Post on 14-Mar-2018
Leading Systems Network
Globalisation of Healthcare, Metrics and Benchmarking
McKinsey Health Systems InstituteDr Alexander Ng
CONFIDENTIAL AND PROPRIETARYAny use of this material without specific permission of McKinsey & Company is strictly prohibited
HA convention 20118th June 2011
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1McKinsey Health Systems Institute
McKinsey work to improve health system performance globally
EXAMPLESAlberta: Provincial health policy Supply-demand
management Quality control Primary care structure Top team building
Ontario: A&E optimization Patient access
and flow
US: National
reform modelMexico: Avian influenza
response
UK: Framework to evaluate
M&A opportunities Governance structuring Workforce planning Capacity planning
France: National hospital
efficiency programme
Norway: IT transformation Merger management
Sweden: Payor and provider model Compensation system
Italy: Assessment of regional
performance MoH � Transparency of
hospital performance
South Africa: Health system
strategy
Namibia: System diagnostic Maternal health
Tanzania: Set country level health objectives; developed
implementation plan for key initiatives
Egypt: National insurance Hospital/clinic coverage
and operations Quality regulator
Saudi Arabia: Greenfield Health
Systems development Build FDA from
scratch
Qatar: Decentralisation of
healthcare provision
Abu Dhabi: Privatise public
hospitals
Dubai: Build a wellness resort, develop AMC from scratch and health delivery network
India: Design & implementation of
emergency response system Service provider for rural populations
Australia: Regional health reform
China: Perspectives on health
reform
2McKinsey Health Systems Institute 2
In tackling various health challenges, different regions around the world has been asking the same questions ...
Which health systems have significantly improved quality and cost? What insights did they learn?
What is the best way to improve our system?
How can we learnfrom others?
How do we build the capabilities we need to succeed?
Where am I among the best in the world?
What value do we get for what we spend?
Who is best in the world on various performance metrics?
3McKinsey Health Systems Institute
▪ Isolating core metrics that are critical to measure
▪ Understanding dynamics of system-level change
How can you assess and achieve lasting change?
▪ Identifying unique improvement opportunities
▪ Executing on effective implementation
How can you drive and implement innovation?
▪ Benchmarking performance through a global database
▪ Learning from what�s been successful around the world
What does world-class performance look like?
Three themes have emerged
Complex, yet common challenges �
� and the keys to finding the answers
4McKinsey Health Systems Institute
Annual Conference: Meet with your peers and industry thought-leaders to address the fundamental challenges you face
McKinsey�s Leading Systems Network (LSN) is set up to meet this need
Knowledge Bank: Learn from the success of others through an online toolkit of case studies, best practices, and how-to-guides
Live Webinar Series: Monthly series to connect you with peers and other experts, with a focus on high impact topics
HealthTracker: Benchmark performance and obtain unique perspectives on opportunities through a global database
Customized Member Report: Deep dive into specific data, with an action plan for improvement and a network-wide comparison
Expert-on-Demand: Access to internal McKinsey experts with direct experience implementing health system change
Analytics
Forums
Evidence
1
2
3
5McKinsey Health Systems Institute
LothianLothian NorthhamptonshireNorthhamptonshire
South WestSouth WestTrentoTrento
RovigoRovigo
TuscanyTuscany Hong KongHong Kong
SingaporeSingapore
QueenslandQueenslandVictoriaVictoria
LothianLothian NorthhamptonshireNorthhamptonshire
South WestSouth WestTrentoTrento
RovigoRovigo
TuscanyTuscany Hong KongHong Kong
SingaporeSingapore
QueenslandQueenslandVictoriaVictoria
A growing network of innovative systems on three continents
Current members
Current conversations
Current members
Current conversations
6McKinsey Health Systems Institute
Definition: Pathways take a health system end-to-end view of performance with a major focus on clinical outcomes. We focus onthe major evidence that drive prioritised outcomes.
