Value Based Healthcare Workshop Diabetes

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2 7 O c t 2 0 2 0 | 9 : 3 0 – 1 0 : 4 5 | W o r k s h o p

Value Based Healthcare

Workshop

Diabetes

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The Implementation Matrix

EIT Health‘sVBHC Report:

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Type 2 Large population, highly modifieable conditions, good study situation, complications very

cost-intensive Type 2 Type 2 Type 2 Type 2 Large population, highly modifieable conditions, good study situation, complications very

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Early prevention of transition to co-morbid conditions, focus on persons with

high-risk to develop conditions, and on most expensive ones

Direct costs of hospitalization Access to treatmen t Type 2 Diabetes

Key cost drivers are chronic complications: cardiovascular and kidney disease Hospitalizati on rate per patient ICHOM PROMs as starting point

Access to up-to-date and condition-specific treatment

and diabetes technologies (pumps, closedloop, …)

Direct costs of prescription medication Direct costs of micro-and macrovascular complications Indirect societal costs (early retirement, …) Adherence to data transmission from PWD to HCP Various types of Adherence (tbd)

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Clinical

data Concepts of_privacy

preserving AI Electronic health record (Ö: „ELGA“) Data at patients Routine care setting -> data has to be

personalized Partner closely_w/national Diabetes Associations and KOLs Virtual data platform instead of physically centralized data warehouses (privacy issue!) Research companies should be part of EIT

Health activities on this topic

Platform will have to adress needs of Stakeholder‘sfull range:

Prevention-Treatment- Post-Treatment-Research-Business European Health Data Space (GDPR,

accessability, commerzialization etc. must be taken in to account) -> org and

structural framework required Insurer‘s data GP‘sdata Research setting -> data has to be anonymized & pseudonymized 2 different aspects Silos

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Germany: Treatment guidelines by German Diabetes Assoc. → EIT Health Partners →University Hosp. KOLs →Publications

from Working groups→Patient Organizations Diabeter could be example to look at Roche project iPDM-GO Comparing within countries, identifying center of excellence and

setting it as benchmark

Data availability could be issue European regional differences make common

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CROs Telehealt h Providers (DITG) Industrial/Pharma/Diabete s Technology partners IMPORTANT: committment

of the org should be already there, incl.

Management

National Diabetes Assoc. →EIT Health Partners →University Hosp. KOLs →Publications from Working groups→Patient

Organizations

Data Management Providers (e.g.

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Photo credit: Patricia Tsernoshova on Unsplash

Thank you for participating and

bringing value to the workshop!

Nandor Gaus

Innovation & Project Manager

EIT Health Germany GmbH

[email protected]

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Value Based Healthcare Workshop:

Diabetes

Workshop held at the Joint EIT Health Germany & EIT Health InnoStars Symposium

27 Oct 2020 | online

Facilitators: Nandor Gaus, Dr. Michael Lüttgen (EIT Health Germany) Participants:

• Ms. Mariana De Freitas, Compliance Counsel, Roche

• Ms. Caroline Fantino, Alternante Healthcare Transformer, Roche

• Mrs. Elisa Gómez Inhiesto, CFO, Hospital Universitario Cruces-Osakidetza • Mr. Dieter Hayn, Senior Scientist, AIT Austrian Institute of Technology • Dr. Dirk Holste, Deputy Head, Center for Health & Bioresources, AIT • Mr. Vladimir Kozak, Strategic Healthcare Consultant EMEA/LATAM , Roche • Mrs. Dunja Loncaric, Manager HEOR, Boehringer Ingelheim

• Dr. Czuee Morey, Digital health consultant, Wega Informatik • Mr. João Quintas, Principal Researcher, Instituto Pedro Nunes • Dr. Seyed Javad Rasouli, Post Doc, MPI Münster

• Dr. Elvira Salazar López, Project Coordinator, Technical University Munich

• Prof. Freimut, Schliess, Director Science & Innovation, Profil Institute for Metabolic Research • Mr. Ralph Steidl, CEO, Portabiles HealthCare Technologies

