Roma, 18 Dicembre 2017

NUOVI STRUMENTI DI VALORIZZAZIONE

DELL’INNOVAZIONE

E SOSTENIBILITÀ DEL SSN

GUIDO BECCAGUTTI

VBHC LEAD MEDTRONIC ITALIA

VERSO SISTEMI SANITARI VALUE-BASED

LA PROSPETTIVA DI MEDTRONIC

I costi per l’assistenza sanitaria stanno

esplodendo

1

SFIDE NEI SISTEMI SANITARI GLOBALI

1. Source: Deloitte. 2015 Global Health Care. Accessed September 8, 2015. 2. Source: ICHOM analysis, Martin Makary, How Health Care’s Successes Became Distractions”, Health Affairs August 2014 3. World Health Organization. The Impact of Chronic Disease in High Income Countries. Accessed September 1, 2015 / UNC Carolina Population Center. Mortality and Cause of Death, 1900 v. 2010. June 16, 2014. Accessed September 1, 2015., 4. Source: Michael Porter ICHOM 2016

2x variation in 30-day mortality rate from heart attack in U.S.

18x variation in reoperation rates from radical prostatectomies in the Netherlands

20x variation in mortality after colon cancer surgery in Sweden

Esiste grandissima variabilità sugli esiti

di salute erogati

2

Consumer-driven healthcare

Evidence-based medicine

Prior authorization for expensive services

Le “soluzioni” incrementali proposte hanno avuto un impatto marginale

4

I bisogni di salute sono solo destinati

a crescere

3

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

SIGNIFICANT OUTCOME VARIATION WHERE EVER DATA ARE AVAILABLE 2-36X VARIATION IN OUTCOME, DEPENDING ON PROCEDURE AND COUNTRY

• variation in 30-day in hospital mortality rate from heart attack in US (25th vs 75th perc.)

• variation in bypass surgery mortality in the UK

• variation in reoperations due to complications after knee replacement in Germany

• variation in emergency readmissions after hip surgery in the UK

• variation in complication rates from radical prostatectomies in the Netherlands

• variation in reoperation rates after hip surgery in Germany

• variation in capsule complications after cataract surgery in Sweden

2x

4x

5x

6x

9x

18x

36x

Source: National institute for cardiovascular outcomes research annual report 2010-2011, The Swedish National Cataract Registry, HSCIC, NIS and SID 2011 data, AHRQ IQI SAS Module, Dimick et al. (2009). Composite measures for surgical mortality in the hospital. Health Affairs, 28(4), 1189–98, Health at a Glance 2013, OECD Indicators; Statistisches Bundesamt (DRG_OPSvier, Stat_Bev_EA), eigene Berechnung und Darstellung (IGES 2014) https://faktencheck-gesundheit.de/die-faktenchecks/interaktive-karten-zu-regionalen-unterschieden/kniegelenk-erstimplantationen/BCG analysis

SISTEMI VOLUME-BASED: PROBLEMI GLOBALI

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

EPISODICI DISCONNESSI INCONSISTENTI CARENZA DI DATI

GLI EROGATORI

SONO FINANZIATI A

VOLUME O SERVIZIO

NON A VALORE

MANCANZA DI

CONTINUITÀ

ASSISTENZIALE

ENORME

VARIABILITÀ DI

ESITO

PATIENT-TO-PATIENT

OSPEDALE - OSPEDALE

(TALVOLTA ANCHE NELLO

STESSO EROGATORE)

I DATI DISPONIBILI

NON SONO

CONDIVISI E/O

VALORIZZATI

LA SOLUZIONE: METTERE IL PAZIENTE REALMENTE AL CENTRO DELLE CURE

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

IL PUNTO DI VISTA L’INDUSTRIA HA UN RUOLO PRIMARIO NELLO SVILUPPO DI SISTEMI VALUE-BASED

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

RESPONSABILITÀ

E

OPPORTUNITÀ

DI AGIRE COME

PARTNER/LEAD

INSOSTENIBILITÀ

DEI SISTEMI

SANITARI

ACCETTAZIONE E

SUPPORTO ALLO

SVILUPPO DI NUOVI

MODELLI DI

EROGAZIONE E

FINANZIAMENTO

PATIENT-

CENTERED MISSION

& MINDSET

SIAMO PREPARATI

PER ESPLORARE

NUOVI SISTEMI DI

PAGAMENTO

STARTS WITH A COMMON UNDERSTANDING: WHAT IS “VALUE” DEFINIZIONI

The Economist Advisory Board:

“A healthcare system that explicitly prioritizes health outcomes that matter to patients relative to their costs.”

