A look at the resilience of value based healthcare systems
In sessions sponsored by Siemens Healthineers, Saudi speakers from the KSA Ministry of Health revealed that healthcare systems adopting Value Based Healthcare (VBH) models - measuring outcomes, standardising data, creating integrated care pathways and implementing payment for performance - have found themselves to be significantly more resilient than others during the pandemic.
Value based healthcare with Saudi values
Dr Reem Bunyan, Chief Executive, Center for Improving Value in Health, KSA Ministry of Health, Co-chair, G20 Health Working Group in Riyadh, established the premise for VBH, namely that people are getting older and are facing more chronic conditions, and that along with more options for treatment, the cost of care is on the rise.
If health systems continue to function in the same way, therefore, they will not be sustainable going forward. Accordingly, they are embarking on change to focus on outcomes.
Defining what VBH is, Dr Reem, emphasised is 'extremely important'. At its basic core is the need for balance between outcomes that matter to patients relative to cost, resources and effort. The Harvard definition is the more famous out there, she explained, and the WEF has published papers based on this. The Oxford group, meanwhile, included other dimensions in a separate defintion.
The EU customised its definition based on its respective values - an approach that Saudi Arabia adopted.
Dr Reem underlined that Saudi Arabia envisioned a 'triple aim' of the health system that was to produce better health; better care; and both lastly at a lower cost.
The journey to establish the Kingdom's first health transformation began in 2016. This transformation journey was large-scale, encompassing new providers, a new way to pay or finance healthcare, and introducing new models of care that engage beneficiaries and customers. Many healthcare workers and facilities have been involved, along with a big budget.
Saudi Arabia looked at the value-based healthcare definitions mentioned earlier, along with unique national elements. She explained that the Saudi nation is spiritual, connected, and close to families and communities, and that therefore the Saudi approach is to maintain balance betwen outcomes that matter most versus resources.
Undestanding what the VBH movement means, she concluded, will impact how each stakeholder plays their respective role in the system. A provider, for example, will be conscious of the impact of illness on community and the population at large, and factor this into their decision-making.
Population health management
Dr Abdullah Khoja, Head of Public Health Department, Project Lead for the Population Health Management Strategy, and Advisor for the KSA Vision 2030 Realization Office at the Saudi Ministry of Health, introduced the nation's overarching plan Vision 2030 and, correspondingly, the National Transformation Program (NTP), which set out to improve value-based care among other objectives.
He explained that VBH is at the heart of Saudi healthcare reform, and shared the three goals introduced earlier by Dr Reem: improving the health of populations; achieving better care (including quality, safety, experience and satisfaction); and reducing the cost of healthcare with financial protection and by also ensuring stability.
Key VBH initiatives in Saudi Arabia included developing a funding mechanism for healthcare systems; developing a governance framework; and moving the current service delivery system towards an accountable care organisation (ACO).
The aim is to move towards population health management as an approach, which he described as an organised and systematic approach to healthcare systems that requires a large-scale transformation, utilisation of the best available resources, health system intelligence and the reorganisation of services.
Saudi Arabia began this large-scale transformation through using the best evidence available. This served to create the right foundation for population management; manage services at scale for the population; and establish a learning system to drive and sustain the work overtime.
Over the past 18 months, Saudi Arabia has embarked on a population health management framework for the country - a way to achieve VBH through identifying the population, and prioritising segments within the population along with interventions required - which Dr Khoja dissected layer by layer through further slides.
COVID-19 vaccines: scientific advances, access models and vaccination acceptance
Recently, there have been several conspiracy theories about how a COVID-19 vaccine would change our genetic makeup or that these vaccines have a chip in them or, bizarrely, are equipped with 5G. At the COVID-19 vaccines: scientific advances, access models and vaccination acceptance session, Dr Soumya Swaminathan, Chief Scientific Officer, World Health Organization (WHO), busted some of these myths.
She said: “The first fear people have is the speed at which the vaccine has been developed, as it usually takes almost 10 years. However, this was possible thanks to the investments made in platform technologies, such as mRNA, that have been developed in different laboratories around the world. This kind of science and technology has not been there in the past and that enabled the fast turnaround.”
