Documente Academic
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Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
In 2008 a leading Swedish industrialist Carl Bennet gathered the 50 most senior leaders from
Payers/providers, from Academia and Industry to discuss the situation and propose actions to Government.
Aug 18 2009 the same group was invited to discuss a concrete proposal and plan for action. In preparation a
BCG team was commissioned to assess the potential importance of Sweden's quality and patient registries.
The team formulated a 10 year vision, translated this into a concrete governance model and a 10 year
implementation plan. The project was jointly sponsored by AstraZeneca and Carl Bennet AB and executed
during 10 weeks May-July, 2009
A central insight in the project is that Health care in the Western countries needs transformational change in
order to improve productivity and secure that the broader population can get access to high quality care and
innovation. This transformation will not be successful if the motivation for clinical staff is efficiency and cost
containment. In order to mobilize the base of the pyramid in the transformational efforts the focus has to be
the quality of care for the patients.
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Executive summary
Providing high quality healthcare at reasonable cost is one of the most pressing issues facing
industrialized countries today
Unsustainable growth in spend across countries, exacerbated by current downturn
Sweden with additional challenge from drop in clinical research and healthcare industry activity
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Emerging health care "value paradigm" will increase industry productivity by focusing on outcomes/cost
Cost-focus needs to be coupled with focus on outcomes to secure strong engagement by practicing
clinicians in the required industry transformation
Sweden with ~5 year head-start in new paradigm due to unique quality and patient registries
With shared vision and a coherent national strategy, Sweden could build world-leading platform in valuebased healthcare within 10 years
Positive and strong incentives to develop effective care for patients through transparency on performance
Increasing clinical demand for innovation to improve care performance will enhance "translational" links
between basic research and clinical practice
Platform for industry to develop and test products meeting market requirements for healthcare productivity
and safety
Swift action needed to leverage ~5 year window of opportunity
Leadership by state and counties to define national strategy and provide seed financing
Participation of all key stakeholders in defining policies, executing the strategy and realizing the vision
Build national platform for quality registries while maintaining strong sense of ownership among clinicians
Value guided healthcare_Final Documentation_Aug09.ppt
Many stakeholders,
initiatives, projects...
Scope of study
to bring efforts together towards
common vision and roadmap
Concrete and realistic 10-year vision with
healthcare system perspective
Ambitious but tried and tested
Anchored in international outlook
Current landscape, vision and roadmap
discussed with all key stakeholders
>70 interviews
Proposal built on strengths of current model
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Preface
This material contains copies of slides prepared by members of The Boston Consulting
Group, Inc, for the seminar "Sweden as the international leader in outcome based
healthcare", held in Gothenburg August 18th, 2009. A list of all the participants at the seminar
can be found in Appendix.
The slides are incomplete without accompanying oral commentary
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
The market and business case estimates contained in this presentation are based upon
standard methodologies using public data, market interviews and assumptions derived from
the insight gained during the project and data entrusted to The Boston Consulting Group
(BCG). BCG has not independently verified all of the data and assumptions used in these
analyses. Changes in the underlying data or operating assumptions will clearly impact the
analyses and conclusions
Agenda
Starting position
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Index
(1992=100)
300
Index
(1992=100)
300
HC Cost
300
GDP
HC Exp
GDP
200
100
1992
Wages1
1995
Index
(1992=100)
1998
2001
2004
2007
HC Cost
200
100
1992
Wages1
1995
1998
Index
(1992=100)
300
200
Wages1
GDP
2001
2004
2007
100
1992
1995
1998
Index
(1992=100)
300
2001
2004
300
HC Cost
HC Cost
200
GDP
GDP
200
1995
1998
2001
2004
2007
HC costs
200
GDP
Wages1
Wages1
100
1992
100
1992
2007
1995
1998
2001
2004
2007
Wages1
100
1992
1995
1998
2001
2004
2007
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Index
(1992=100)
Drop in
registered patents
Patents registered
at PRV (#)
600
400
# PhD students
at medical faculties1
CAGR
6,000
~-25%
+4%
300
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
4,000
400
200
-1%
2,000
200
100
Average 95-97
Average 04-08
00
01
02
03
04
05
06
07
08
90
92
94
96
98
00
02
04
06
Industrial chemistry
Organic chemistry
Biotechnology
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
1980
1990
2000
2010
Scientists
Administrators
Efficiency
Clinicians
Outcome
Cost
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Pre-1980
Value
= Value
Source: Institute of Strategy and Competitiveness, Harvard Business School; BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
