantation (OTDT) with its previous support for the Canadian Centre for Donation and Transplantation, which was merged with Canadian Blood Services in On this front, Health Canada was instrumental in implementing a model of interprovincial collaboration particularly in the field of organ sharing by taking part in a five year FPT agreement to co fund a new national OTDT system for Canada. In September of 2014, building on continued discussions with PT officials and Canadian Blood Services, Health Canada renewed its support to continue building the national OTDT system being created under the organization s auspices. Canadian Blood Services acknowledges Health Canada s role in facilitating dialogue within FPT circles to highlight the need for a public cord blood bank in Canada. Currently, there are nearly 1,000 patients waiting for a lifesaving stem cell transplant a number that s tripled over the past five years. The building of Canada s national public cord blood bank will improve the chances of finding matches for ethnically diverse Canadian patients in need. With the funding support of PT governments and Canadian Blood Services For All Canadians fund raising campaign, a national cord blood bank with partner hospitals in Ottawa, Brampton, Edmonton and Vancouver is well underway. Equally important is the ongoing funding Health Canada has provided to the Canadian Blood Services Centre for Innovation, which is matched in total by the organization s corporate members. Through the Centre, Canadian Blood Services plays a unique pan Canadian role across the spectrum of blood transfusion medicine, including discovery, development and clinical research a role that maximizes knowledge transfer by providing a national voice. The Centre allocates information, expertise and funding across three interrelated areas benefiting all member jurisdictions: research (targeted to improve the safety and quality of blood products); development (applied process and product

6 Submission to the Advisory Panel on Health Care Innovation 5 development driven by research findings and the needs of the national blood system); and knowledge mobilization (acquiring, evolving and translating knowledge in Canada and internationally to advance patient care and help shape policy and clinical practice). On behalf of the broad spectrum of stakeholders it serves, Canadian Blood Services appreciates Health Canada s ongoing funding of its OTDT and research and development programs, as well as the collaborative policy decisions that have helped enable other aspects of its work. 5. Conclusion Through the national blood system and its related programs, Canadian Blood Services delivers products and services that allow provinces and territories to do more together than they can alone. By supporting the creation of Canadian Blood Services in 1998 and continuing to fund selected programs, the federal government has been and continues to be, a key enabler of this ongoing pan Canadian collaboration. The result has been a substantively positive change for the benefit of Canadian patients in the delivery of blood and blood products, as well as stem cells and organs for transplantation. While much has been accomplished, more can be done together by continuing to build on existing investments in health systems. There is no singular approach, however, to innovative interjurisdictional collaboration. Canadian Blood Services has developed multiple collaborative models that vary from operating a virtual monopoly (in blood) to operating in a more federated network (in OTDT) and in providing specific, customized services to certain health care stakeholders (bulk purchasing of plasma derived pharmaceuticals to treat hemophelia and other blood disorders; the creation of a national umbilical cord blood bank to help build a greater, more ethnically diverse supply of stem cells for transplant in Canada). According to respected health journalist and author André Picard in a 2013 report by the Conference Board of Canada, Canadian Blood Services has created a national health care delivery model that retains provincial control. This is what Canadians should expect on a grander scale a multijurisdictional, federated health care system. There is no constitutional barrier to using this approach, and many benefits to be derived from doing so. It s a concrete demonstration that transformation is possible. 2 No argument is being made here that the Canadian Blood Services model is a cure all. But in its short 16 year history, the organization has acquired experience that can be leveraged nationally and regionally for other health system challenges. Seen through this lens, innovation is about doing things differently and setting up conditions for success, in this case, through pan Canadian collaboration making the whole more than the sum of the parts. Canadian Blood Services welcomes the opportunity to share its experience in more detail with the panel. 2 Andre Picard, The Path to Healthcare Reform: Policy and Politics (Conference Board of Canada, 2013), p. 113.

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