Pathways help to measure, understand, and improve the underlying causes of clinical outcomes. Pathways:
▪ Measure primary and secondary endpoints as well as actionable outcomes relative to regional, national, and international benchmarks
▪ Are complementary to guidelines but are NOT clinical guidelines for decision making at the patient level
▪ Create a methodology that can extend across borders and differences in clinical practice
SOURCE: McKinsey analysis
1 McKinsey Pathway ApproachAnalytics
7McKinsey Health Systems InstituteSOURCE: McKinsey analysis
Define what to include in the pathway
Map best practiceinterventions
Prioritise the most important interventions
▪ Define the scope of disease area
▪ Identify discrete phases of the disease pathway and map the relevant best practice interventions
▪ Review literatureand interview experts to prioritise interventions based on clinical benefit and cost effectiveness
1 Creation of pathwayAnalytics
8McKinsey Health Systems Institute
Not met
Met
Approach DescriptionPatients�benefits Payors� benefits
Clinicians�perspective
Patients�perspective
Payors�perspective
Clinical guidelines
▪ Operational guidelines covering single and specific events, written by clinicians and based on clinical studies
▪ Improved pa-tient out-comes, thanks to the adoption of standardised protocols
▪ Indirect benefits, depends on reimbursement mechanisms
Productivity driven
▪ Efficiency-oriented approach, aimed at maximising each system�s component productivity without an overall view
▪ Indirect benefits ▪ Cost savings, thanks to a specific focus on direct and indirect costs containment
Clinical pathways
▪ Evidence-based and patient-centred perspective, consid-ering patients rather than disease events
▪ Increased satis-faction, thanks to the single point of contact at each step▪ Increased
quality of care and of life, thanks to evidence-based interventions
▪ Cost savings thanks to increased efficiency along the whole chain and better capacity planning▪ More appropriate use
of resources � e.g., avoided unnecessary hospital stays▪ Reduction of
providers� variabilityin outcome
1 The pathway approach ensures that all major stakeholders�perspectives are being considered
Analytics
9McKinsey Health Systems Institute
Primary prevention Acute stroke management
Rehabilitation and secondary prevention
Healthy adultDevelopment of symp-toms suggestive of stroke
Patient physiologically stable
Pathway definition
Start
Development of symp-toms suggestive of stroke
Patient physiologically stable
End of lifeEnd
Outcome of specific part of pathway
▪ Annual incidence of first time stroke
O1 ▪ In-hospital mortality due to stroke
O3
▪ % of patients who die within 28 days after all strokes
O4
▪ % of stroke patients readmitted to inpatient care within 30 days after discharge
O10
▪ Annual incidence of secondary stroke cases
O9
1 Note: O = Outcome
Example Stroke pathway
1Analytics
We mapped key stages of the stroke pathway
10McKinsey Health Systems Institute
1Analytics
And identified internationally recognised interventions
General management
Hemorrhagic stroke
Ischemic stroke
Acute management of stroke
Specialised careDiagnosis confirmation
Acute treatment
Admission
▪ General population� Hypertension reduction in
population� HbA1c reduction to less than 7 in
diabetics� Cholesterol reduction of 1 mmol
LDL� Regular exercise� Obesity management � Smoking prevalence reduction� Excessive alcohol consumption
reduction� Na intake reduction� High veg/ fruit and fish intake� Atrial fibrillation management with
INR of 2�3 � Carotid artery screening programs� Asymptomatic carotid artery
intervention if suitable▪Population specific � Careful anticoagulation monitoring� Surgical repair for asymptomatic
intracranial aneurysm � Blood transfusion for sickle crisis
patients � Stop females >35 years who
smoke taking OCP� Reduce HRT prescriptions
▪Diagnosis � Seen and investigated at specialist
service within 1 days of TIA▪Treatment � Prescribe an alternative
antiplatelet therapy immediately following TIA
� Give BP controlling medication irrespective of baseline BP
� Reduce smoking in TIA patients� Cholesterol reduction following TIA� Carotid Doppler investigation
following TIA� Appropriate neuro-imaging