10
Patients
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Academia
Industry
Unique platform for outcomes
based safety, efficacy and
pricing studies
New healthcare information
services industries
Source: BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
11
80
20
69
60
15
22 registries
Start year
of registry
10
9
40
10
13
3
5
20
8
2
0
>95%
14
00-05
2
4
1
1
05-09
1
1
2
2
1
3
1
2
95-00
90-95
85-90
4
2
1
<65%
80-85
75-80
Not
known
Patient coverage
1. Only including registries receiving funding from SKL
Source: "National Healthcare Quality Registries in Sweden 2007"; Grant applications; BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
12
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
29
# of registries
80
Short-list:
69
Cataract
Cataract
60
Gallstone
Gallstone surgery
surgery
46
45
40
24
24
30
35
17
12
17
All registries
Pain
Pain rehabilitation
rehabilitation
Rectal
Rectal cancer
cancer
Registries with
>70% coverage
Stroke
Stroke
10
4
Intensive
Intensive care
care
Rheumatoid
Rheumatoid arthritis
arthritis
19
20
Hip
Hip arthoplasty
arthoplasty
Swedeheart
Swedeheart
5
Vascular
Vascular surgery
surgery
Clinic-oriented
Patient-type oriented
Note: See Appendix for detailed registry example
Source: SKL, registry annual reports, registry grant applications to SKL; BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
13
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
28
Committed
specialists
Valid &
reliable
metrics
Atmosphere of cooperation
Evidence-based discussion
Mutual respect and team spirit
Peer pressure in joint efforts
Evidence-based approach
Strong foundation in research
Willingness to measure
4
Systematic
feedback
5
Easy-to-use
IT interface
6
Stable
financing
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
~2%
150
4%
25%
17
0.3
29
106
25
41%
50
36
35
25
0
Inpatient1
Outpatient2
Primary care3
Psychiatry4
Total
1. Analysis based on KPP-data 2. Assumptions: Share captured same as for inpatient with adjustment for clinic coverage; for registries covering outpatient care, clinic coverage is same for inpatient
and outpatient 3. Quality registries for diabetes, leg ulcer and heart failure cover primary care; assumptions: cost/patient and visit 2000 SEK, 4 visits/year for diabetes patients; cost/patient and visit
2000 SEK, 52 visits/year for leg ulcer patients; cost/patient and visit 4000 SEK, 4 visits/year for heart failure patients 4. Only existing quality register for psychiatry is eating disorder; assumption
cost/patient and year 200000 SEK; 1355 patient registered in RIKST 2007
Note: Not including cost of pharmaceuticals, dental care, political activities and restructuring activities
Source: KPP-database; SKL; annual reports for quality registries, grant applications to SKL; BCG analysis and estimates
Value guided healthcare_Final Documentation_Aug09.ppt
15
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
100
25%
00 Ungroupable
01 Nervous system
02 Eye
03 Ear, Nose, Mouth And Throat
04 Respiratory System
05 Circulatory System
06 Digestive System
07 Hepatobiliary System And Pancreas
08 Musculoskeletal System And
Connective Tissue
09 Skin, Subcutaneous Tissue And
Breast
10 Endocrine, Nutritional And Metabolic
System
11 Kidney And Urinary Tract
12 Male Reproductive System
13 Female Reproductive System
14 Pregnancy, Childbirth And
Puerperium
15 Newborn And Other Neonates
16 Blood and Blood Forming Organs and
Immunological Disorders
17 Myeloproliferative DDs (Poorly
Differentiated Neoplasms)
18 Infectious and Parasitic DDs
19 Mental Diseases and Disorders
21 Injuries, Poison And Toxic Effect of
Drugs
22 Burns
23 Factors Influencing Health Status
24 Multiple Significant Trauma
30 Chest problem
90 Post-MDC
100
80
60
40
20
31
05
08
01
06
62
22
11 07 00 15 17 03 18 23 10 21 30
13 09 12
24
Total specialized inpatient healthcare cost by MDC (BSEK)
99 02
16 19
04
14
16
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Personal ID number
620510-XXXX
Epidemiology
Comparative effectiveness
Health economics
Longitudinal studies
...
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Socioeconomic data
Statistics Sweden
Genetics data
Biobanks
Other data
17
Agenda
Starting position
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
18
In the past 10 years Sweden has emerged as the leading nation in value based healthcare and personalized medicine.
Today, Swedish physicians and nurses work interactively with outcomes analysis and decision-support tools to deliver
world-class healthcare results for their patients. The Swedish healthcare system displays several unique characteristics:
Clinical researchers have access to some of the best data sources in the world. Many important clinical breakthroughs
have been made over the last years by teams integrating comprehensive clinical outcomes data with high quality data
from national population and cost registries.
Swedish patients and their relatives are empowered to make informed care choices based on the quality of care.
Outcomes information services provide transparent performance data for all providers in the country.
Sweden is the fastest nation in the world in making valuable new drugs available to their population. The Swedish
MPA (LV); the Dental and Pharmaceutical Benefits Agency (TLV) and clinical research competence centers work
closely together to define how to best assess the value of conditionally registered products and efficiently determine
appropriate reimbursement levels.
