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Transcript of Disrupting the game- how charities can get a commercial edge and improve outcomes for their...
Disrupting the
Game – how charities
can get a commercial edge
and improve outcomes for their beneficiaries
Hilary Thomas,
KPMG
Breakthrough Breast Cancer
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2© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game - Outline
� Context – my journey
� Healthcare globally and in the UK today
� The unique position of Charities
� Why engagement is key
� Examples of public engagement as a disruptive innovation
3© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game - A personal story
� Age 9
� In my 20’s
� Being a Consultant
� Being a Patient
�Moving to the private sector
� Being a Trustee
4© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game - Healthcare in the UK todayWorld Economic
Forum, Davos 2012: “The financing of health systems
has increasingly burdened
developed economies, which has
been exacerbated by the fiscal
crisis. Participants agreed on the
drivers of the expenditure growth
and, since many of these factors
are unlikely to recede (e.g. ageing,
lifestyles, public expectations),
there is a clear need to develop a
more sustainable way of
managing health systems. The
magnitude of health financing
challenges suggests that
incremental solutions may not be
enough; however, a shared vision
of new models for health systems
does not yet exist.”
Source: The Great Transformation: Shaping New Models – World Economic Forum Annual Meeting Davos 2012
5© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
We are well aware of the challenges...
People and products:
Aging
Multi-morbidity
Rising expectations
Lifestyle diseases
Technology and devices
Process:
Poor system and process design
Specialisation
Organisational culture
Problems with the economic model
Growing complexity
6© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Active strategies to cope are transactional.
Question - Which
strategies are
providers likely to
adopt to respond to
these changes?
Major cost reduction
Lean and improvement methods
More focus and specialisation
Investment in Health IT
New workforce models
Extra income from existing payers
85
%
81
%
82
%
78
%
74
%
44
%
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
7© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
The problems with hospitals:
Not specialist enough for complex cases.
Not general enough.
Based on some odd design rules.
Not very safe out of hours.
8© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
The leadership and governance mechanisms to address all these
problems are poorly developed
The dominance of professional autonomy: the
tendency to reject mechanisms of accountability.
A reluctance to give or receive feedback or
to share information about performance.
Emphasis on individual judgment and knowledge
rather than on the value of teams.
Reluctance to accept the idea that clinical decisions
have resource consequences.
A paternalist approach to care and inadequate
involvement of patients in their own care.
Undervaluing and under investment in management and
a divide between clinicians and managers.
The problems
with the
organisational
culture:
Leadership not just better management.
9© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
The design rules need
to change.
■ Treat each episode as a single event.
���� Anticipate need and manage years of
care■ Treat patients as though their time is free.
���� Eliminate wasted time and travel
■ Move patients.
����Move staff and information
■ Batch and queue.
���� Patients flow through the system
■ Patients are passive recipients of care.
���� Patients actively manage their own care.
10© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game - Healthcare in the UK today
� The Health and Social Care Act 2010
� Putting patients at the heart of the NHS - no decision about me without me
� Focus - improving outcomes, emphasis on high quality care and not on process
� Empowering local organisations and professionals
making NHS services more directly accountable to patients and communities than they
currently are
11© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game - Value Based Reimbursement
.
:
Focus - on a process,
on a procedure or on a disease area.
Channel shifting - move services
to online, telephone and other modes.
Patients and their networks as a source of value -
co-producing or even co-designing the product or service.
Disintermediation - Taking out steps in
the supply chain to reduce costs or increase value.
Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.
12© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game – Focus on WellnessDisrupting the Game -
.
:
Move from a National Sickness Service ,
To a National Health Service.
Consider Prevention as today’s problem
Not something to be deferred until tomorrow
Incentivise the right behaviours
Build on behavioural economic understanding
See the patient as a source of value
Support and foster self care and better understanding
Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.
13© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the game – Segmentation, Stratification and Personalisation
.
:
Segmentation
Define the most important segments
Stratification - who
Agree principles to risk stratify populations
Personalisation
Build on voluntary sector experience/ expertise
14© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Summary
�There is a huge opportunity
�Be ambitious – identify value added opportunities which are scaleable
�Work with new commissioners of care to disrupt the system
�Ensure you measure your impact – Porter principles -
Value = Appropriateness x (Outcome)Cost
�Engage the public and use the new world order – social media – to advantage
15© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Disrupting the Game
Hilary Thomas
Partner and Industry Expert Global Health Practice
KPMG Health Advisory
Vice Chair
Breakthrough Breast Cancer