• Dr. Katharina Ladewig, Managing Director, EIT Health Germany • Mr. Mathis Palm, Business Creation Manager, EIT Health Germany • Dr. Jeff Wilkesmann, Education Manager, EIT Health Germany • Dr. Tamas Babel, Regional Manager Hungary, EIT Health InnoStars • Mr. Zsolt Bubori, Regional Manager for Hungary, EIT Health InnoStars • Mr. Mikołaj Gurdała, InnoStars Manager, EIT Health InnoStars

1. VBHC Implementation Matrix – Dimension “Condition”

Introduction

The goal of this Workshop is to capture your basic ideas of the VBHC implementation matrix with regards to a specific disease are, and condition, in order to ideally trigger the initial sparks of a VBHC-driven project idea for the upcoming BP 2022 (so-called “HVC/High Value Care projects”). We will work with you together through five selected sheets of the nine matrix “dimensions” in total. At the end, one or more participants

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2 EIT Health is supported by the EIT,

a body of the European Union

are invited to take the lead in further processing the results from today, and shape them towards a BP 2022 HVC project, or use them for individual activity or project ideas in their own institution.

In this regard, EIT Health Germany wants to reinforce the importance of VBHC and has developed the Discover & Elevate Workshop format, of which we are using here a (reduced) version of the Discover part. These workshops, which we would like to offer as our CLC’s service to our partners, aim to enable providers to:

• Understand the steps and activities involved in the VBHC journey

• Evaluate the current state at a provider organization to design the right starting point

• Communicate the next steps ahead as the organization moves through the transformation process

While the Discover Workshop is an initial 2-4 hour workshop, intended to capture the basic understanding of the provider’s responses to the key dimensions of the Implementation Matrix, the Elevate Workshop is a much more comprehensive engagement and requires a multi-day commitment (2-4 days) from the facilitators and the provider’s team.

In this reduced Workshop format here, with time and logistical constraints given, we will not be able to fully apply the original methodology. Thus, our Workshop here serves rather as an initial step, focusing on the most important VBHC implementation matrix dimensions, and outlining first basic ideas of how addressing the specific disease area and condition through an VBHC-approach could look like.

Key points

• Scope of this sheet: to determine the key conditions on which to focus. • Very clear decision to focus on Type 2 Diabetes (T2D)

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2. VBHC Implementation Matrix – Dimension “Scorecard”

Key points

• Scope of this sheet: to develop a Scorecard for the selected condition (T2D), with metrics for outcomes, costs, processes, and treatment mix required for a VBHC-driven approach on T2D.

• Additional comments on Treatment mix:

o Lots of hospitalization are not necessary. Many patients could be treated at home. o The access to treatment is also determinant. At early stage you start with one medicine

and then it evolves. In Eastern Europe treatment is different. Access to treatment is different as it is not necessarily completely covered by the health insurance.

o Also, patient satisfaction is important.

o Insulin treatment is not state of the art. Up to date treatment and new devices are required. Also, conditions must be met for treatment.

o Early prescription is required.

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o Direct costs: hospitalization / prescription medication / physician consultation / macro- and microvascular complication / kidney disorder

• Potential Cost and Process measurement sources:

o Time-Driven Activity Based Costing (TDABC) - mapping of every administrative and clinical process involved in the complete care cycle; estimates cost per minute. o NHS Wales - „Finance Academy“ programme, task to develop practical methodologies. o Analytic tools - e.g. tool of finance department of Cruces University Hospital, Bilbao,

Spain.

• Potential Outcome measurement sources:

o ICHOM - PROM metric sets for 28 medical conditions.

o Guidelines by Professional Society for Health Economics and Outcome Research (ISPOR).

o Other instruments - e.g. Casquest-9SF, Catprom-5. • Outcome measures in place:

o CROMs - Clinician Reported Outcome Measures

o PROMs - Patient Reported Outcome Measures; before, during and after care o PREMs - Patient Reporter Experience Measures

• Additional comments on Costs:

o We should focus on those diseases that are most expensive. Costs increases with the possible complications (especially the chronic complications). Cardiovascular and kidney disease are key elements. Hospitalization is one of the metrics that can be measured. These costs are high, compared to anti diabetes medication, which is cheaper (insulin).