Sweden is the pharmaceutical and medical technology industries' country of choice for conducting post-approval
safety, efficacy, and cost-benefit studies. This has been one of the key factors that have enabled a reinvigoration of
the Swedish life-science industry.
In addition to the clinical benefits, focusing on value based healthcare has saved the Swedish taxpayer ~50 BSEK in
reduced direct medical costs. No wonder Sweden is being flocked by researchers from other countries eager to learn how
outcomes and cost measurements can lead to world class research and clinical care.
19
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Academia
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Payers &
Providers
Patient
Best possible
outcome...
... at minimal cost
Industry
20
Payers &
Providers
Cost/capita
(SEK)
22,000
Gotland
Norrbotten
20,000
rebro
Gvleborg
Stockholm
Dalarna
Jmtland
Vrmland
Skne
18,000
Uppsala
Vstragtaland
Halland
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Vsternorrland
Vsterbotten
Kalmar
Vstmanland
Kronoberg
Jnkping
Srmland
stergtland
16,000
40
45
50
55
60
21
Example
Reduction of hip
arthroplasty re-operations
from elimination of risk
factors
Reduced amputation
frequency from
systematic selection of
patients for distal bypass
surgery
Reduction in stroke
readmission from
secondary-preventive
activities
Reduction of chronic
disease prevalence and
complications from early
identification of risk
factors
Overall medical cost
savings from adoption of
health information
technology2
Cumulative
throughout period
studied
Medical
category
Source of
saving
Annual
savings11
Surgery
Best-practice sharing
1.5 2.0%
Hip-prosthesis registry
Surgery
Prevention
1.0%
Swedvasc
Acute
Prevention
1.5 2.0%
Patientregistret /
Socialstyrelsen
Chronic conditions
Prevention
3.0%
Overall
Patient-data analysis
that supports medical
practice
3.0%
Source
Pitney Bowes /
Harvard Business
School
RAND Corporation /
The Economist
1. CAGR 2. EMRs and patient-data analysis tools Source: Hip-protesis annual report 2007; Swedvasc annual report 2007; Harvard Business School case study; The Economist April, 2009;
ppna jmfrelser 2008; BMC Health Serv Res. 2007 7:209. Bjrkdahl et al.; Riks stroke annual report 2008
Value guided healthcare_Final Documentation_Aug09.ppt
22
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Payers &
Providers
Payers &
Providers
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Halmstad hospital
23
Payers &
Providers
Starting point
Ryhov hospital ranked #31
of 47 hospitals in 2003
Actions
Staff trained on procedures
Impact
National ranking dramatically
improved:
2005
2006
2007
11
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
2003
2004
Clinical improvements:
Sphincter injury
13.7 5.6%
Perineotomy1 20% 5%
24
Academia
# of publications
50
400
Dissertations
Peer reviewed journals
Dissertations
300
18
2
2
21
200
360
44
20
212
36
30
10
25
2006
2004
2005
Short-listed registries
Cataract
Hip arthroplasty
Rheumatoid arthritis
Rectal cancer
Coronary artery disease
Gallstone surgery
Intensive care
Pain rehabilitation
Stroke
Vascular surgery
248
100
13
2003
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
40
30
30
2007
36
Potential /
year
(adding new
registries)3
1. # of publications for 10 short listed quality registries in 2007 2. Average number of publications per short-listed registry 2007 multiplied by number of registries (59)
3. Adding 31 new quality registries to capture a larger share of total HC-cost
Note: Total number of publications in clinical medicine: 4,000 / year; Total number of dissertations in medicine: 900 / year
Source: Hgskoleverket & SCB 2008, KLiniks forskning ett lyft fr sjukvrden 2009; registry annual reports, registry grant applications to SKL; BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
25
Industry
Clinical research
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Payers &
Providers
Treatment convergence
facilitates testing of new therapies
Industry
1,5
27
18
0,5
50%
of values
(separator indicates
median for sample)
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
95%
of values
2000
2001
2002
2003
2004
2005
2006
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
mj
a
mr
a
2007
1. Dipotre = measured as average change of dioptre per clinic based on individual patient data 2. CRP-C = reactive protein level in blood indicating level of inflammation. Lower level of CRP indicate
lower level of inflammation short-term as well as lower risk for inflammation long-term 3. National coverage 56% while Falun coverage is 100% for all types of RA-patients. Since 1997 Falun has
measured and followed-up all its RA-patients on a monthly basis. Data has been used for regional quality work.
