VBHC PROGRESS IN CANADA — ROUNDTABLE DISCUSSION Aligning Value
Medtronic brought together healthcare leaders in Canada to examine the implementation of — and potential barriers to — value based healthcare (VBHC) and value-based procurement there.
More than a dozen senior health system leaders participated as expert panelists in a full-day forum on the implementation of VBHC in healthcare for Canada. The forum was sponsored by Medtronic as part of the Healthcare Professionals’ Roundtable for Strategy, a program of the Canadian College of Health Leaders. Panelists examined barriers to VBHC and potential solutions, developing recommendations to support the implementation of VBHC in the region, with a focus on neurovascular therapies.
The ongoing shift toward VBHC is reflected internationally through the efforts and programs of the International Consortium for Health Outcomes Measurement (ICHOM), the World Economic Forum, and other organizations. In Canada, VBHC as a priority is evident through the work of groups like the Federal Advisory Panel for Healthcare Innovation, the Ontario Health Innovation Council, and the Ontario Expert Panel on Supply Chain.
At a recent roundtable discussion in Ontario, sponsored by Medtronic, participants agreed that transparency, shared learning and an unwavering desire to improve patient outcomes will facilitate a shift to VBHC models globally. Focusing on the region’s early adoption of some key elements of VBHC —such as procurement innovation —they discussed barriers to implementation, and what a sustainable solution might look like in the future.
"In Canada, VBHC as a priority is evident through the work of groups like the Federal Advisory Panel for Healthcare Innovation, the Ontario Health Innovation Council, and the Ontario Expert Panel on Supply Chain.
Canada is making progress as an early adopter of VBHC principles, but the country faces limitations of a traditional, siloed system. “We have ‘pockets of greatness’ but the system is very fragmented,” explains Medtronic Canada President Neil Fraser.
With multiple stakeholders and the complexity of what value means to different stakeholders, tracking progress is a challenge. “There are examples of good performance in areas such as technology assessment and clinical care, but they are not connected in the way we are looking for. This is a challenge for VBHC. We need to break down barriers and fix the transitions,” adds Fraser.
Clearly defining value and measurable outcomes — within the parameters of a single-payer system — will help shape a VBHC framework in the region. Cardiac care was highlighted as a specific area where change and innovation may be accelerated towards a VBHC model. There are well-established working relationships and experience with technologies such as transcatheter aortic valve implantation (TAVI) already in place, panelists noted, as well as robust data and standardized processes that can be leveraged.
There are examples of good performance in areas such as technology assessment and clinical care, but they are not connected . . . We need to break down barriers and fix the transitions.– Neil Fraser, President, Medtronic Canada
Once key players agree on desired, measurable outcomes, building long-term partnerships is crucial. Clinicians, system leaders, and other stakeholders sharing data and working together beyond a single program or initiative provides the foundation needed for a sustainable, integrated model of care. A particular area of focus in Canada for fostering strong partnerships is through innovative procurement processes.
“Value-based procurement is an approach that involves making purchasing decisions based on overall value, rather than cost alone,” says Dr. Gabriela Prada, Health Policy Systems Strategist for Medtronic. “This can often lead to reengineering of healthcare toward a system of population health improvement and management, where better outcomes are attained at the lowest possible cost.”
Dr. Eric Cohen, Cardiologist at Sunnybrook Health Sciences Centre and Associate Professor at the Faculty of Medicine, University of Toronto, noted there are efforts underway in the region to develop value-based outcomes and criteria, and different methods for evaluating technologies. One example is the Resources for Evaluating, Adopting, and Capitalizing on Innovative Healthcare Technology (REACH) program, designed to support Ontario health care provider organizations in using new methods to procure solutions to their high-priority needs.1
Value-based procurement is an approach that involves making purchasing decisions based on overall value, rather than cost alone.– Gabriela Prada, Medtronic Strategist, Health Policy Systems.
Progressing from standalone successes to true systemic change takes time. For VBHC, it relies on a long-term commitment by all stakeholders to innovation, improved patient outcomes and continued validation. With each incremental gain — referred to by many attendees as “baby steps” — we can build a proven structure for long-term scalability.
Dr. Sean Christie, Associate Professor, Vice Chair and Director of Research, Division of Neurosurgery, at Dalhousie University spoke of minimally invasive surgery (MIS) for spine patients as an area where improved outcomes coincide with lowered system costs. Christie reviewed data showing the cost savings achieved through MIS, and outcomes such as reduced length of stay (LOS), reduced infection risk, reduced need for pain medications, and quality of life benefits. While the data is promising, he noted, access to MIS remains a challenge.
Because it’s often easier to lead change by example, running carefully designed pilot projects could build a platform to showcase continued value-based potential.
Dr. Sandrine Moirez of Medtronic referenced using early learnings to expand VBHC programs to new patient populations. “We would like to see VBHC initiatives, for example, being adopted in the field of Neurosciences, leveraging the experience of existing projects in the cardiovascular space.”
Panelists agreed that by sharing outcomes and learnings, we can collectively elevate the need and rationale for VBHC.