� Regular neurological observation
� Screening of patients swallowing
� Management of potential complications ▫ Nutrition▫ Hydration▫ Hyperthermia ▫ Hypoxia ▫ Glycemic control
� Early mobilisation � Deep vein thrombosis
prevention� Doppler US to exclude
DVT on admission� Blood pressure
management
▪ Specialist assessment to confirm stroke diagnosis
▪ Baseline blood tests
▪ CT scan within 3 hours of onset of neurological symptoms
� Thrombolysis if patient clinically suitable
� Start aspirin 24 hours following thrombolysis (300 mg) or immediately if not suitable for thrombolysis
� Treat >185 SBP
� Reduce INR if patient on warfarin
� Consider surgical intervention if ▫ Hydrocephalus or
brainstem compression
▫ Lobular haemo-rrhage is >10cm3
� Give antihypertensive treatment for hyper-tensive emergency
Risk factor minimisation
TIA treatments
▪ Immediate transfer by emergency services
▪ Admitted directly to specialised acute stroke facility
Diagnosis
� Rehabilitation� Multi-disciplinary
assessment: Psychological, cognitive, communication, motor, sensory impairment assessment▫ Physiotherap-
y in 24 hrs▫ Speech and
language therapist within 7 days
� Functional rehabilitation interventions ▫ Occupational
therapist with neuro rehab. within 4 days
� CPAP for sleep disorder breathing
� Early supportive discharge
Rehabilitation
▪ Reduce smoking rate amongst stroke patients
▪ Reduce excessive alcohol consumption
▪ Low salt diet ▪ Regular exercise▪ Register patients
who have had a stroke
▪ Reduce HbA1c ▪ Lower cholesterol to
<3.5 mmol/l after 1 week of event
▪ Lower BP to 130/80 ▪ 12 lead ECG when
arrhythmia or no cause found
General
▪ Antiplatelet therapy with aspirin/dipyridamole MR/ clopidigril combinations
▪ Anticoagulation for AF patients after 14 days (without concomitant anti-platelets) to INR of 2�3
▪ Perform Doppler ultrasound of carotid if history of carotid territory stroke
▪ Symptomatic carotid intervention only considered for select cases performed in specialist centre
Ischemic specific
Public education programs
We identified 63 best practice interventions on stroke pathway
Primary prevention of stroke Rehab & Secondary prevention
Stroke rehabilitationGeneral secondary prevention
Specific secondary prevention
Example Stroke pathway
11McKinsey Health Systems Institute
Primary prevention of stroke
Acute management of stroke
Rehab & secondaryprevention
Primary end point
Secondary end points
Actionable outcomes
Average alcohol consumption per capita
PH1
% of adult daily smokersPH2
% of adults with BMI > 30PH3
% of AF or atrial flutter patients at prescribed warfarin
P10
% of high risk TIA patients seen within 24 hours of referral
P18
% of patients with a history of TIA/ stroke with BP< 140/90 mmHg
P20
% of patients with a history of TIA/ stroke with total cholesterol < 5 mmol/l
P22
% of stroke patients prescribed physiotherapy within 74 hours of symptom onset
P52
% of patients with the diagnosis of any stroke for whom rehabilitation services are planned after discharge
P44
% of patients with the diagnosis of ischemic stroke and TIA who were prescribed antiplatelet therapy at discharge
P39
% of hospitalised ischemic stroke patients given aspirin within 48 hours of symptom onset
P51
% of stroke patients who smokeP50
Annual incidence of secondary stroke cases
O1 O9In-hospital mortality due to strokeO3
28 day mortality of strokeO4
Readmission rate for strokeO10
% of stroke patients treated at a special stroke unit
P24
% of patients with ischemic stroke who have thrombolysis within 3 hours of symptom onset
P38
% of patients with ischemic stroke who receive thrombolysis
P38a
% of suspected stroke patients receiving CT or MRI scans within 3 hours
P30
Total mortality due to stroke per 100,000 population
G1
Annual incidence of first time stroke cases
O5 All-stroke 3 month mortality rate post event
O8 % of hospitalized patients returning to the same level of care after discharge for stroke
Average length of stayO2
% of patients returning home after discharge for stroke
P08a
% of ischaemic patients with a diagnosis of nonvalvular atrial fibrillation or atrial flutter and history of stroke who were prescribed warfarin
P10a
1Analytics
Output is a shortlist of the most important metrics along strokepathway
12McKinsey Health Systems Institute