Source: Cataract Annual Report 2007; RA Annual Report 2008-09
Value guided healthcare_Final Documentation_Aug09.ppt
27
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
36
Payers &
Providers
Academia
Industry
MSEK
50
30
20
10
applied
research
funding
Academia
Public funding
direct
registry
funding
Industry
28
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
40
20
Electronic health
records
15
5-7 years
10
Health-information
exchanges
5
2011
2013
2015
Patient-data analysis
supporting medical
practice and drug
research
2017
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
BUSD
0
2009
European examples
Source: "National Healthcare Quality Registries in Sweden 2007", CSC Healthcare; The Economist, BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
29
Agenda
Starting position
Shared vision and value gained
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Way forward
Governance model
Business case
Roadmap and milestones
Appendix
30
All registries patient and disease focused capturing outcomes over care-cycle across provider
organizations
All registries used to identify quality of care best practice and drive continuous improvements
of care. Data use for academic and industrial studies is at the discretion of registry leaders
Better data usage and registry support through shared resources with expertise and tools
Registry industry regulator (LV and TLV) interfaces are formalized to ensure transparent
and efficient relationships
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
31
Academia
Governance structure
other
regs
Steering
Committee
Competence
Centers
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Quality Registries
Industry
32
Steering Committee
Population
registries
SKL/Landsting
SoS
LV
UMC1 rep
Academia rep
Industry rep
TLV
Registry rep
Patient rep
Executive body
(initially PMO role)
Providers
Licensing
(LV)
Data use
interface and
services
Reimbursement
(TLV)
Data analysis
services
Facilitate best
practice sharing
Industry
Quality Registries
1.University Medical Center
Source: BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
33
Steering committee
Industry
Fee-for-services
"Development funding"
"Base funding"
Quality registries
1. After reimbursing study specific costs at Competence Center and at registry in question 2. provided by Socialstyrelsen
Source: BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
34
Agenda
Starting position
Shared vision and value gained
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Way forward
Governance model
Business case
Roadmap and milestones
Appendix
35
...equaling >10x
direct medical cost payback
BSEK
300
280
12
9
240
4.75%
220
4
4.10%
200
1
180
0
-5%
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
14
260
176
2009
1
185
0
193
201
209
2013
218
2014
226
235
244
254
36
Competence centre
seed funding
500
80
80
150
60
60
400
40
40
200
50
100
09 10 11 12 13 14 1518
Annual basic funding per
registry 4 MSEK
20
20
09
10
11
12 13-18
09
10
11
12
13
1418
09 10 11 12 13 14 15 1618
Quality IT investments
complementary to national IT
strategy initiative
Total required investment across
time period: ~600 MSEK
37
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
100
300
Agenda
Starting position
Shared vision and value gained
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Way forward
Governance model
Business case
Roadmap and milestones
Appendix
38
2012
2019
Negotiate governance,
financing
Establish PMO1
Set targets, deadlines
Identify legal obstacles
Establish shared
capabilities, resources
Define IT infrastructure
Drive legal changes
39
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registry
initiatives
Functional
initiatives
Strengthen foundation
PMO1
Establish
to
drive initiative
Negotiate governance
setup, key targets
and milestones
2011
2012
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
2009
Ramp-up phase
40
Backup
EMR
database
Quality
registry
EMR
application
Quality
application
EMR
database
Quality
registry
EMR/Quality
application
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
41
Backup
77%
43%
23%
37%
63%
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Additional 6% coverage
from adding key diagnoses
18%
82%
37%
57%
63%
Inpatient
Outpatient
Primary care
Psychiatry
Total
1. Analysis based on KPP-data 2. Assumptions: Share captured cost same as for inpatient
Note: Not including cost of pharmaceuticals, dental care, political activities and restructuring activities
Source: KPP-database; SKL; annual reports for quality registries, grant applications to SKL; Lkartidningen; peer-review journals; BCG analysis and estimates
Value guided healthcare_Final Documentation_Aug09.ppt
42
2009
2012
Expansion
2015
IT framework established
World-leading commercial
applications
43
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Strengthening
Foundation & Ramp-up
Agenda
Starting position
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
44
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
