EMERGING MARKET DRIVERS TOWARDS VBHC PERSPECTIVES
An article from the Insights Series
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An article from the Insights Series
Medtronic leaders highlight powerful drivers of value-based healthcare in EMEA, Latin America, and Asia Pacific.
Contributors: Maarten Akkerman, Hsien-Hsien Lei, and Jason Arora
At Medtronic, we are committed to accelerating a global shift towards value-based healthcare (VBHC).
Working with stakeholders across the care continuum — from payers and providers to tech innovators and government agencies — we have VBHC experts at regional and country levels implementing programs aimed at improving outcomes for patients. We sat down with three of those leaders recently, and discussed VBHC opportunities, and barriers that need to be addressed, within emerging markets.
“Value-based healthcare implementation across the globe requires a vision of standardization that can be applied through customization,” explains Medtronic vice president Medical Affairs & Value-Based Healthcare EMEA, Maarten Akkerman. “Building toward a global framework while tailoring the approach allows for strategies to adapt based on market maturity.”
“True,” adds Jason Arora, director of VBHC in Latin America. “And with varying progress across the globe, the challenge is always to meet each market where it’s at.”
“While more developed countries are proving success and scaling initiatives, emerging markets are still developing awareness and building a foundation for VBHC,” offers Vice President Medical and Scientific Affairs for APAC, Hsien-Hsien Lei. “The more we can understand the status of the ecosystem, the more suitable path we can build to get us to an outcomes-based model for healthcare delivery,” she says.
In the global evolution of VBHC — the three agree — there are five powerful drivers to watch for across emerging markets:
Non-communicable diseases are responsible for more than 36 million deaths each year with 80% of these deaths occurring in low and middle income countries1. In these regions, existing payment systems, which are mostly fee-for service, are unsustainable given escalating costs with no corresponding improvements in patient outcomes. As the number of patients requiring more complex, chronic care management increases, and as there are increasingly scarcer resources, VBHC is seen as one of the most promising — and necessary — solutions with a focus on improving patient outcomes at lower cost.
Arora: In a volume-driven system, spending continues to go up. The resources needed to cover such costs don’t exist in these markets. VBHC allows for optimization of a system that needs it most, while increasing overall quality. There is a clear rationale for VBHC in emerging market health systems. Many would argue that there is a more urgent need in these markets than in advanced health systems.
Akkerman: In most fee-for-service systems there is lack of accountability for outcomes across the whole healthcare chain, which leads to waste. When everybody gets paid for services but no one is accountable for outcomes and costs, you get escalating costs.
In emerging markets, interest in VBHC continues to grow. Government stakeholders — along with payers and providers — are taking steps to set the strategic direction and implement core components, (e.g., integrated practice units (IPUs)). Specifically, emerging markets around the APAC region are aware that they will need to incorporate VBHC principles into healthcare delivery systems, including bundled payment models, data interoperability, outcomes measurement, etc.
Lei: Most of the APAC countries, including some emerging markets, have identified high priority disease states and outcomes they believe will be most important to measure. Thailand, for example, has prioritized type 2 diabetes and hypertension. They are actively looking for VBHC solutions that will help with the chronic care management of these conditions, and in particular, how to better support primary care for those patients.
Increasing awareness and identifying more opportunities, like this, are an important piece to the healthcare transformation.
Akkerman: In EMEA, we set up VBHC Global Consoles to focus on the “why”. If we focus on change management through driving awareness around the importance of why VBHC can work — especially in emerging markets — we can accelerate the change. Medtronic has to start by leading the conversations in accountability for value-based care and working with all the stakeholders to better understand the driving motivations for each group.
Akkerman: As technology evolves, so does progress. Improvements in IT infrastructure create more efficient outcomes data collection and analysis. It is crucial that we demonstrate the value that we promised. For that, we need new technologies that might be outside the scope of the stand-alone device, such as digital support products and monitoring. And with that, we see improvement in integrated care networks that allow for better sharing of patient data. VBHC can only happen with the collection and use of this high-quality data.