Rehab & secondary prevention
Primary preventionEarly manage-ment of CHD
Acute Management of AMI
Secondary end points
Actionable outcomes
Primary end point
G1 Total mortality due to CHD per 100,000 population
O5 AMI readmission rate within 30 days
O4 In-hospital mortality of AMI
O1 O2 O3 30 day mortality of AMIIncidence of AMI per 100,000 population
PH3 P50% of adults with BMI > 30
P28 % of AMI patients given aspirin within 24 hrs of arrival
P15 % of CHD patients currently treated with beta-blockers
PH2 % of adult daily smokers
P33a % of AMI patients who receive PCI for revascularisation
P16 % of CHD patients treated with aspirin
P33 % of AMI patients with PCI who receive PCI within 90 minutes
P13 % of CHD patients with total cholesterol < 5mmol/L
Average alcohol consumption per capita
PH1
P41 % of AMI patients who receive LMWH during hospitalization
P20 Exercise tolerance testing for patients with new angina
% of AMI patients who receive beta-blockers within 24 hours of AMI onset
P40
P11 % of CHD patients with BP ≤ 140/90 mmHg
% of CHD patientsimmunized w/ flu vaccine
P17 P56a
CHD prevalence rate per 100,000 population
P28a % of AMI patients given aspirin within 60 min of symptom onset
P59 % of AMI patients receiving smoking cessation counsel during hospital stay
P54 % of AMI patients prescribed beta-blockertherapy at discharge
P51 % of AMI patients prescribed a statin at discharge
% of AMI patients assessed for cardiac rehabilitation
P50
% AMI patients currently treated with ACE-I or ARB
P56a
P52 % of AMI patients prescribed aspirin at discharge
1Analytics
Also 24 core metrics for the Coronary Heart Disease pathway
13McKinsey Health Systems Institute
� Diabetes incidenceO1a
� Diabetes prevalenceO2
� Proportion of diabetic patients who have reached the defined glycemictarget
O3a
� Prevalence of retinopathyO4
� Annual incidence of foot ulcersO5
� Prevalence of elevated micro albumin
O6
� Prevalence of elevated cholesterolO7a
� Prevalence of neuropathyO8
� Prevalence of obesityO10
� Incidence of major limb amputationsO13
� Prevalence of renal failureO14
� Prevalence of CHDO15a
� Avoidable diabetes admissionsO16
� % of asymptomatic adults receiving regular BMI check
P25a
� % of diabetics receiving annual retinopathy screening
P24a
� % of diabetics receiving annual foot examinations
P24b
� % of diabetics receiving annual micro albumin excretion screening
P24c
� % of diabetics receiving annual cholesterol screening
P24d
� % of diabetics receiving regular HbA1c testing
P9
� Incidence of StrokeO15b
� Incidence of MIO15c
Prevention of complications
Management of complications
Primary prevention of diabetes
Outcome metrics
Process metrics
� Diabetes incidence without complications
O1a
� Prevalence of elevated blood pressureO7b
� % of diabetics receiving annual blood pressure tests
P25d
1Analytics
� and 24 core metrics Diabetes pathway
14McKinsey Health Systems Institute
Every year, each member on average�
� spend 2,400 per capita on healthcare
� control 265 hospital beds
� employ 183 physicians
� treat 21,749 A & E attendances
� admit 18,295 inpatients
PPP adjusted US dollars
Per 100,000 population
Per 100,000 population
Per 100,000 population
Per 100,000 population
SOURCE: HealthTracker members data collection
1Analytics
15McKinsey Health Systems Institute
Elective Non-elective
Daycases
Inpatient admissions by type
Per 100,000 population
SOURCE: HealthTracker members data collection
23%
27%
50%
18,916
37%
42%
21%
19,652
48%
37%
16%
22,394
11%
40%
14,442
49%
14,153 13,48335%
21%
21%
52%
27%
51%
37%
13%
25,565
43%
Standardised for age and gender mix difference across member
PRELIMINARY RESULTS
R5 R1R4R3 R2 R6 R8
Acute care admission1Analytics
16McKinsey Health Systems InstituteSOURCE: HealthTracker members data collection
Average length of stay for elective coronary artery bypass graft procedures1
Days
Average length of stay for elective hip replacement procedures1
Days
Average length of stay for elective hysterectomy procedures1
Days
Average length of stay for elective knee replacement procedures1
Days
Improvement potential
1 Standardised for age and gender mix difference across member
13.8
6.69.8
6.58.61.4
8.40.67.8
1.27.2
7.2
07.50.3
0
5.5
11.4
1.70.87.26.11.30.2
7.05.9
5.9
7.6
1.16.8