45
Carl Bennet
Anders Ekblom
Maria Anvret
Sigbrit Franke
Claes nstrand
Gunnar Alvan
Tidigare GD Lkemedelsverket
Gran Sandberg
Kjell Asplund
Tidigare GD Socialstyrelsen
Joakim Dillner
Professor, forskare
Anna Hedborg
Nina Rehnqvist
Gran Stiernstedt
Direktr, avd. chef vrd och omsorg SKL, tidigare bitrdande landstingsdirektr
Ulf Wahlberg
Gunnar Nemeth
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Reference Group
Steering group
Name
46
Role
Company
Date
Hospital Director
May 28
Kristina Pernvi
Astra Zeneca
May 29
Frederic Sachs
VP Clinical T
Astra Zeneca
June16
Olle Bjrk
Generaldirektr
Barncancerfonden
Jun 03
Sren Johansson
VP Business development
Elekta
Jun 16
Ulf Wahlberg
Vice President
Jun 11
Gunnar Persson
Register manager
May 07
Johan Malmqvist
CEO
Getinge
Jun 12
Per Btelsson
CEO
May 29
Patrik Sobocki
GSK
Apr 27
Johan Thor
Medical Doctor
Hgskolan i Jnkping / KI
Gran Karlstrm
Register responsible
Linus Jnsson
CEO
i3Innovus
Niclas Adler
Jnkping International BS
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Name
May 04 , Jun 10
May 07
Jun 1
May 07
47
Role
Company
Date
Gran Henriks
Development director
Jnkpings LL Qulturum
May 12
Anita Aperia
Professor Pediatrics
Karolinska Institutet
Jun 04
Bo Angelin
Karolinska Institutet
Jun 04
Anders Ekbom
Professor Epidemiology
Karolinska Institutet
Jun 24
Lars Klareskog
Professor rheumatology
May 13
Mats Lundstrm
Registry Manager
Kataraktregistret, EyeNet
May 28
Martin Neovius
Researcher
Jun 1
Richard Bergstrm
Director-General
LIF
Jun 8
Alicia Lycke
Ombudsman
Lkarfrbundet
May 04
Christina Rngemark
Generaldirektr
Lkemedelsverket
May 19
Gunnar Alvan
Lkemedelsverket
Jun 15
Nils Feltelius
Medical Doctor
Lkemedelsverket
May 05
Joakim Dillner
May 28
Eva Leach
Project leader
Nationella Patientversikten
May 07
Johan Brun
Medical director
Pfizer
Apr 29
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Name
48
Role
Company
Date
Lars Phlman
Register manager
May 19
Anna Hedborg
Riksfrskringsverket
May 28
Sari Wallin
Register coordinator
Riks-Stroke Norrlands US
May 06
Sten Walther
Registry chairman
SIR
May 25
Nina Rehnquist
SBU
May 06
Pr Sundstrm
IT manager
Sjukvrdsrdgivningen
May 06
ke Karlsson
SKL
May 19
Gran Stiernstedt
Head of Division
SKL
Aug 11
Roger Molin
SKL
May 15
Department Head
SKL
Jun 16
Bodil Klintberg
Registry responsible
SKL, e-health
Jun 5
Karin Johansson
State Secretary
Socialdepartementet
Aug 11
Sara Johansson
Department Secretary
Socialdepartementet
Jun 24
Tobias Nilsson
Political Advisor
Socialdepartementet
Aug 11
Elisabeth White
Research coordinator
Socialdepartementet
Aug 11
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Name
49
Role
Company
Date
Henrik Lundstrm
Topic Expert
Socialdepartementet
Aug 11
Jesper Olsson
Special Advisor
Socialdepartementet
Jun 24
Anders berg
Socialstyrelsen
May 18
Karin Nyqvist
Researcher
Socialstyrelsen
Jun 10
Kjell Asplund
Socialstyrelsen
May 29
Mona Heurgren
Director
Socialstyrelsen
May 18
Mona Bostrm
June 26
Ulf Stenestrand
Register manager
Swedeheart Linkping
May 08
Jonas Malmstedt
Register manager
Swedvasc KI
Apr 28
Peter Fritzell
May 11
Maria Fagerqvist
Medical Researcher
TLV
May 07
Thord Redman
Coordinator
TLV
May 07
Peter Lnnroth
Director
Aug 10
Gran Sandberg
Vice-Chancellor
Ume University
Bertil Lindahl
Professor
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Name
Jun 9
May 26
50
Role
Company
Date
Schn Kliniken
Apr 30
Roland Brandmeier
Medical Doctor1
Schn Kliniken
May 5
Caroline Powell
CEO
Picker Institute
May 11
Alexander Kirstein
CFO
Universittsklinikum Eppendorf
May 4
Joe Foley
Cleveland Clinic
Apr 30
Tom Wadsworth
Administrative Director
Cleveland Clinic
Apr 30
Raymond Baxter
Kaiser Permanente
Jun 12
Alide Chase
Kaiser Permanente
Jun 12
Jennifer Baron
Apr 24
Philipp Ostwas
CFO
May 4
Gunnar Nemeth
CEO
Capio
May 18
Dr. Mansky
Medical doctor
Helios
May 15
Gene Nelson
Dartmouth-Hitchcock
May 21
Virginia Mason
May 11
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Name
Site visits
Schn Kliniken2
Cleveland
Clinic3
May 7
May 14
1. Former head of the department and advisor; 2. One day site visit, incl. discussions with 3 physicians; 3. One day site visit, incl. discussions with quality personnel and 2 physicians
Value guided healthcare_Final Documentation_Aug09.ppt
51
Regeringen
Karin Johansson, statssekreterare Socialdepartementet
Akademi
Professor Karin Markides, rektor Chalmers
VMD. Johan Carlsten, vicerektor Chalmers
Professor Pam Fredman, rektor Gteborgs universitet
Professor Olle Lark, dekanus vid Sahlgrenska akademin
Professor Harriet Wallberg-Henriksson,
rektor Karolinska Institutet
Professor Karl Tryggvason, dekanus fr forskning p KI
Professor Peter Gudmunson, rektor KTH
Professor Mathias Uhln, KTH
Professor Mille Millnert, rektor Linkpings universitet
Professor Bjrn Gerdle, prodekan Hlsouniversitetet
Professor Bo Ahren, dekanus medicinska fakulteten
Lunds universitet
Professor Gran Sandberg, rektor Ume universitet
(referensgrupp)