Michael Porter’s definition for “value:”

“The health outcomes achieved that matter to patients relative to the cost of achieving these outcomes.”

International Consortium for Health Outcomes Measurement (ICHOM):

“Value is defined as the outcomes that patients experience relative to the cost of delivering those outcomes. Value-based Healthcare, or VBHC, is healthcare that delivers the best possible outcomes to patients for the lowest possible cost. ”

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

We are actively partnering to drive meaningful dialogue from thought-leaders across healthcare about how we can transform the incentives in healthcare today to focus on outcomes.

“

” Omar Ishrak Chairman & CEO, Medtronic

8

LA VALUE AGENDA

CHRONIC CARE MANAGEMENT

OUR FOCUS:

EPISODIC CARE BUNDLES

THERAPY OPTIMIZATION

Routine treatment delivered typically includes our product

Impacting care over a more sustained period of time (beyond the product sale)

Products/ technologies that by design impact outcomes and cost

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

VBHC SIGNATURE PROGRAM CASE STUDIES

CHRONIC CARE MANAGEMENT: DIABETE

13

CHRONIC CARE MANAGEMENT TRATTAMENTE DEL DIABETE DI TIPO1 (DT1) IN BAMBINI O ADOLESCENTI

La sfida: IL DIABETE DI TIPO

1 RICHIEDE CURE

COSTANTI E

SPESSO CONDUCE

A COMPLICANZE

CLINICHE GRAVI E

INGENTE

CONSUMO DI

RISORSE

Globalmente il 10% di

tutti I pazienti con

diabete ha un DT1

70,000 nuove

diagnosi/anno di

bambini/adolescenti

Circa 500,000

bambini nel mondo

convivono con DT1

Curare un bambino

DT1 is 6 volte più

costoso di uno senza

diabete

1

1 Diabetes Voice, International Diabetes Federation. https://www.idf.org/sites/default/files/attachments/DV_56-SI2.pdf

2

2 Medical Costs for Youth with Diabetes More than $9,000 a Year, CDC. https://www.cdc.gov/media/releases/2011/p0427_youthdiabetes.html

3 Diabetes Voice, International Diabetes Federation. https://www.idf.org/sites/default/files/attachments/DV_56-SI2.pdf

3 4

4 Diabetes Daily, ADA. https://www.diabetesdaily.com/forum/diabetes-news-studies/89393-type-1-diabetes-type-2-diabetes-historical-trends-theories-about-cause/

14

CHRONIC CARE MANAGEMENT DIABETES CLINIC NETWORKS

Le cliniche Diabeter utilizzano un

approccio di cura integrato in cui il rimborso

è per l’itero ciclo di presa in carico in

relazione al valore clinico ed economico

creato e non al volume dei servizi generato.

Ciò che rende Diabeter all’avanguardia non

è solo il miglior livello di cure, ma la

capacità di seguire il paziente dentro e fuori

le cliniche.

L’APPROCCIO.

L’

EVIDENZA.

Più di 2,000

pazienti

seguiti cin

approccio di cura

integrato

50% dei bambini

raggiunge il target

di HbA1c target, il

miglio risultato

clinic in Olanda5

8.6% di

risparmio sul

percorso di cura,

principalmente

dovuto alla

diminuzione dei

rates

ospedalizzazione

5 Zorg instituut, 2014

SHARED ACCOUNTABILITY

CONCLUSIONI

• Trend globale di sviluppo di sistemi outcome-based anziché volume-based

• Necessità di visione olistica e di politiche coordinate

• Necessità di esperienze pilota

• Necessità di vedere le innovazioni dentro un percorso di cura

«orizzontale» del paziente

WHERE TO LEARN MORE PARTNERING TO LEAD THE TRANSFORMATION

The Economist Intelligence Unit Report, “Value-based Healthcare:

A Global Assessment” http://vbhcglobalassessment.eiu.com/

Harvard Business Review Insight Center,

“Measuring Costs and Outcomes in Health Care” https://hbr.org/insight-center/measuring-costs-

and-outcomes-in-health-care

©Medtronic plc 2016 All Rights Reserved. No further copying or dissemination without permission of Medtronic.

medtronic.com

Position papers and case studies can be found on the “Transforming Healthcare”

section on our website: http://www.medtronic.com/us-en/transforming-

healthcare.html/