HEALTHCARE CASE STUDIES Aligning Value

THE NATIONAL CENTRE OF TECHNOLOGICAL EXCELLENCE IN HEALTH, MEXICO
Cost containment, better resource allocation

The Centro Nacional de Excelencia Tecnológica en Salud (CENETEC), the national centre of technological excellence in health in Mexico, advises policymakers on the most cost-efficient emerging health technologies.

• A staff composed of doctors and biomedical engineers uses a multidisciplinary process to conduct a health technology assessment (HTA)
• Mexico is one of the region’s leaders in the use of telemedicine, thanks in part to CENETEC’s work

MINISTRY OF HEALTH, NEW ZEALAND
Digital strategy improves care

In 2016, New Zealand adopted a new strategy emphasizing data and technology to improve value in healthcare by 2026. The 10-year plan includes:

• Connecting technological investment with value delivery
• Crowdsourcing data to track common problems
• Collating information from both government and non-government sources to highlight correlations

GESUNDES KINZIGTAL, GERMANY
Population health, efficiency, cost containment

Gesundes Kinzigtal (GK) is a joint venture between a healthcare management company and a network of physicians and psychotherapists in southwestern Germany. The GK uses an integrated care approach to:

• Provide a better care experience
• Improve population health
• Reduce costs

The approach has shown promise, particularly for the multimorbidity populations.

INSTITUTO DE EVALUACIÓN TECNOLÓGICA EN SALUD, COLOMBIA
Resource allocation, cost containment

Colombia’s health technology assessment agency, IETS, plays an important role in the transition to value-based care. IETS:

• Reviews outcomes data and literature
• Provide s recommendations about pharmaceuticals and other treatments

PARTNERS IN HEALTH, RWANDA
Resource allocation, preventative care improvement

Rwanda invited Partners in Health, a Boston-based nonprofit, to collaborate on value-based strategies. Together they have worked to:

• Improve healthcare infrastructure
• Build capacity

SHOULDICE HOSPITAL, CANADA
Process efficiency, cost containment

To deliver value-based healthcare, Shouldice instituted a care delivery model predicated on specialization, standardization, and high volume.

• Reduced hernia surgery turnaround time (10 minutes versus up to an hour at other hospitals)
• Offered hernia treatments at approximately half the market rate
• Adjusted staffing ratio of staff-to-bed (approximately 1.8:1, while others maintain a staff-to-bed ratio from 9 to 12.6 per bed) 
• Achieved world-class clinical outcomes
• Earned high patient satisfaction

APOLLO HOSPITAL GROUP, INDIA
Personalized care, improved outcomes

Apollo used robust data collection and analysis to scale and improve treatment, inform pilot programming, and integrate value-based care on an individual basis.

• Placed greater emphasis on preventive programming for non-communicable diseases
• Re-examined how service lines are structured
• Used technology to deliver care to the inaccessible and underserved

IMPERIAL COLLEGE HOSPITAL, LONDON
Process efficiency

Medtronic Integrated Health Solutions took over the daily management of Imperial’s cath lab equipment and materials and found new ways to better utilize hospital resources.

• Shared risk — Medtronic pays for the inventory it manages, so if materials are overstocked and expired, Medtronic pays, not the hospital
• Decreased time spent looking for products by 75 minutes per day
• Patient procedure on-time starts are up from 50 percent to over 90 percent
• Improved overall staff retention
• Projected to save more than £1.5 in the first few years
• Saved £840,000 in first year due to improved efficiency

EINSTEIN HOSPITAL, BRAZIL
Transitioned to a value-based payment model

Einstein, a large hospital system that manages dozens of public and private health centers, collaborated with Medtronic to transition from a volume- to value-based care model.

• Began working with doctor-led multidisciplinary groups grouped by medical condition or therapy
• Began measuring clinical outcomes, patient-reported outcomes, and patient-reported experiences
• Started charging for the complete cycle of care, based on clinical results, patient satisfaction levels, and quality of life achieved

METRO-AREA HOSPITAL, UNITED STATES
Process efficiency, cost containment

With the assistance of Medtronic Integrated Health Solutions experts and analytics, a metro-area hospital engaged its surgeons to align preference cards.

Based on an annual volume basis of 450 lap chole cases at the hospital, the preference card optimization effort resulted in:¹

• 30% fewer line items across preference cards
• 50% less variation in surgical supplies across surgeons
• 50% fewer door openings during lap chole procedures
• 30% less time spent on picking and putting back supplies
• $90 decrease in cost per case
• $42,000 overall savings annually from efficiencies made to the operating room

LATIN AMERICA TELEMEDICINE INFARCT NETWORK, LATIN
Improved access to care

A partnership between the LUMEN Foundation (education program), ITMS (telemedicine provider), and Medtronic built patient-centric care infrastructures. These “hub and spoke” models allow health systems to provide optimal care for serious heart attacks (STEMI). 

• Established education-based initiatives for cardiologists, emergency care professionals, and patients on how to recognize and react to STEMI
• Provided local cardiovascular disease patients emergency treatments and services comparable to those found in the U.S. and Europe
• During the two-year pilot program one hospital experienced:
  • A 30 percent increase in STEMI case volume
  • A 50 percent reduction in STEMI mortality
• Established 18 hubs and 90 spokes throughout Latin America
  
• During 20-months of the trial:
  • 100 operational centers were opened in Brazil and Colombia
  • 124,000 EKGs were transmitted using the telemedicine system, with about 1 percent diagnosed as STEMI and 47 percent of total STEMI diagnoses were treated cases in these regions

SHRUTI PROGRAM, INDIA
Improved access to care

Medtronic helped integrate advanced technology with on-the-ground specialists to bring sustainable, low-cost otology services to underserved communities, particularly in densely populated, low-income urban areas of India.

• Established awareness education, screening, diagnosis, and treatment services
• Performed nearly 115,000 ear screenings during the program’s first two years

MAASTRICHT UNIVERSITY MEDICAL CENTER, THE NETHERLANDS
Process efficiency

A five-year partnership between a large academic hospital and Medtronic provided classroom work, mentoring, and on-the-job learning to embed efficiency principles into the hospital and ensure lasting, transformational change.

Hospital wide results include:

• 36 percent rise in productivity in the orthopedics outpatient clinic
• 50 percent decrease in referral-to-diagnosis time in the urology outpatient clinic
• 90 percent decrease in admission time and 20 percent increase in productivity in the dermatology outpatient clinic
• In the Heart + Vascular Center:
  • Overall cost savings of $2.5 million in one year
    
  • 33 percent shorter patient stays, resulting in: $120,000 in savings
  • 50 percent decrease in time to intervention

HORIZON HEALTH NETWORK, NEW BRUNSWICK HEART CENTRE, CANADA
Process efficiency, expanded access to care

Medtronic Integrated Health Solutions (IHS) advised Horizon’s heart surgery department on how to improve operating efficiency and treat more patients.

• Increase operating room capacity by 14 percent
• Reduced average surgical wait times by 44 percent