Professor Anders Hallberg, rektor Uppsala universitet
Utlndska talare
Professor Michael E. Porter, Harvard Business School
Jens Deerberg Wittram, Chief Operating Officer Schn
Kliniken
Value guided healthcare_Final Documentation_Aug09.ppt
Regioner - landsting
Sren Olofsson, regiondirektr region Skne
Anders Thulin, medicinsk direktr region Skne
Hannie Lundgren, forskningschef region Skne
Thorbjrn Ekstrm, FoUU-direktr
Stockholms lns landsting
Marie Beckman-Suurkla, sjukhusdirektr Akademiska
sjukhuset Uppsala (referensgrupp)
Jack Lysholm, chef fr FoUU-staben
Vsterbottens lns landsting
Peter Lnnroth, bitrdande hlso- och sjukvrdsdirektr
Vstra Gtaland
Martin Magnusson, utvecklingsdirektr
stergtlands lns landsting
Anders Heijl, FoU-samordnare stergtlands lans landsting
Referensgrupp
Professor Gunnar Alvan
Professor Kjell Asplund
Professor Joakim Dillner
Anna Hedborg, tidigare statsrd
52
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Industri
Professor Jan Lundberg, Executive Vice President,
Global Discovery Research AstraZeneca
Anders Ekblom, Executive Vice President,
Global Drug Development AstraZeneca
Martin Nicklasson, VD och koncernchef Biovitrum
Gunnar Nemeth, koncernchef Capio (referensgrupp)
Tomas Puusepp, VD och koncernchef Elekta
Vice President Ulf Wahlberg, industry research relations
Ericsson (referensgrupp)
Peter von Ehrenheim, VD GE Healthcare AB
Per Btelson, VD och koncernchef Global Health Partner
Magnus hman, VD St Jude Medical AB
Johan Malmquist, VD och koncernchef Getinge
Carl Bennet, styrelseordfrande och huvudgare Getinge
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
53
Registry examples
54
History
Governance
Financing
Coverage
Initial discussions to
start register in 2003
2003
2004
>90% hospital
coverage
~90% patient
coverage in 2008
Start of register in
2005
2005
2006
2007
2008
2009
Metrics
Reporting
process
Feedback
process
Key
initiatives
55
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registry example
Process metrics
Reason for intervention, type of surgery and graft, manufacturer
Health metrics
Complications, function, infection, stroke, mortality
Financing
Coverage
Start of VRISS1
registry in 1987
1985
1990
Changed name
to Swedvasc
1994
1995
Registration
on surveys
ended 2003
2000
Swedvasc 2.0
launched in
May 2008
2005
2009
Metrics
Reporting
process
Feedback
process
Key
initiatives
1. Vascular Registry In Southern Sweden 2. Uppsala Clinical Research and Registry Center
Source: Interview; National Healthcare Quality Registries in Sweden 2007; SKL; annual report; grant application
Value guided healthcare_Final Documentation_Aug09.ppt
56
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registry example
Process metrics
Care on stoke unit, treatment with pharmaceuticals
Health metrics
ADL functions before and after stroke, complications, survival
Governance
Financing
Coverage
1990
1995
2000
2005
2009
Metrics
Reporting
process
Feedback
process
Web-based reporting
Surveys filled in by care takers at occasion of hospitalization,
one person on each hospital responsible for reporting in web
module
3 months follow-up of patient experienced data
Annual report; with many health metrics by hospital
On-line analysis of own results and county council average
Participate in "ppna jmfrelser"
Key
initiatives
Source: Interview; National Healthcare Quality Registries in Sweden 2007; SKL; annual report; grant application
Value guided healthcare_Final Documentation_Aug09.ppt
57
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registration of stroke
History
Governance
1975
1980
1985
Start registration of
Registry
became web- partial arthroplasty
in 2005
based in 1999
1990
1995
2000
2005
2009
Financing
Coverage
Process metrics
Implant type, surgical method, operation environment
Health metrics
Pain, life quality, re-operation, survival after 2, 5 and 10 years
Metrics
Reporting
process
Feedback
process
Key
initiatives
Web-based reporting
Touch screen linked to registry's website to collect
preoperative patient related metrics
Surveys are used in follow-up, coordinator report on website
Patient records from re-operations collected and analyzed
Annual report; with many health metrics by hospital
Participate in "ppna jmfrelser"
Source: National Healthcare Quality Registries in Sweden 2007; SKL; annual report; grant application
Value guided healthcare_Final Documentation_Aug09.ppt
58
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registry example
Governance
Financing
Coverage
Metrics
1990
Heart surgery
registry started
1992
SCAAR, national
coronary angiography
registry, started in
1998
1995
2000
2005
2009
Reporting
process
Web-based reporting
New IT infrastructure under development after consolidation of
old registries
Attempt to build in decision-support functionality in registry,
unclear legal consequences
Feedback
process
Key
initiatives
Source: National Healthcare Quality Registries in Sweden 2007; SKL; annual report; grant application, Mayo clinic
