Something to Teach, Something to Learn. Dr Mark Britnell Chairman and Partner Global Health Practice KPMG

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1 Something to Teach, Something to Learn. Dr Mark Britnell Chairman and Partner Global Health Practice KPMG

2 Mark Britnell 54 countries, 160 occasions 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 ( KPMG International ), a Swiss entity. All rights reserved. This document is confidential and its circulation is restricted. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 1

3 World 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

4 KPMG research: Transaction trumps transformation. 3,000 CEOs from all industries see the importance of transformational change but focus their attention on short term transactional efficiency. Changing business operations to realize cost efficiencies 43% Improving cash and working capital management Exploiting growth opportunities through successful transactions Preparing your organization for major business model changes Managing and retaining the right people within the organization Addressing risk throughout the organization Looking for growth in emerging markets Innovation through product development Adapting to take into account changing customer and stakeholder behavior Using information to forecast response to uncertain times Refinancing or seeking capital Using technology as a strategic enabler, not just an operational facilitator Embedding sustainability in the business model Responding to regulatory change Seizing opportunities offered by increasing public/private sector interaction Note: (a) Due to rounding up and down total figure may vary from 300% Source: KPMG Succeeding in a Changing World % 30% 25% 24% 21% 21% 20% 18% 15% 13% 12% 10% 10% 6% Total adds up to 300% all respondents had three votes (a) 3

5 Healthcare leaders are even more focused on the urgent issues of today and less on the important ones of tomorrow. Healthcare Note: (a) Due to rounding up and down total figure may vary from 300% Source: KPMG Succeeding in a Changing World 2012 Improving cash and working capital management Changing business operations to realize cost efficiencies Addressing risk throughout the organization Exploiting growth opportunities through successful transactions Using information to forecast response to uncertain times Preparing your organization for major business model changes Seizing opportunities offered by increasing public/private sector interaction Looking for growth in emerging markets Adapting to take into account changing customer and stakeholder behavior Using technology as a strategic enabler, not just an operational facilitator Embedding sustainability in the business model Managing and retaining the right people within the organization Refinancing or seeking capital Innovation through product development Responding to regulatory change Healthcare Total 27% 32% 15% 21% 33% 30% 15% 15% 18% 25% 18% 4% 17% 21% 20% 18% 10% 12% 12% 10% 27% 24% 17% 13% 17% 20% 5% 10% 50% 43% Total adds up to 300% all respondents had three votes (a) 4

6 KPMG in Rome, Over 40 senior executives and clinicians from 22 countries debated major global challenges of today. Prof. Dr. Bastiaan Bloem Medical Director, Radboud University Nijmegen Medical Center Martin Gerber CFO, Universitätsspital Basel Anne McElvoy Public Policy Editor, The Economist Paolo Rolleri Director General IRCCS San Raffaele Pisana Istituto di Ricovero e Cura a Carattere Scientifico Christian Boel Vice Healthcare President in Region Midtjylland Tim Harford Senior Columnist at the FT and Author of Adapt: Why Success Always Starts with Failure Valerie Michie Global Head of Health, SERCO Dr. Giancarlo Ruscitti CEO Fondazione "Opera San Camillo" Prof. Dr. Hans Büller CEO, Erasmus Medical Centre Dr. Pieter Hasekamp CEO, Dutch Health Insurers Association (ZN) Dr. Terry McWade Deputy CEO, Royal College of Surgeons in Ireland Dr Brian Ruff Head of Risk Intelligence and Access Innovating Divisions, Discovery health Sir Ian Carruthers CEO, NHS South of England Unni Hembre President, European Federation of Nurses Associations (EFN) Sir Jonathan Michael CEO, Oxford University Hospitals NHS trust Dr. Masami Sakoi Planning Policy Director, Ministry of Health, Labour and Welfare Lord Nigel Crisp Independent Crossbench Member of the House of Lords Prof. Dr. Udo Janssen Chairman, German Hospital Institute Filippo Monteleone Managing Director, General de Santé Prof. Anupam Sibal Medical Director, Apollo Hospital Paul Cummings Director of Finance, Northern Ireland Health and Social Care Board Gary Kaplan CEO, Virginia Mason Medical Center Sir Robert Naylor CEO, University College London Hospitals NHS Foundation Trust Dr. Kevin Smith President and CEO, St. Joseph's Health System Frances Diver Executive Director, Victorian Department of Health Sir Bruce Keogh Medical Director of the NHS and NHS Commissioning Board Prof. Benjamin Ong CEO, National University Health System Dr. Arthur Southam Executive Vice President, Kaiser Permanente Dr. Jennifer Dixon Director, Nuffield Trust Bala Krishnan Director of Development Office of Chairman, Aspetar Scientific Advisory Board Carlo Perucci Head of the National Outcomes Programme, National Healthcare Agency Isabel Vaz CEO, Espírito Santo Saúde Prof. Axel Ekkernkamp CEO, Unfallkrankenhaus, Berlin Dr. Chul Lee CEO, Yonsei University Health System Glenna Raymond President and CEO Ontario Shores Centre for Mental Health Sciences Prof. Shan Wang CEO, Peking University Peoples Hospital Orsida Gjebrea Senior Policy Advisor, Supreme Council of Health Dr. Claudio Luiz Lottenberg Chairman & President, Hospital Israelita Albert Einstein Chris Rex CEO, Ramsay Health Care Ron Williams Former Chair & CEO of Aetna Inc. and member of President Obama s Management Advisory Board 5