Other factors that helped in speeding up the process included increased investments in research and manufacturing. “A lot of at-risk manufacturing took place, which means that even if there is wasted capacity, people were investing. Also, there has been global coordination. The WHO has worked with countries around the world to smooth any pitfalls and has set up a global compensation fund. Though the timelines are short, no shortcuts have been taken,” she explained.
Understanding vaccine immunity and side effects
Dr Swaminathan stressed that there has been a lot of focus on studying the immune response and it looks like it lasts for six months. “We are going to learn more from vaccine trials and will be able to compare antibodies,” she said. “Over the next few months, we will be able to define what the immunity looks like. The good thing is most of the early vaccines used the spike protein and it is eliciting immunity.”
Several questions still need to be answered, she stressed. First is about protection versus infection. It is not known if the vaccine prevents asymptomatic infection. But if it only protects an individual’s body and passes it on to other others, it will continue to circulate in the community. Secondly, would these vaccines be effective in preventing severe disease? Thirdly, it is essential to know about the safety of vaccines for women who are in the age group of getting pregnant and for children. Also, how long does the protection last?
“Over the next year, we will some interesting results from different candidates. But right now, we need to start with what we have,” she added.
When asked about side effects, Dr Swaminathan said that all vaccines have side effects and many of them are mild such as a headache or fever. But the serious side effects vary from vaccine to vaccine and nothing major has been seen during COVID-19 trials. It is always about benefit versus risk, she stressed.
Currently, Emergency Use Authorisation for COVID-19 Vaccines is being carried out globally to bring an end to the acute number of deaths due to the virus. She elaborated that this is a temporary authorisation for the vaccine to be used where the manufacturer commits to provide more information to the regulator, especially on the safety of vaccines. After a certain period, the regulator will either withdraw the use or allow it to be released to the wider population.
She concluded: “All countries need to communicate with the public on what the policy for the vaccine is for that country. How will it be rolled out? What are the side effects going to be? How is the government is going to monitor and collect data? People need to understand the scientific process, which is not very well understood.”
The future of AI in Healthcare
COVID-19 has proven that with the help of technologies such as Artificial Intelligence (AI), solutions can be scaled very quickly, but how can these technologies be sustainable? Answering this and other concerns were Dr Shauna Overgaard, Assistant Professor, The College of St.Scholastica, Clarity Applied Intelligence, U.S., and Samar Nassar, Healthcare Director, KPMG.
Dr Overgaard shared: “I am so excited about what computers can do for humans and can, for instance, help us regain things that we have lost. There might be an opportunity if we think about it in terms of neurodegeneration, eyesight, paralysis, etc. Can we build on what we know in order to assist humans in becoming better? Can we take advantage of AI do our repetitive tasks for us so that we can continue to evolve and be innovative?
“I am not advocating that AI take the role of the radiologist, but we are in a position now where we can work together. It is not a competition but a collaboration between computers and clinicians.”
While Nassar shared that she often tells radiologists to think of an AI platform as a super assistant that provides answers in just 10 seconds. However, AI does come with its challenges such as leveraging data and data management.
“If we don’t have a strong foundation it won’t be successful. Another challenge is about policies and regulations such as cloud policy, the flow of data, patient privacy, among others.
"We are using AI for our own good, to augment our practice, drive productivity and fix that algorithm for better productivity, and provide better patient experience,” she added.
Radiology leadership and successful business
At this session, Prof Dr David Yousem, Associate Dean for Professional Development, Johns Hopkins University School of Medicine, highlighted that some of the characteristics of leaders are to seek input, admit that there are others who have more skills at dealing with certain issues and are more knowledgeable. “Advice can be critical to arriving at the best solution,” he said.
According to Yousem, strategic positioning is essential when it comes to business and includes variety-based positioning that involves the choice of product/service rather than customer segment or needs-based positioning, which targets a customer segment. It also includes access-based positioning that involves, for instance, putting imaging centres in hubs where more people can get access to it.