Value guided healthcare_Final Documentation_Aug09.ppt
59
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
History
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
60
1 Societal value
61
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Establishing of CoCe1
+
Investment
needs
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
5% of healthcare costs
eliminated by 2018
IT investment for
complete EMR
1. Competence Centers 2. Multiple of money = Accumulated savings/Accumulated costs 3. Discount rate of 6% assumed
Value guided healthcare_Final Documentation_Aug09.ppt
62
HC cost development
HC cost development
HC cost development
250
160
160
140
140
6.23%
200
150
4.75%
3.50%
120
120
4.78%
100
100
80
1995
2000
2005
100
80
2008 2010 2012 2014 2016 2018
1. SKL estimate assumes efficiency improvements from better use of IT-systems, org changes and unidentified other systematic improvements (no reference to specific initiatives/actions is made)
Source: OECD Health data 2008; SKL publication "Kommer vi att ha rd med sjukvrden?" 2005
Value guided healthcare_Final Documentation_Aug09.ppt
63
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
5,0
4,0
3,0
2,0
1,0
0,0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CAGR (%)
w/o
initiative
2,0
1,5
Impact of
proposed plan
1,0
0,5
0,0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
100
4.0
with
initiative
50
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Source: OECD Healthcare Cost 2008, BCG estimates
Value guided healthcare_Final Documentation_Aug09.ppt
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
CAGR (%)
64
Backup
Comments
BSEK
5x
60
29
24
40
3x
19
14
7
0
0
1
2 4
7
1 2 1 4 2
4
10
5
29
24
10
20
14
7
19
9
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
80
12
14
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Societal saving max
Societal saving min
Medical cost saving
1. Sick-leave compensation mainly driven by psychological and musculoskeletal diseases
Source: IHE, stergtland community council healthcare report 2007, Healthways, TLV
Value guided healthcare_Final Documentation_Aug09.ppt
65
Backup
IT-supply
Development/updates1
IT costs
Licenses/Software
1,600-1,800 TSEK
Other2
Personnel cost
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Registry management
1,800-2,000 TSEK
Coordinate outcome
improvements across clinics
2-4 Meetings/year
Other costs
Book
400-450 TSEK
Other
1. Including cost for FTEs 2. Follow-up, mobile internet
Note: All figures in real numbers
Source: SIR registry funding application, lnestatistik.se, BCG analysis and estimates
Value guided healthcare_Final Documentation_Aug09.ppt
Backup
2010:
2011:
2012:
~6,000 TSEK
~13,000 TSEK
~13,000 TSEK
2010:
2011:
2012:
~850 TSEK
~700 TSEK
~400 TSEK
Legal expertise
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Financial expertise
OH
Training
Specific training
Rent
Office
IT
Other
2010:
2011:
2012:
Required
funding/year:
~1,200 TSEK
~1,300 TSEK
~1,300 TSEK
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
68
80
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
40
0
0
31
Total specialized inpatient healthcare cost by MDC (BSEK)
62
Cost not captured
Cost captured if current registries reach full coverage
Cost currently captured
69
Pacemaker
100 operation
Defibrillator operation
Fibrosis
Cirrhosis
Hepatitis
Liver failure
Pancreatitis
Lung emboli
Appendicitis
Ileus
Diverticulitis
Gastrointestinal bleeding
Skin cancer
80
60
40
Osteoarthritis
Other rheumatic disorders
Chronic pain (palliative care)
Osteoporosis
Skeletal cancer
20
0
0
Parkinson
Epilepsy
31
Kidney cancer
Bladder cancer
Urinary tract infection
Burns
62
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Share of specialized
inpatient cost captured
by quality registry (%)
Heart failure
COPD
Dementia
Atrial fibrillation
Renal failure
Child obesity
Multiple sclerosis
Quality of registry2
Primary care included in registry, high coverage
Primary care included in registry but currently low coverage
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Pilot
categories
Leg ulcer
Diabetes
Asthma
SKL
UCR
Funding
36.2MSEK
2008-2010
Support and
expertise
Required actions
Ensure establishment of new competence center is
aligned with proposed Competence Center structure
Detail ongoing initiative
Plan including concrete goals and milestones
IT interface1
Monitoring of initiative to ensure progress according to
plan
Competence Center
BipolR
BUSA
SBR
PsykosR
SK
RttspsyK
1. Specifications on portal: capacity to handle all national quality registries in psychiatry, existing as well as new registries; one single module for patient base information for all users, diagnosis
specific quality registries connected to portal as separate modules
Note :RIKST Eating disorders, BipolR - bipolar affective disorder, RUSA - severe adhd, PsykosR psychosis, SBR Svenskt Beroende Register, SK - Nationellt kvalitetsregister fr barn och
