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Boundaryless Hospital -
Rethink and Redefine Health Care
Management
New Chains of Value Creation
Partner and Head of McKinsey Hospital InstituteCologne, Germany
Sören T. Eichhorst, MD PhD
PROPRIETARYAny use of this material without specific permission of McKinsey & Company is strictly prohibited
McKinsey & Company | 1
Quantitative network analysis reveals hospital boundaries
SOURCE: McKinsey Hospital Akademie
Number of quotesn = 287
Individual staff
Medical unit
Functional unit
Nursing staff
Administration service
Administration
McKinsey & Company | 2
A gap exists between medical evidence and clinical practice
SOURCE: McKinsey Hospital Institute
Clinical practice
No generally accepted
quality metrics
Outcome-oriented
quality initiatives
Interfaces only
partially optimized
Seamless external
cooperation
Hospitals built around
professionals
Patient-centered
approach
Truly integrated
care still a vision
No sector
boundaries
Suboptimal internal
communication
Close exchange of all
professionals
Quality aspiration
McKinsey & Company | 3
The focus needs to be on value creation
SOURCE: McKinsey Hospital Institute
CostAccess
Quality
VALUE
McKinsey & Company | 4
Five major trends for value creation in hospitals
SOURCE: McKinsey Hospital Institute
Patient experience matters and can
be monetized
11
22
33
44
55
McKinsey & Company | 5
Factors influencing a patient’s choice of hospital
Patient experience matters…
SOURCE: 2007 McKinsey survey of >2,000 U.S. patients with commercial insurance or Medicaid and >100 U.S.
physicians; McKinsey Hospital Institute
Focus on clinical outcome and effectiveness
Care deliveryCare delivery
Clinical qualityClinical quality
Patient experiencePatient experience Focus on perceptions of care
Would you request a hospital if it wasdistinctive on patient experience?
Physician’s decision 21
Location18
Hospital reputation
20
Patient experience
41
In percent
Might or might not request
44
Would definitely request
56
In percent
McKinsey & Company | 6
… and can be monetized
SOURCE: 2007 McKinsey survey of >2,000 U.S. patients with commercial insurance or Medicaid and >100 U.S.
physicians; McKinsey Hospital Institute
Dimensions of patientexperience
Impact on hospital recommendation
Hospital recommendation
Best practice recommen-dation score
85%
Improved recommen-dationscore
81%
Improve-ment of high impact elements
13%
National average
68%
0
0
0
1
2
Physician communication
Responsiveness
Medication explanation
Facilities
Noise level
Pain management 10
Aftercare 15
Nurse communication 15
McKinsey & Company | 7
The way we see patients is changing
SOURCE: McKinsey Hospital Institute
Today Tomorrow
Population
based
approaches
Prevention and
prediction
Informed and
active patients
McKinsey & Company | 8
Five major trends for value creation in hospitals
SOURCE: McKinsey Hospital Institute
Patient experience matters and will
be monetized
11
Value based health care is key and will
be paid for
22
33
44
55
McKinsey & Company | 9
Comprehensive disease pathways are a tool for value creation
SOURCE: McKinsey Health Systems Institute – CRC Improvement Network project team
Surveillance and follow-up
Treatment/ management of disease
Palliative/end of life care
Primary prevention
Diagnosis and screening
▪ Prevention to end-of-life care
▪ Full range of interventions
▪ Comprehensive international evidence base
▪ Prioritize how resources are allocated
▪ Efficacy
▪ Cost
▪ Specific diseases
▪ Condition groups
Focused
Comprehensive End-to-end
Evidence-based
McKinsey & Company | 10
Levels of cost are distributed across the pathway
Individual
cost buckets
Pathway stage
total spend
Cost waterfall tool – absolute cost waterfall colorectal cancer improvement network
SOURCE: McKinsey Hospital Institute
McKinsey & Company | 11
Five major trends for value creation in hospitals
SOURCE: McKinsey Hospital Institute
Patient experience matters and will
be monetized
11
Value based health care is key and will
be paid for
22
Health care starts to converge towards a
provider-payor-life science continuum
33
44
55
McKinsey & Company | 12
Health care starts to converge towards a provider-payer-lifescience continuum
Example globally integrated player Fresenius
SOURCE: Fresenius website; McKinsey Hospital Institute
Vamed
5
Kabi
Helios
17
24
Medical Care
54
100% = 20.4 bn EUR
▪ Medical Care - dialysis machines and
dialysis centers
▪ Kabi - infusion therapy, clinical nutrition
and home care
▪ Helios - integrated health care provider
(hospitals, rehab clinics)
▪ Vamed - consulting, planning, developing
and running of health care facilities
▪ Netcare - IT services, business processes
solutions
Fresenius’ Business Units
Revenues in percent
McKinsey & Company | 13
Medtech and Pharma companies use support services to deepen partnerships with providers
Business modelHospital needs Example
Improve operating margin
Debottlenecking and implemen-tation of new clinical pathways
Reduce burden on balance sheet
Pay-for-usage models
Optimize patient referrals
Support referral networks
SOURCE: McKinsey Hospital Institute
McKinsey & Company | 14
Five major trends for value creation in hospitals
SOURCE: McKinsey Hospital Institute
Patient experience matters and will
be monetized
11
Value based health care is key and will
be paid for
22
Health care starts to converge towards a
provider-payor-life science continuum
33
New technology will be fully exploited44
55
McKinsey & Company | 15
160.000 Terabyteglobal medical imaging scan
data volume p.a.
8,000,000 millionMRT scans in Germany
2 Terabyteraw reads from sequencing
1 human genome
19,000,000,000claims data sets collected
by German payors p.a.
Full exploitation of new technology
SOURCE: McKinsey Hospital Institute
McKinsey & Company | 16SOURCE: McKinsey Hospital Institute
Five predictions for digitalization of health care
▪ Patients start to assume more responsibility for
their own data
▪ Real world will become the norm
▪ Sensor data as “new source of data” surpass
digital imaging as biggest data asset
▪ Personalized care plans will be faster in the
market than personalized medicine
▪ Analytical capabilities are necessary to keep up
with the champions
McKinsey & Company | 17
Embracing IT solutions creates value
SOURCE: Press; company websites
Innovative documentation, database search, consulting, training
Timely data collection from multiple sources across the health care
value chain
Handheld apps for transmission of stethoscope sounds, ultrasound,
otoscopy, etc.
Mobile telehealth platform - medical consultations and triage via any
device anywhere globally
Wireless sensors allows patient monitoring at ICU-level
McKinsey & Company | 18
Five major trends for value creation in hospitals
SOURCE: McKinsey Hospital Institute
Patient experience matters and will
be monetized
11
Value based health care is key and will
be paid for
22
Health care converges towards a
provider-payor-life science continuum
33
New technology will be fully exploited44
Disruptive changes and innovative
hospital concepts will appear
55
McKinsey & Company | 19
Principles
ParkinsonNet is an example for a regional initiative driving quality andsaving cost
SOURCE: ParkinsonNet; Prof. B. R. Bloem, Nijmegen Medical center
11 Define catchment area or regional
hospital
Select dedicated therapists22
Track these therapists using guidelines
and tell them what to STOP doing33
Promote communication among them44
Establish 24/7 communication between
professionals and patients66
Make them visible55
McKinsey & Company | 20
How could the hospital of the future look like?
Today Tomorrow
Innovative hospital concepts
Balanced doctor-patient relation-ships
Up-to-date means of communication
SOURCE: McKinsey Hospital Institute