4.8
8.4
0.44.0
0.23.8
6.5
4.44.00.9
3.60.4
2.9
3.6
0
10.51.6
10.01.3
9.20.9
9.2
0
13.312.2
13.1
10.8 4.24.03.1
PRELIMINARY RESULTS
R4 R7 R3 R6 R5 R2 R1
R4 R3 R2 R7 R5 R6 R1
R4 R5 R3 R2 R6 R1 R7
R2 R4 R6 R5 R3 R7 R1
Average length of stay by procedure1Analytics
17McKinsey Health Systems Institute
0
10
20
30
40
50
60
70
80
90
100
Cataract Inguinalhernia repair
Varicosevein stripping
Pregnancytermination
Myringotomy Sub mucousresection
Arthroscopy Extraction ofwisdom teeth
Proportion of surgeries performed as daycases
Percent
Upper middle quartile range (50%-75%)
Lower middle quartile range (25%-50%)
SOURCE: HealthTracker members data collection
Standardised for age and gender mix difference across member
PRELIMINARY RESULTS
R6
R1
R1
R5
R5
R1
R1
R1
R1
R5
R5R5
R2
R2
R4
R6R6
Day case surgeries1Analytics
18McKinsey Health Systems Institute
Avoidable hospitalisationsPer 100,000 population 2,514.8
2,053.41,811.1
1,639.31,271.3
+
347.1
141.7139.2
59.110.5
1,363.3
864.6
554.1514.7483.2
1,360.2
1,099.3936.0
777.5646.4
Vaccine preventable Per 100,000 population
Chronic conditionsPer 100,000 population
Acute conditionsPer 100,000 population
SOURCE: HealthTracker members data collection
Top condition
Influenza & pneumonia
Angina
COPD
COPD
Diabetic complications
Diabetic complications
Urinary tract infections
Dental conditions
Urinary tract infections
Urinary tract infections
Urinary tract infectionsStandardised for age and gender mix difference across member
All
R4 R2 R6 R3 R5
R6 R5 R3 R4 R2
R4 R2 R3 R6 R5
R4 R2 R6 R5 R3
R4
R2
R6
R3
R5
R4
R2
R6
R3
R5
Acute care admissions due to ambulatory care sensitive conditions1Analytics
19McKinsey Health Systems Institute
2.4
3.4
3.7
7.7
9.0
11.4
13.3
>5x
In-hospital mortality of AMI
% of AMI admission
In-hospital mortality of Stroke
% of stroke admission
10.5
10.7
12.9
13.1
15.5
17.7
21.1
2x
SOURCE: HealthTracker members data collection
Standardised for age and gender mix difference across member
PRELIMINARY RESULTS
R3
R2
R7
R6
R4
R5
R1
R3
R7
R1
R4
R2
R5
R6
Clinical outcomes1Analytics
20McKinsey Health Systems Institute
Primary screening & Diagnosis
Management of CHD Outcomes
Share of adult daily smokersPercentage
Share of adult with BMI over 30Percentage
AMI patients discharged with beta-blockersPercentage
AMI patients treated with ACEIor ARB
Percentage
AMI inpatient mortality ratePercentage
Readmissions within 30 daysPercentage
21.0
22.9
21.7
13.6
6.9
22.3
23.2
24.5
95.0
40.0
95.0
98.6
86.0
88.5
89.2
92.7
3.7
7.7
9.0
11.4
10.7
12.3
17.6
25.5
SOURCE: HealthTracker members data collection
Standardised for age and gender mix difference across member
PRELIMINARY RESULTS
R6
R4
R5
R2
R6
R4
R5
R2
R6
R4
R5
R2
R6
R4
R5
R2
R6
R4
R5
R2
R6
R4
R5
R2
Coronary heart disease pathway1Analytics
21McKinsey Health Systems InstituteSOURCE: HealthTracker members data collection
Stroke patients given aspirin within 48 hours of symptom onsetPercentage
Patients treated at stroke unitPercentage
Readmissions within 30 days (Stroke-O10)Percentage
Inpatient mortality ratePercentage
48.2
40.0
80.0
64.0
10.7
12.9
15.5
17.7
85.4
79.0
72.3
84.1
5.1
19.2
7.8
2.7
Management of Stroke Outcomes
Standardised for age and gender mix difference across member
PRELIMINARY RESULTS
R4
R2
R1
R5
R4
R2
R1
R5
R4
R2
R1
R5
R4
R2
R1
R5
Stroke1Analytics
22McKinsey Health Systems Institute
Prof. James Barbour � Chief Executive NHS Lothian (Scotland)
Sir Ian Carruthers � Chief Executive NHS South West (England)
Dr. Jack Cochran � Executive Director Kaiser Permanente (US)
Dr. Lim Eng Kok � Deputy Director Ministry of Health (Singapore)
Dr. Adriano Marcolongo � Director General Rovigo (Italy)
Dr. Tony O�Connell � Chief Executive Centre for Healthcare Improvement (Australia)
Dr. Hartley Stern � Chief Executive Jewish General Hospital (Canada)
Stephen McKernan � former CEO, Ministry of Health (New Zealand)
Delegates from 15 countries included:
Executive Panel on Innovation
Comparative Analytics: Patient Level Data
Measuring Value for Money in Healthcare
Optimising Clinical Pathways
Driving Value for Healthcare Reform
High impact topics included:
More than 80 health system executives and leading academics in Valencia in 2010
2Forums
23McKinsey Health Systems Institute
Back in Valencia� � members decided that they wanted to
