Transformation of services and care pathway re-design – creating a sustainable future for healthcare
One of the major issues for global pharma currently is the global anxiety around the sustainability of healthcare. There is a broad consensus that transformation rather than transaction is key to creating a financially stable health economy.
Unfortunately, the evidence indicates that certain markets have had limited success to date. In the UK for example, 47% of PCT clusters in 2011-12 reinvested less than a quarter of their cash releasing savings in transforming services. The proportion of cash-releasing savings reinvested in transforming services varied and there is no evidence of a shift in staff from the acute to the community sector
Transformation of services includes initiatives such as integrating care, meaning that multiple providers work together to provide a coordinated service for patients, and expanding community-based care.
However, there are a number of challenges to delivering service transformation:
1. Changes take time to implement and may initially cost, rather than save, money
2. Redesigning care pathways to deliver seamless integrated care, whilst giving consideration for personal health budgets, can be difficult
3. Financial incentives do not always encourage healthcare providers to undertake service transformation.
Prospective payment schemes such as PbR can create perverse incentives now that the NHS is seeking to reduce hospital activity; and in community settings, 90 per cent of care is reimbursed under block contracts, which does not provide an incentive to increase activity.
BioPharma and MedTech manaufacturers need to engage with ‘Activist Payers’, the ones who seek value in outcomes, contract more selectively, are willing to shape patient behaviour and focus more on moving care upstream in terms of primary prevention. These payers are critical to supporting the transformation of service delivery and changing the face of healthcare.
At this year’s ISPOR Conference in New Orleans, I gave a paper entitled “Transformation of Services and Care Pathway Redesign in the NHS: Further Reforms in Health Policy”.