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Archive for March, 2007

Conference commentary: interviews with WHCCE attendees

by Hylton Jolliffe

Lloyd Davis, whose comprehensive coverage of the World Health Care Congress Europe kicked off this blog, has asked me to post a few more of the short interviews he conducted with some of those in attendance at the event. See below for the latest.

Attendee interview: Andy Harris

by Hylton Jolliffe

A systems architect for a UK-based organization discusses their plan to recruit, over the next three years, a half million individuals to participate in their project to gather personal data and medical history into a resource that can be used for research on diabetes and other diseases. Also touched upon: patient-centered care.

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Attendee interview: Dr. Ogbo Harbor

by Hylton Jolliffe

A specialist in family medicine from South Africa discusses his observations on European models for care, noting the growing emphasis on community care, rather than hospital care, for chronic diseases, and how that maps on to models in his and other countries in Africa. Also touched upon: disease management.

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Attendee interview: Jim Murphy

by Hylton Jolliffe

A Nova Scotia-based health care professional comments on the surprising universality of the problems seen in Canada related to chronic disease management and population health management. Also noted: the “bravery” of those willing to share their insights and learnings from political struggles within their respective countries.

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Attendee interview: Volker Amelung

by Hylton Jolliffe

A brief chat with Volker Amelung, Professor at Hannover Medical School and Managing Director of German Federal Association of Managed Care, on what in particular interested him at the conference: discussions on the management of chronic diseases, pay for performance, and different countries’ approaches.

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Attendee interview: Graem Dowden

by Hylton Jolliffe

[The first of a few more interviews conducted by Lloyd Davis that we’ll be posting today.]

An Australian physician comments on the shared challenges faced by all countries as they manage aging populations, rising costs, etc. Some of the tools and methods for which he sees great potential: tele-medicine and nurse coaching.

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WHC blog update and evolution…

by Hylton Jolliffe

For those of you just arriving at the World Health Care Blog, welcome! The blog has, to date, been a repository for Lloyd Davis’ numerous interviews and exhaustive notes from the World Health Care Congress Europe. The conference, which ran from Monday through Wednesday of this week in Barcelona, convened leaders of many of the continent’s most interesting and innovative health care-related initiatives as well as a few of their American counterparts for an intense discussion of how the industry’s evolving to advance health care quality, improve access, and contain costs. Among the many speakers whose talks Lloyd reported on:

  • Dr. Hans Jürgen Ahrens, Chairman, AOK-Bundesverband, Germany
  • Cor Spreeuwenberg, Dean, Faculty of Health Sciences, Professor, Department of Integrated Care, at University Maastricht, Netherlands

  • David Nicholson
    , Chief Executive of the UK’s NHS
  • Marina Geli, Minister of Health for Catalonia
  • George Halvorsen, the Chairman and CEO, Kaiser Foundation Health Plans and Hospitals
  • Walter Bergamaschi, General Director, Information Systems, Ministry of Health for Italy
  • Bernard Kouchner, co-founder of Doctors Without Borders and of Médecins du Monde
  • Jennifer Dixon, Director of Health Policy at the King’s Fund in the UK and a board member of both the Audit Commission and the Healthcare Commission
  • Jack Lord, CEO of Humana

And be sure not to miss this exclusive interview with Muhammad Yunus, the Nobel Peace Prize-winning Bangladeshi banker and economist who here discusses his prescription for reforming health care in his and other developing countries. We’ll be compiling all posts from the blog into a reference link in the next day or two - for now please take a look back at the last few days of coverage by scrolling down from this post.

With that said…

With that said we move on to the next, equally exciting phase of this new blog of ours: a group discussion, led by some of the field’s most insightful bloggers, on the broad theme of innovation in the industry. Tune in over the next few weeks and you’ll find an expanding cast of contributors discussing and debating the issues, challenges, and opportunities that face this massive and ever-changing sector of our economy and civil society.

Kicking off the discussion (they’ll be joined by others): Matthew Holt of the Health Care Blog, Derek Lowe of In the Pipeline, Emily DeVoto of The Antidote, and David Williams of the Health Business Blog.

If case you’re not familiar with them - they’re some of the blogosphere’s keenest observers, commentators, and reporters on health care and we’re thrilled they’ve agreed to join us here for what we hope will be an interesting and edifying discussion in the weeks leading up to the World Health Care Congress, the World Congress’ signature event (find out more about the event, which runs from April 22-24 in Washington, DC here). We encourage you to engage with them and the blog in general - some of them will be attending the event as well and our hope is that some of the discussions that start here on the blog will be continued at the event itself.

Did you vote? Would you like to see how others voted?

by Lloyd Davis

The PDAs for Audience ParticipationTwo innovations in the use of information technology were apparent at the conference. One was (*blush*) this blog, but the one that no-one who spent any time in the main hall can have missed was the interactive audience response system provided by Visiontree.

When participants at the conference were asked “How well did the interactive, PDA-based Audience Response
System enhance your experience?” on a scale of 1 to 5, two-thirds of them answered with 4 or 5. So if you enjoyed taking part in the audience response, you may find it interesting to have a look at the results of the surveys.

On the same site you can also download electronic versions of many of the slide packs from presentations throughout the conference.

All these files are made available in PDF format.

Jack Lord on consumer engagement

by Lloyd Davis

Jack Lord, Humana Inc.Background: CEO, Humana Inc., USA
Theme: Consumer Engagement: A Model for Shared Decision-making
A US insurer’s perspective on reform in commissioning in the UK NHS

The challenge: achieving financial balance while delivering national targets.