7 The paradox. Most people believe that their health sectors need substantial change but think their own organisational plans are robust. They can t all be right. Transformational changes requires the majority to have a new vision. That's why change is hard. Focus remains on transactional change not transformational reforms. 6

8 From volume to value (USA): Leading hospitals, health plans and life sciences executives believe their business models are somewhat sustainable Sustainability of current business models over next 5 years: 2% 2% 9% 18% 20% 18% 40% 53% 43% Not at all sustainable Not very sustainable Somewhat sustainable Very sustainable Extremely sustainable 25% 20% 8% 8% 19% 17% HC Systems (104) Health Plans (51) Pharma (54) Source: Transforming Healthcare: From Volume to Value New Research on Emerging Business Models KPMG 2012

9 But they don t feel their industries will stay the same with moderate to major change coming in their sectors Extent of changes to your industry over next 5 years: 2% 4% 13% 33% 53% 63% 65% 41% 24% Minor changes Moderate changes Major changes HC Systems (104) Health Plans (51) Pharma (54) Source: Transforming Healthcare: From Volume to Value New Research on Emerging Business Models KPMG 2012

10 Healthcare leaders in Rome also demonstrate the paradox. Question The current business models operated by hospitals are: Somewhat sustainable Most (75%) think that current business models are somewhat sustainable but almost all (95%) expect moderate (30%) or major (65%) business model change in the sector Question How much change do you expect to see in the shape of the provider system and in their business models in the next 5 years? Major changes Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome

11 Active strategies to manage are transactional. 85% Major cost reduction 81% Lean and improvement methods 82% More focus and specialisation 78% Investment in Health IT Question Which strategies are providers likely to adopt to respond to these changes? 44% 74% New workforce models Extra income from existing payers Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome

12 ..but they expect payment systems to focus more on quality, value and risk. 78% Become more integrated 78% Contain more quality incentives 74% Focus more on patient value 74% Share more risk with providers Question I expect payment systems to: 11% 55% Reduce prices & cap volumes Remain largely the same Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome

13 They do believe integrated care will.. offer new possibilities for quality and cost Reduce costs (75%) Improve outcomes (90%) Source: Pre-conference survey Something to teach, something to learn, KPMG Rome 2012

14 Consensus on major trends. 1 Payers are becoming activist. 2 Some hospitals are transforming into health systems. 3 Patients becoming active partners. 4 High growth health systems, providing new perspectives on health reform. 5 Innovative integration and partnership. 13

15 Passive funder to activist payer. Make the organisation capable of contracting for outcomes and value. Find new ways to connect with and empower patients. Increase focus on the management of overall population health, moving care upstream. Information, segmentation and stratification. Delivery must be integrated and coordinated. Payment reform is key; from volume to value. 14

16 Providers: Transact or transform? In spite of fiscal crisis, many providers are still healthy and solvent. Uneven momentum for change. All face big strategic question do things better or do better things? For some M&A and new international markets offer growth e.g. Ramsay, Fortis, SECOM, Netcare. Much to be done operationally: Lean, workforce, care system re-design, clinical informatics and quality improvement at scale e.g. Intermountain, Virginia Mason, Buurtzorg, Salford. Some hospitals are transforming into health systems through integration or acquisition e.g. Geisinger, Apollo, Saskatchewan (Canada), Albert Einstein, Brazil. Some become narrow and focus using Lean, e.g. Aravind, Narayana Hrudayalaya, Fortis and Coxa in Finland. 15

17 Patients as partners: Patients are no longer passive recipients and new systems and ways of working are required to manage this change. It has taken a decade for us to realize that better care is usually less expensive care. It will take another decade for us to realize that patients are partners either creating or compromising value. Techniques that allow patients to create more value include: shared decision making; Al Mulley s preference misdiagnosis ; amplified patient voice; informed care and (internet) coaching. End of life care and chronic care are the most important immediate areas to create better value. Tools that patients need to control and secure better value include: pathways, records, decision aids, social networks and technology e.g. PatientsLikeMe. 16

18 From God to Guide ParkinsonNet: 5 design criteria: Helping to create an active patient able to manage their care and take key decisions Bas Bloem created ParkinsonNet: a revolutionary partnership approach involving Parkinson s patients in the Netherlands, has led to a 50% reduction in associated hip fractures and 20 million worth of savings. Defining what value based care would look like from the perspective of the patient Changing the way that doctors and other clinicians work with patients by shifting to a partnership approach with patients Creating a network of experts Linking all of these together with information technology tools 17

19 High growth countries. Something to teach, something to learn isn t a new form of Western Imperialism. High growth countries and emerging markets can be characterised by 3 words: speed, buzz and leapfrog. Many still have under-developed primary care platforms but entrepreneurs see this as white space. Much greater reliance on technology, smart operational processes and public-private partnerships. Growing middle class with increase in NCDs demands leap-frog over 20 th century care models. Asia, Africa and South-America all developing low-cost delivery models and point-of-care diagnostics. Reverse innovation. 18

20 Leaders in Rome identified 10 characteristics: Enduring Values Shared purpose Consistent and stable leadership 4 Deep engagement with clinical staff Strong focus on front-line Set culture, hold professionals to account Align individual, team and organisational objectives 8 Information transparency internal and external 10 9 Curiosity about high performance Authentic partnership 19

21 Coming soon... Global perspectives on clinical governance

22 This document is CONFIDENTIAL and its circulation and use are RESTRICTED 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 KPMG name, logo and cutting through complexity are registered trademarks or trademarks of KPMG International Cooperative (KPMG International).

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