� focus your efforts on one topic for a year of study
�collaborate with other regions to learn new ideas
� move from finding opportunities to proving results
� build capability in your region for clinicians to lead change
� drive innovation through your HSI membership
The Pathway Improvement Network was born as a joint effort from the LSN members to improve the performance across one specific area of care
SOURCE: HSI Conference � November 2010
Four members committed for 2011:
1. Hong Kong
2. NHS Lothian3. Queensland
4. Singapore
Cardiac Improvement Network � the beginning2Forums � Cardiac Improvement Network
24McKinsey Health Systems Institute
An analysis of how your CHD pathway looks likeacross different settings and disciplines compared to best practices
A view on the biggest cost and quality improvement opportunities translated into a prioritised set of initiatives to implement
Insights from peer regions on how to tackle the priority issues along the CHD pathway
New leadership skills for leads and working teams on how to manage change in pathways developed through capability building programme
SOURCE: CIN members
Goals for the improvement network2Forums � Cardiac Improvement Network
25McKinsey Health Systems Institute
Acute managementof AMI
Early managementof CHD
SOURCE: McKinsey
Spend per intervention in CHD pathway, $m per year
Primary prevention
Rehab and secondary prevention
PP
to
tal
EM
tota
l
AM
to
tal
46
55-6
1545352511-4
32, 3
5, 3
8, 4
53736343331
23-3
0222120 501817161514131211 199875-6 48 49
To
tal s
pen
d4710
Reh
ab t
ota
l
Intervention
� Interventions grouped into cost buckets � Interventions 1-4 represent cost of GP appointments related to CHD
Intervention cost waterfall2Forums � Cardiac Improvement Network
26McKinsey Health Systems InstituteSOURCE: McKinsey
7 dimen-sions to achieve excellent pathway manage-ment
Relevant sub-dimensionsRationale
Strategic vision▪ Shared vision and strategy▪ Long-term goals▪ Aim for continuous improvement and innovation
▪ Test if the organization has a clear vision on where to go for a specific care pathway
▪ Existence of standardized protocols ▪ Coherence of patient pathways ▪ Good use of human resources
Process execution
▪ Test if there are standardized processes and if these are well executed
▪ Clearly defined organizational departments and roles▪ Shared set of values▪ Forma/informal coordination tools
Organization/culture
▪ Test if the organization is correctly structured and has the basic elements to perform
▪ Clearly defined clinical leadership roles▪ Adequate clinical leadership skill set▪ Adequate clinical leadership mindset
Clinical leadership
▪ Test whether there is formal clinical leadership that overviews the pathway
▪ Existence/quality of performance reviews and dialogues
▪ Appropriate consequence management▪ Sufficiently broad set of metrics and clear targets▪ Single points of accountability
Performance management
▪ Test whether performance across the pathway is tracked using meaningful metrics and with appropriate regularity
▪ Information systems▪ Infrastructure and equipment▪ Financial support
Resources▪ Test whether the organization has
sufficient resources to provide expected outcomes
Talent management
▪ Test emphasis put on talent management
▪ Value proposition to attract talent▪ Organization�s performance on talent retention
Management practices assessment2Forums � Cardiac Improvement Network
27McKinsey Health Systems InstituteSOURCE: McKinsey
Patient outliers Practice outliers
8
12
0
10
2
14
6
4
Patients100% = 777
Admissions per patient
Identify frequently admitted patients to target
1015
1010
50
4035
30
>6050-60
40-50
30-40
20-30
10-20
5-10<5
GP practices with various numbers of admissions per 1000 CHD patients
Identify opportunities to improve primary care at practice level
Patient and practice outliers2Forums � Cardiac Improvement Network
28McKinsey Health Systems Institute
November 2010 in Valencia, Spain at the Annual LSN Conference
Sir Ian Carruthers (CEO of NHS South West), Jack Cochran (Executive Director at Kaiser Permanente) met with Valencia Deputy Minister Alofonso Bataller to learn more about the Valencia model of allowing private concessions, with capitated payments, within the existing healthcare system.
