GABRIELA PRADA

A healthcare executive who has worked on both the public and private sides describes ‘valuebased healthcare’.

on Value-based Healthcare

After several years at the Conference Board of Canada, you recently left that role to take on a new challenge in the U.S. What prompted this career change?

I loved my job, which involved working on innovation policy for healthcare — but after 10 years in the same role, I needed a new challenge. For me, the role at Medtronic has been a great transition: I still get to work on healthcare policy, but this is an opportunity to do so from a private-sector perspective. It is also allowing me to build up my knowledge and skills by working on these issues more globally, which has been wonderful.

Broadly speaking, would you say the challenges you face in this role are similar or different from those you faced before?

I do a lot of work in South America and some work in Europe, Asia and the U.S., and one thing that has become clear to me is that the healthcare challenges societies face are global. At the Conference Board, we used to talk about our

aging population, because we recognized that it will mean more chronic disease, which will put even more pressure on the system. Well, guess what? These issues are not unique to Canada. It is the same story everywhere. This is a global phenomenon.

Even developing countries are now concerned about chronic diseases, which is a big change for them. They used to focus mostly on communicable diseases, but now their focus is the same as Canada’s: How to effectively manage non-communicable diseases like cardiovascular disease and diabetes. The good news is that there are now even greater opportunities to learn from different countries, because we all have similar challenges and priorities.

In many countries — including Canada — there are wide variations in healthcare quality. Why is that?

This is true, and it’s because the system we adopted was not designed to reward good outcomes. We are always counting things: The number of hospitals we have, the number of programs available, the number of active physicians and nurses, the number of consultations occuring; but until very recently, we have not been measuring something very important: results.

For example, we carefully count the number of people in each diabetes program across the country and how often we measure their A1CS, but we don’t necessarily count the proportion of patients whose A1C levels are in a normal range. Nor do we reward the teams that deliver better results. We are still largely measuring, funding and rewarding healthcare performance in terms of volume. That was really important when we designed the system many decades ago. At the time, the goal was to to provide healthcare access to everyone, so volume was really important.

Today, most people working in healthcare understand that we also need to be accountable for results. I am very passionate about the transition that is underway from volume to value, because when we focus on the value aspect, everybody wins — but particularly, patients. And that should significantly increase quality evaluations across the country.

For those who are not familiar with it, how would you define ‘value-based healthcare’?

Value-based healthcare is a framework that allows us to organize healthcare services to achieve two important goals: To improve outcomes for patients and to do so at a manageable cost. In the past, we typically made decisions in terms of cost alone. With value-based healthcare, we identify what good outcomes look like (which are really about patients), and then determine at what cost we can achieve those outcomes. Value-based healthcare is a philosophy that allows us to reorient the entire healthcare system to focus on what matters: better results for patients.

If I were to walk into a hospital that embraces valuebased healthcare, what would I see?

From the patient’s perspective, you should be able to see services that are more aligned with what patients need and value — and that is not necessarily the case today. For example, in some places, it still takes two months from the moment a patient gets a referral to explore a pressing health issue until she receives a diagnosis and treatment plan. In redesigning this process from a value-based perspective, we have been able to reduce the waiting time from two months to one day.

From a patient’s perspective, that really adds value. Not only are you decreasing the anxiety that the patient might experience, but you are also making the services themselves

Most people working in healthcare understand that we need to be accountable for results.

more effective and efficient, and getting to a resolution much faster. The more we keep an eye on the quality of outcomes and results, the better the system will be.

Could you touch a bit on ‘value-based procurement’ and how it fits into the picture?

This is actually really important. It is pretty easy to understand the value-based healthcare philosophy. Virtually nobody disagrees that we should take steps to improve patient outcomes at a reasonable cost. Intuitively, people get that. The challenge is, how to implement and execute it, and the procurement portion is a critical piece of the puzzle.

If you make a decision that you want to reorient your healthcare system towards value, but you continue purchasing products and services based only on cost, there is a misalignment of objectives. It will be very difficult to achieve a value-based healthcare system if we don’t change how we address the procurement piece.

From my perspective, procurement is critical for a country like Canada, where we have a national healthcare system that relies on public procurement to purchase everything required to deliver healthcare. Procurement can be an enabler in implementing value-based healthcare.

You have worked for an influential think tank and are now on the supplier/manufacturing side. Are there conflicting goals between the two sides that need to be addressed?

I don’t think so. At the Conference Board, we had executive networks that brought people from the public and private sector together. To me, that was always critical, because the challenges we face in healthcare are very complex. There is no way that the public sector alone can solve these issues. Implementing value-based healthcare requires a strong partnership between the public and private sectors.

I don’t think there is any conflict of interest there. Par- ticularly with leading companies like Medtronic — whose stated mission is ‘to improve patients’ health’. We just need to be really clear about the role that each stakeholder brings to the table to improve patient outcomes.

How will artificial intelligence and other types of technological innovation contribute to all of this?

Medical devices are advancing at a very fast pace. Already, there are many tools that are adding tremendous value to the technologies that we have today. AI is one of them, and Big Data is another. There is a huge volume of data being generated, and data analysis will be extremely helpful in measuring outcomes.

We are already seeing some of these technologies being used. For example, Medtronic has a partnership with IBM to look at data from the diabetes centres we work with. With more and more data, we will better understand not only patient behaviours, but also how much value we can add to those behaviours. For instance, there are lots of people out there who are not yet diabetes patients but who could use some help to stay healthy. That’s where the prevention piece can kick in.

Having worked on both sides of the issue, what is the reception like from actual healthcare providers? Are you being welcomed with open arms?

I see awareness of the need for change. Clinicians are generally very enthusiastic once they realize the possibilities of value-based healthcare for their patients. But there is uneven readiness for change. Reorienting the entire system from volume to value is a massive challenge.

What is your greatest challenge in making value-based healthcare ‘the new normal’?

I would say it’s inertia. Like any large, complex system,

Implementing value-based healthcare requires a strong partnership between the public and private sectors.

healthcare is very difficult to change. It’s even difficult to change entrenched processes a little bit, never mind embracing a whole new way of seeing problems and solutions. At the same time, the challenges are now so overwhelming that it is opening up opportunities that we didn’t have in the past.

At the end of the day, what will make the biggest difference is our inherent ability to change. We need to be open to new ideas, paternerships, perspectives and models and believe that we can all be part of improving health outcomes. Many people say, ‘It’s not my role to do that; that’s someone else’s job’. But that is wrong. When you are engaging in systemic transformation, everyone has a contribution to make.