ungdomar som konstaterats/misstnks ha blivit utsatta fr sexuella vergrepp, RttspsyK Rttspsykiatriskt kvalitetsregister
Source: SKL; Socialstyrelsen; BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
72
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
73
Program
Management
Office (PMO) /
Exec. body
2010
Establish
PMO
2011
Set up steering
committee
Functional
initiatives
2013
2014
2015-20
Run IT framework
project
Registry
initiatives
2012
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
2009
74
1
Financing
Socialdepartementet
Counties
Socialstyrelsen
Steering Committee
SKL
SoS
LV
TLV
Provider rep
Patient rep
Academia rep
Industry rep
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
4 Initial roadmap
Anchoring3
Licensing
(LV)
Reimbursement
(TLV)
Industry rep
1. Avtal om Lkarutbildning och Forskning Negotiated agreements between the state and select counties regarding co-financing for specialised medical education and research. 2. Program
Management Office. 3. Potentially involving Letters of Intent from key stakeholders. 4. Potentially nvolving Vetenskapsrdet. Source: Interviews with Claes nstrand June 2009, BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
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Functional initiatives
2009
2010
Estab. PMO1
Governance
2011
2012
2013
2014
2015-20
Resource/
competence
development
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Information
technology
(IT)
Legal
Revise law on patient data to allow real-time feedback
1. Program Management Office
Source: BCG analysis
Value guided healthcare_Final Documentation_Aug09.ppt
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Functional initiatives
SC established
Funding model in
place
CoCe operating
according to
defined model
2010
2011
2012
2009
Establish
Exec.
body/PMO1
2013
Establish Steering
Committee
Appoint members,
define plan / vision
Governance
National framew.
for cond.
licensing in place
6 CoCes
established
PMO phased out
2014
2015-20
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Key
milestones
Set up framework
for conditional
licensing &
reimbursement
Test framework
w. pilot
Strengthening of existing CoCe
Create coherent vision
Set up objectives, time plans and resource needs
Determine process for
making outcome data public
to patients
Integrate regional cancer registries
into new national CoCe-model
Ensure full and
stable basic
registry funding
Determine BP sharing
process
77
Functional initiatives
All required
registries started
2009
2010
Assessment
of resource
requirements
for CoCe
2011
2012
New CoCe /
governance model
fully in place
2013
2014
2015-20
Resource/
competence
development
78
Functional initiatives
Key
milestones
2009
2010
Framework and
timeplan defined
Integrated EMR
solution for all
registries
2011
2012
2013
2014
2015-20
Define framework,
timeplan for
integrated IT
solution
Information
Technology
(IT)
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Legal
Revise Law on patient data to enable e.g. individual
feedback from quality registries and cross-referencing
79
Registry initiatives
2009
Increase
coverage in
current
registries
2010
2011
2012
2013
2014
2015-20
Launch initiative
Define action plan
Monitor progress
Arrange BP-sharing meetings
Add new
registries
App. owner
Build registry
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Support process
Integrate cancer registries
Develop action plan
Primary
care
Assign pilot
"owner"
Expand registry
Develop evaluation
process
Psychiatry
Build registry
80
Key
milestones
2009
2010
2011
Registry initiatives
2012
2013
2014
2015-20
Launch
coverage
initiative
Increase
coverage in
current
registries
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
81
Registry initiatives
Key
milestones
2009
2010
2011
2012
2013
2014
2015-20
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
New quality
registries
Develop individual
action plan for new
registry
Identify
resources and
competence
needed
Identify metrics
Decide on
CoCemembership
Organize BP sharing
Integrate regional and national
cancer registries for each
diagnoses
82
2009
2010
Assess. of
pilot
registries,
appoint
owner
2011
2012
Expand registries
to primary care
Communicate
importance
and benefits
of participating
Primary care
2013
2014
All chronic
conditions treated
in PC covered in
quality registries
2015-20
Ensure full
coverage in
pilot
Ensure
compliance
from clinics
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Key
milestones
Full patient
coverage
selected
disorders in pilot
Registry initiatives
Organize BP sharing
Identification
of expansion
registries,
appoint
owner
83
Full patient
coverage existing
registries
Key
milestones
2009
2010
2011
2012
Registry initiatives
2013
2014
2015-20
Psychiatry
Identification
of expansion
registries,
appoint
owner
Copyright 2009 by The Boston Consulting Group, AB. All rights reserved.
Develop action
plan for new reg.
Resources and
competence
needed
Identify metrics
Build registry
according to
identified bestpractice model
84