He stressed that radiology as a business has to deal with five competitive forces: rivalry among existing firms; the threat of new entrants; the threat of substitutions, which is where people are worried about teleradiology groups; bargaining power of suppliers; and bargaining power of buyers
“Strategic planning requires a trade-off, and the work should fit the mission, vision, and values,” he concluded.
Leaders insights: Supply chain and increasing hospital efficiency
In a session on supply chain and increasing hospital efficiency (sponsored by Nupco), experts looked at how supply chain contribute to an increase in the treatment capacity of a hospital or a hospital system or an entire country.
Jan Willem Adrian, logistics VP, Nupco (Saudi Arabia's National Unified Procurement Company), said obtaining the correct data was critical, to see if products are within the expiry date, and to ensure physical flow of products. Nupco is putting emphasis on getting the right products to the hospital on time in the right quantity, and is working with Saudi ministries to obtain better data.
Arsalan Sheikh, Senior Partner, Continuum Consulting, shared the following three key areas or considerations:
- Healthcare and leadership needs to see supply chains as a strategic advantage, rather than a cost centre – a fundamental change that needs to be realised. The number 1 cost for any hospital is people, followed by supply chain. Is supply chain therefore seen as a cost centre or as strategic advantage
- Efficiency needs to be seen as a directive towards waste reduction rather than as a cost saving (a by-product of waste reduction, rather than end goal)
- Supply chain is the collaborative network, or the collaboration that can be done on the network, with distributors and manufacturers. The typical activity of a supply chain in a hospital is what can be done in terms of inventory management and pushing costs up-stream towards distributors and manufacturers, instead of looking at the whole chain and reducing waste which would make it more efficient
Adrian said Nupco was formed exactly for these three reasons in Saudi Arabia, adding that it aimed to get inefficiencies out of the system, reduce stockholding for better cashflow, the availability of all products in the hospital needs to go up, and therefore value can therefore be created for the system as a whole. It’s a holistic approach.
Answering a question on how supply chains may contribute to sustainabilty and viability of hospital systems or an entire country, Adrian contributed the point that it was important to ensure that they have the best products in the market for the best treatments. Second, hospitals need to ensure that the best products are available at the right time.
Sheikh said that the supply chain was responsible for product availability, cost and cash (in terms of inventory and payment). In a healthcare context, this means availability on time and in the right place to reduce turnaround times in turn having a positive effect on patient experience.
This will result in patients demonstrating loyalty to the hospital. Cost will drive the margins to make the hospital more sustainable, and if it can profit it will grow and continue to operate.
Within Saudi, the margins tend to be higher in the US for every 1,000 dollars saved in the supply chain, it’s equivalent to 33-50,000 dollars of revenue. It’s easier to generate 1,000 dollars in supply chain savings. Strong negotiation will free up more cash for investment and revenue-generating activities.
In his mind, supply chain should be responsible for end to end, so that when inventory is consumed it is reflected in the right bills and patient charges. More often than not he doesn’t see this handled by hospitals.
Another aspect is product visibility, so in the event of a product recall hospitals know which items were used on which patient. Hospitals mostly don’t have visibility beyond central warehouses, he explained. They can’t connect this to patients, and this increases risk of patient safety.
In response to a question on how smaller hospitals may compete, Sheikh said that the solution was collaboration. Hospitals need to learn to be able to collaborate, and work diligently together through sharing information – this will in turn benefit the patient. Each hospital presently sees each other as a competitor.
Adrian told of an online Nupco marketplace similar to Amazon that allows hospitals to join and access rates that were negotiated for the overall contract for smaller individual shipments. Lastly, Nupco has also launched a programme which allows access stock to be shared with other entities to reduce shortages. It's an effort to take waste out of the market. Finally, demand planning will be key (wrong products are bought), to reduce expiry and overstock – and this is about having the right consumption data.
In conclusion, Sheikh described the evolution of GPU-type models an important initiative that should be established in the private sector. In the region supply chain evolution is 10-15 years behind the US, he told, and that the next logical step was a group purchasing organisation (GPO).
Adrian concluded by saying that all panelists were aligned in wanting to improve the healthcare system in Saudi Arabia, but they also needed to get better at communicating and exchanging information in what will be a long journey with small steps.