Arora: Outcomes data is the currency on which health systems need to run. We need payers, providers, medical technology companies, pharmaceutical companies and others to come together and collaborate. But that collaboration can only be made possible if everyone — globally — has the same ‘truth’ to work from. And that truth is the data.
Like all shifts in mindset, successful case studies and best practice sharing are critical. While LATAM and APAC have yet to implement full VBHC programs, pilots are underway. These include implementing ICHOM standard sets and bundled care in APAC, to remote patient monitoring technology in LATAM.
Arora: A VBHC initiative in LATAM is underway in Chile, where Medtronic is working with a public payer and a hospital system. Collecting and sharing certain data from our heart monitoring devices, we’re working to help patients who must travel far for frequent trips to the hospital. If we succeed in helping the patient remotely, we can reduce congestion in the hospitals, produce better outcomes and lower the cost, for everyone. Read more about VBHC in LATAM.
Progress, especially in emerging markets, is largely determined by the national agenda and alignment between policies and politics. In all regions — Akkerman, Lei and Arora agree — support of local governments on their journey towards VBHC is critical.
Arora: In LATAM, it’s about encouraging dialogue between stakeholders, and finding the early innovators. Partnering with them to generate local proof points is critical.
Lei: In APAC, it’s about forming partnerships with individual providers and networks to execute value-based initiatives of full VBHC outcomes-driven, risk sharing programs that can then be scaled up for wider implementation.
Akkerman: In Europe — where we have a more developed landscape — it’s about finding the right partners in the field who are engaged and want to truly go on the journey. Getting to outcomes will require more collaboration and cannot be done in isolation.
Lei: Medtronic is seen as a strategic partner with a strong understanding and commitment to VBHC. Although every country has a different nuance to their execution of VBHC, at the end of the day it’s about delivering value that makes sense in the context of their greatest healthcare challenges.
Maarten Akkerman is vice president Medical Affairs & Value-Based Healthcare Europe Middle East & Africa (EMEA) at Medtronic. Prior to joining Medtronic, he held the end responsibility for the procurement for Hospital Care, Primary Care and Mental Healthcare at ‘Zilveren Kruis’ – the largest health insurance company in the Netherlands. He also served as Business Unit Manager at ‘Mediq’, a Dutch healthcare company. Maarten holds a Doctoral in Pharmacy (Major in Clinical Chemistry) and Post-doctoral education as pharmacist from the University of Utrecht, The Netherlands. He holds a diploma in Pharmaceutical Management from the Business school in The Netherlands and Transition to General Management from INSEAD in Fontainebleau (France) and Singapore. He graduated from the Program for Executive Development at IMD in Lausanne (Switzerland). Maarten is a member of the Board of Directors of ‘Diabeter’, the specialized treatment center for type 1 diabetes in children and young adults in the Netherlands.
Hsien-Hsien Lei oversees APAC medical affairs, clinical research activities, training & education, and VBHC, including health policy and reimbursement. Her career has spanned the scientific, clinical, and commercial sides of healthcare with experiences that include bench research, epidemiological and biostatistical data analyses and modeling, pharmacy clerkship, business development, and scientific, medical, and healthcare communications. Hsien has a PhD in Epidemiology from The Johns Hopkins University Bloomberg School of Public Health where she was the recipient of a US National Institutes of Health Cardiovascular Disease Epidemiology Training Grant. She completed her post-doctoral fellowship at National Taiwan University Hospital in the Department of Endocrinology and also holds a BA (with honors) in Human Biology from Stanford University.
Jason Arora leads VBHC work across Latin America for Medtronic. He also serves as a Global Health Expert at the World Economic Forum and Young Global Leader at the Center for Health Care Innovation, and was previously a Director at the International Consortium for Health Outcomes Measurement (ICHOM) and a practicing physician in the UK. Jason was the recipient of Harvard’s Public Health Innovator Award in 2018, and was named on Forbes’ "30 under 30 Health Care and Science" list in 2017 and on KPMG’s "Top 100 Asians in Tech" in 2018. Jason holds degrees from Oxford and Harvard and is a Fulbright Scholar.
World Health Organization (WHO). (2013, March). 10 facts on noncommunicable diseases. Retrieved from http://www.who.int/features/factfiles/noncommunicable_diseases/en/