�At the Valencia hospital's ED I saw the future: An integrated approach across care settings with a risk transfer to the private sector for the public good. Incentives are beginning to align for both the individual and the institution". -Sir Ian Carruthers
April 2011 in London
Alfonso Bataller and Sir Ian Carruthers gave a joint presentation at the London School of Economics on "The Valencia Model and what the NHS can learn from Spain". Sir Ian determined to introduce the concept of private concessions to the NHS to "fuel innovation�."At its best, integration of care provides the right incentives to rally around the patient, not their own respective part of the system.� -Alfonso Bataller
May 2011 in Valencia, Spain
An entire delegation from the Singapore National Health Authority, led by Professor Kwong Ming Fock, went to Valencia to better understand the Valencia system.Discussions included Valencia´s innovative delivery formats and Singapore´s experience in how partial subsidisation/co-payment for health services affects demand, showing how systems have much to learn from each other.
�Health systems need to move towards a more integrated care. Valencia�s model is an intelligent way to create incentives for clinicians and managers in different care settings to align� - Kwong Mong Fock
Network connections carry far beyond the annual conference2Forums
29McKinsey Health Systems Institute
New York City:Combined public health and legislative strategies reduced the smoking rate by over 20%
U.K. and global: Coordinated programmes reduced BMI and increased healthy behavioursamong children ages 7 � 13
London: Restructured stroke services improved stroke outcomes and treatment
New Zealand: High impact smoking cessation reforms in primary care
Michigan: Simple protocols reduced catheter-related bloodstream infections by nearly 70% in >100 ICUs
l
Singapore: Chronic disease management programmesimprove outcomes
Washington: Significant reduction in hypertension with pharmacist care management, home monitoring, and web training
Knowledge bank provides case studies on how new knowledge is successfully being turned into practice
3Evidence
30McKinsey Health Systems Institute
▪ Guidance materials help with virtually any Initiative such as McKinsey�s Five Framework approach to organisational change
▪ Toolkits provide step by step guidance for specific initiatives:
� Improving patient pathways in hospitals
� Assessing primary care performance
� Improving GP access
Insights and tools provide practical guidance from McKinsey�s experience
3Evidence
31McKinsey Health Systems Institute
CHDrehabilitation
▪ Kaiser Permanente�s Collaborative Cardiac Care Service (CCCS) improves secondary prevention in coronary heart disease� Speakers: Dr. John Merenich, program leader, with Jon
Rasmussen, Pharm D. and lead pharmacist
End of life care
▪ Royal Marsden�s Hospital2Home programme allows more patients to die in their chosen setting� Speakers: Dr. Julia Riley, program leader, with researcher
Claire Smith
Diabetes and integrated care
▪ Tower Hamlets PCT�s integrated care programmes have improved outcomes and productivity in diabetes and beyond� Speakers: John Wardell, program director, with Caroline
Bailey and Ryan Meikle
Webinar detailsTheme
Improving Patient pathways
▪ Creating flow in patient-centered pathways� Speakers: John Drew and Rom Revington from Mckinsey
and Ciara Moore, from Cambridge University Hospitals NHS foundation trust
Regular webinars to help member identify improvement opportunities and how that might apply to their region
3Evidence
32McKinsey Health Systems Institute
Questions