Commissioning ensures that the NHS provides equity, choice, information transparency, and optimal care pathways within resources allotted. Commissioning depends on assessing providers, managing them, recruiting, capability, fostering local partnerships, and ensuring a system of accountability, so that people know that the monies they raise through taxes actually go towards what they want in the health system.

We’ve made data more available and improved links between health professionals. Allows for real time multi-payer services.

In engaging consumers we take the role of a cultural anthropologist to understand people first rather than getting people to understand us. For example, an emblem of the health care system is the hospital gown - no consumer-oriented operation would create it.

I have a USB device that tracks all of my activities - it’s a sort of “frequent flyer” program that provides incentives for people for what they do for their health. What we recognize is that health is co-created, not something that doctors do to patients. We also want to make things fun - traditionally we tell people what they shouldn’t do, don’t want to hear, prod, probe them, and make them wait for hours, and never make anything fun or engaging. If we’re really going to work on these things we have to truly engage them rather than just giving them information.

We’ve also focused on using information for predictive modeling - looking for predictive signals that you’re at risk for a heart attack and seeing what we can do to prevent that.

We did work with families doing diaries and this helps us to give them back information in a useful way. Everyone gets a statement from their bank often with suggestions of how you could improve your financial health, but you don’t get something like that from the health system - we’re starting to that with our “smart summary”.

Taking this to the UK means blending the best of both worlds, understanding the local culture and what’s important to people so that you can better engage with them. At the end of the day it’s in order to positively influence health inflation.

Q: Providing information back to the patient is very interesting - how are patients reacting?
A: We’ve approached it by saying you should have equal symmetric information. One of the problems in the U.S. is that no one doctor knows what other doctors have done. We give people a card so so they can see all of the medications they’ve been prescribed. It’s made practice easier especially with over-65-year-olds who are generally on 5+ medications.

Q: How do you measure the impact?
A: Our #1 focus is compliance with medication - we’ve seen a 12% increase since we’ve provided messages as well as statements. And now we’re also thinking of financial incentives.

Q: Who will drive the uptake of wellness programs in the U.S.?
A: We the health insurers are responsible for everything. We believe that more activity means more health and so we’re trying hard to get people over 65 active and promoting fitness clubs. It’s in our interest over time to have healthy people. We’ve just started a brain gym too and that is having a positive effect too.

Q: How do we have to change the payment systems to support preventive care?
A: You have to have a vision and culture that is focused on health as opposed to illness. Our industry has developed differently so we don’t always have good systems for looking after health. It’s not a bureaucratic change as much as a cultural change. If you take an ecologist’s view, we have the levers inside of our systems but we have to work out which ones work and we have to celebrate diversity and engage with people differently accordingly - remember that consumers are people too.

John de Zulueta on the balance of public & private provision

by Lloyd Davis

John de Zulueta, SanitasJohn is Chairman, Sanitas, the Spanish arm of the BUPA Group, Britains largest private healthcare provider.

Theme: Balancing State and Private Contributions in European Healthcare Systems

I’ve been in the health business for 16 years - this is my penance for selling fast food snacks and soft drinks earlier in my career :)

If you look at an ideal health system, you want low cost, high quality and easy access and if you can do all three you’re doing well. Spain is good at cost and quality but access isn’t easy, they have crowding and waiting lists.

When Spain reached a population of 40m all predictions were that it would reduce, but now thanks to immigration, particularly in the last five years it’s gone up to 44m. We have universal coverage for people who live here, provided by 17 autonomous regions. Catalonia, where we are today was one of the earliest and so one of the most developed but still services are characterised by budget deficits and patient dissatisfaction.

We offer complementary services - eg adult dental care or IVF where the public services can’t or won’t provide but we also play a substitute roles where public services are farming out their services to private provders. In Spain we have the equivalent of PFI (Private Finance Initiative) both in terms of construction of a hospital, or as in the Valencia model the private provision of the core clinical practice. 7 new hospitals are being built this way in Madrid and others in the Balearics. Valencia is doing PPP in 5 hospitals and 1 such hospital is coming in Madrid.

Our investement so far is 144m euros and we expect an 80m euro per year turnover or 1,200m over 15 years. The challenge for us is that we are responsible for *all* the medical care.

We have oportunities in long term care too. In long term care, public and private have been working together since the start. Most nursing homes are privately owned and managed with a 60:40 ratio of private to public funding, although public funding is set to increase soon.

There’s a range of ways to cooperate with the public system.

Direct management of publically owned care homes.
Private ownership, private management, public offer
An allocation of a quota of publically funded beds within a private home
PFI project to build and manage for the provincial government.

I believe there’s quite a potential for us to work as partners with the public system. Because we can do things cheaper, because we control our costs and are willing to work with a capitative price. Theres been more interest in conservative-controlled areas, but it’s increasing in all the regions because the advantages are so clear.

Q: I’ve had responsibility for PPP and one difficult thing is service levels - who sets the clinical criteria by which you decide, say, how many transplants get done (or not)?
A: We haven’t really started on that battle yet as we’re just starting building. But it’s a joint decision. In the ones that are operating there is a dialogue - if we don’t have capacity then sometimes it will be picked up by public but occasionally, we will lose money and then we cry :(

Q: How does a public system deal with profits or gains in productivity.
A: Profits are capped, so gains in productivity are immediate for the public purse. They allow us a certain margin but above that it goes back to them.

Q: Why was it necessary for this mix of public and private? (Why not just private?)
A: It’s a political objection, since it’s based on universal coverage and politicians are very unwilling to give the whole pie away because privatising the public system is a vote-loser.

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