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3. VBHC Implementation Matrix – Dimension “Data Platform”

Key points

• Scope of this sheet: to determine the current state of Data Management for the selected condition (T2D), and try to sketch the desired future state, incl. what steps or actions are necessary to get from the current state to the future state.

• Additional comments:

o Generally, data is siloed.

o If you want to perform AI or other analysis, a common data pool is needed. We need also to improve education for this.

o We need better data transformation and data optimization, better operativity and accessibility.

o Privacy issues will appear and must be taken into account.

o The different stakeholders of the ecosystem must be involved, know their roles and be aware of the responsibilities and possibilities to exchange data. If you are focusing only in one sector, you will not have the necessary synergy

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4. VBHC Implementation Matrix – Dimension “Benchmarks”

Key points

• Scope of this sheet: to determine the current state of Benchmarks for the selected condition (T2D), and to identify the internal/external sources of data.

o Historic controls are important as reference.

o Pre- and post-events are important to register per hospital. This historic controls depend on data availability.

• Recommendations external Benchmarking - Europe:

o European Hospital Alliance (EUHA) - nine hospitals striving toward a more value-driven model and more person-centric care; establishing a shared data platform.

o Nordic Interoperability Project - access, exchange and benchmark data between Scandinavian countries.

o ERA-EDTA: European Renal Association – European Dialysis and Transplant Association registry.

o European Registry of Quality Outcomes in Cataract and refractive Surgery (EUREQUO) - regional, EU, Surgeons from 15 countries; identification and dissemination of best practice (BP/G),

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• Recommendations external Benchmarking - Germany:

o Institute for Quality and Transparency in Health Cate (IQTIG) - centralized quality assurance; mandatory; national; annual; self-reported provider cards.

o Qualitätssicherung mit Routinedaten (QSR) operated by AOK.

o Initiative Qualitätsmedizin (IQM) - 500 members in 2020 and Qualitätskliniken.de (4QD) private hospital initiative.

o Cancer registry. o RKI.

o German Stroke Registry

• Recommendations external Benchmarking - England:

o National Joint registry (NJR) - case volume, clinical outcomes, PROMs about hip, ankle, elbow and shower joint replacement.

o National Cardiac Surgery Audit - 6 cardiac audits.

o HSCIC - administers Hospital Episode Statistics; generated Summary Hospital-level Mortality Indicator (SHMI); collects PROMs for treatment areas of hip and knee replacement, groin hernia and varicose veins.

• Recommendations external Benchmarking - Worldwide:

o ICHOM(International Consortium for Health Outcome Measurement) - standard sets for outcome tracking for 28 diseases and conditions: https://www.ichom.org/standard-sets.

o The GLOBE Programme - benchmarking initiative by ICHOM. • Recommendations external Benchmarking - Netherlands:

o Dutch Institute of Clinical Auditing (DICA) developed 22 registries for reporting. o Health and Youth Care Inspectorate - supervise quality, safety and access in Dutch

medical care providers; 68 quality registries with open benchmarks. o Dutch Hospital Data (DHD) foundation.

o Consumer Quality Index (CQI) - measures PREMs. • Recommendations external Benchmarking - Sweden:

o Swedish Association of Local Authorities and Regions - 110 quality registries; e.g.: o SWEDEHEART - web-system for Enhancement and development of evidence-based

care in hearth disease evaluated according to recommended therapies; public reporting + identification and dissemination of best practice.

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5. VBHC Implementation Matrix – Dimension “External Collaborations”

Key points

• Scope of this sheet: to identify possible high-value partners for this initiative.

o DITG - Deutsches Institut für Telemedizin und Gesundheitsförderung have digital Diabetes care patient management programs with evidence-based benefits in place, which could be a starting point for such VBHC activities. They are running since more than 10 years.