Measure what matters – why the EU should support the standardisation of health outcomes measurements
17.10.18
In the second of our series of blogs giving the story behind the EFPIA manifesto, our Executive Director of Strategy and Healthcare Systems, Thomas Allvin discusses how to drive the evolution of towards patient-centred, outcomes-focused healthcare systems.
When the European Commission published its report on the State of Health in the EU last year, it recognized five ongoing trends in health system reform: shifting to prevention, stronger primary care, integration of care, supporting a resilient health workforce and developing better patient-centered data.
All these developments are important to make European healthcare systems more sustainable despite mounting pressure from an ageing population and multi-morbidities. The fifth trend however, which is also the most aspirational one, is the key to making European healthcare systems truly patient-centered and outcomes-based.
What do we mean by outcomes-based?
It means that we must get much better at measuring true patient-relevant outcomes across diseases and conditions. We know that outcomes for such common diseases like cancer, heart failure and diabetes vary considerably between and within countries, but most of this data is still hidden or simply not collected in a systematic way. While our health systems are awash with process data - for instance what kind of procedures have been performed and what medicines have been prescribed – we don’t have the standardized and comparable outcomes data to sufficiently analyse what all these interventions actually bring in terms of benefits to patients.
It means that health services must become much more integrated, to help deliver better health for patients in a coordinated way. Today, much of healthcare is still operated in silos, where everyone (be it a hospital, a general practitioner, a specialist or a pharmacy) only takes responsibility for their specific part of the patient journey, and no one is responsible for the patient as a whole. Integrating services also means integrating budgets – an investment in primary care or prevention could save money for the hospital and the entire system, so it is paramount that smart spending is not made impossible by budget silos or conflicting incentives.
It means that we must change how we reward and remunerate health services and products away from volume and towards value. A system which rewards the number of surgical interventions performed, or the number of prescriptions written, will certainly produce multiple surgeries and use of medication, but is this always the same as better health for the patient? Experiments all over Europe with bundled payments, pay-for-performance schemes and outcomes-based reimbursement are showing us the path to better ways to pay for care.
So what role can the European Union play in this transformation? As soon as you start talking about health policy in Brussels, someone will sooner or later point to the limited competence of the EU when it comes to healthcare. And it is true that the provision of healthcare is a member state, or in many cases regional, responsibility. However, there is so much that can be done for healthcare reform in Europe which doesn’t involve legislation or allocation of resources.
The first, and arguably most important, step to creating an outcomes-based system is to collect and make transparent comparable data on health outcomes. The ability to compare, for example, how stroke patients fare in terms of survival and quality of life between providers and regions – within and across countries – has an incredible power.
When in 2006 Sweden introduced yearly “open comparisons” of outcomes and quality of care between Swedish regions and hospitals, the initial fear of some providers of potentially scoring low was soon replaced by an urge to move upwards by learning from neighbors. And up they moved – data show that since 2006, the gap between the worst performers and the best performers has narrowed, and all have improved. Transparent data on outcomes is therefore also the great equalizer in healthcare, through a mutually beneficial race to the top.
When making comparisons and analysing data, scale is everything. Therefore, it makes a lot of sense to have a coordinated European approach to outcomes data standardization, collection and risk-adjustment, rather than having a plethora of national or regional initiatives. The OECD PaRIS project is taking important steps in this direction, and the EU should reinforce and scale up these pilots and supporting their long-term implementation and sustainability.
This is why EFPIA calls on the EU to drive the evolution towards patient-centered and outcomes-focused healthcare by assessing and benchmarking EU health systems through patient-relevant outcomes data. Few other investments on the part of the EU would have such power to improve the health of patients and reduce health inequalities across Europe!
When the European Commission published its report on the State of Health in the EU last year, it recognized five ongoing trends in health system reform: shifting to prevention, stronger primary care, integration of care, supporting a resilient health workforce and developing better patient-centered data.
All these developments are important to make European healthcare systems more sustainable despite mounting pressure from an ageing population and multi-morbidities. The fifth trend however, which is also the most aspirational one, is the key to making European healthcare systems truly patient-centered and outcomes-based.
What do we mean by outcomes-based?
It means that we must get much better at measuring true patient-relevant outcomes across diseases and conditions. We know that outcomes for such common diseases like cancer, heart failure and diabetes vary considerably between and within countries, but most of this data is still hidden or simply not collected in a systematic way. While our health systems are awash with process data - for instance what kind of procedures have been performed and what medicines have been prescribed – we don’t have the standardized and comparable outcomes data to sufficiently analyse what all these interventions actually bring in terms of benefits to patients.
It means that health services must become much more integrated, to help deliver better health for patients in a coordinated way. Today, much of healthcare is still operated in silos, where everyone (be it a hospital, a general practitioner, a specialist or a pharmacy) only takes responsibility for their specific part of the patient journey, and no one is responsible for the patient as a whole. Integrating services also means integrating budgets – an investment in primary care or prevention could save money for the hospital and the entire system, so it is paramount that smart spending is not made impossible by budget silos or conflicting incentives.
It means that we must change how we reward and remunerate health services and products away from volume and towards value. A system which rewards the number of surgical interventions performed, or the number of prescriptions written, will certainly produce multiple surgeries and use of medication, but is this always the same as better health for the patient? Experiments all over Europe with bundled payments, pay-for-performance schemes and outcomes-based reimbursement are showing us the path to better ways to pay for care.
So what role can the European Union play in this transformation? As soon as you start talking about health policy in Brussels, someone will sooner or later point to the limited competence of the EU when it comes to healthcare. And it is true that the provision of healthcare is a member state, or in many cases regional, responsibility. However, there is so much that can be done for healthcare reform in Europe which doesn’t involve legislation or allocation of resources.
The first, and arguably most important, step to creating an outcomes-based system is to collect and make transparent comparable data on health outcomes. The ability to compare, for example, how stroke patients fare in terms of survival and quality of life between providers and regions – within and across countries – has an incredible power.
When in 2006 Sweden introduced yearly “open comparisons” of outcomes and quality of care between Swedish regions and hospitals, the initial fear of some providers of potentially scoring low was soon replaced by an urge to move upwards by learning from neighbors. And up they moved – data show that since 2006, the gap between the worst performers and the best performers has narrowed, and all have improved. Transparent data on outcomes is therefore also the great equalizer in healthcare, through a mutually beneficial race to the top.
When making comparisons and analysing data, scale is everything. Therefore, it makes a lot of sense to have a coordinated European approach to outcomes data standardization, collection and risk-adjustment, rather than having a plethora of national or regional initiatives. The OECD PaRIS project is taking important steps in this direction, and the EU should reinforce and scale up these pilots and supporting their long-term implementation and sustainability.
This is why EFPIA calls on the EU to drive the evolution towards patient-centered and outcomes-focused healthcare by assessing and benchmarking EU health systems through patient-relevant outcomes data. Few other investments on the part of the EU would have such power to improve the health of patients and reduce health inequalities across Europe!
