Health Authorities & Cost Drivers:the VCH perspective

Mary Ackenhusen

President & CEO

Vancouver Coastal Health

The Iron Triangle of Healthcare

Our Current State

• Growing demand on the system with status quo models of care

• Default into acute and residential care in the face of few viable alternatives

• Uneven resource allocation with over-served and under-served populations

• Lack of integration between services and providers reinforcing a provider centric approach

• Cost and process pressures from advancements in clinical technology and procedures

• Underinvestment in technology and data analytics

Our Current State

5

Technology/data investment

VCH

US HealthcareProviders

UniversityHealth Network

UK Healthcare

Calgary Regional Health Authority

Professional Services

US Banking/Financial Services

6

$9 billionRegional Health Authorities

$1 billionPharmacare

$2.5 billion Ministry of Health & PHSA

$4 billionMSP/Physicians

Fiscal year 13/14

Provincial health funding

7

Corp, Benefits, IT 7.5%

VCH Budget allocation

Acute Care 60.5%

Residential Care 13%

Population Health & Wellness 3%

*2014/15 – 2016/17 Service Plan (includes Providence Health Care)

8

9

OECD Healthcare comparison

“The way our system is funded – predominantly with block transfers to hospitals and fee for service payments to physicians – encourages volume of procedures and status quo. It does not reward quality of care, or responsible stewardship.

In fact, when an individual or a program goes out on a limb and makes changes to improve efficiency and cost effectiveness, the benefits often accrue to others; perverse incentives are commonplace and counterproductive.”

Andre PicardJuly 28, 2015

IncrementalChange Transformation

System Enablers

• Modern and open information management systems

• Good analytics (big data)

• Good supports for clinicians to learn/adapt to new IM systems

• An open mindset to innovation and outside partners

• A skunk works/test bed infrastructure tasked to introduce new technology and ideas.

Pacific Health Innovation eXchange (PHIX)

Attributes of innovation?

• Largely funded outside the global health budget

• Can be proven to save money or align with mandated quality improvement goals

• True partnership, often with shared financial risk

• Credible, influential champion

Funded through philanthropy Reduction of c-difficile was mandated Championed by physician lead for

Infection Control

UV Disinfection

Funded through philanthropy Majority of costs were paid by Masimo Championed by the Senior Medical

Director

Patient Safety System

Funded by vendor as a value add innovation fund in provincial contract Proven to save money Partnered to provide resources to develop, implement and evaluate Championed by the Ministry of Health

Home Health Monitoring

Funded through philanthropy and CESEI Reduces costs Championed by partnership between

clinician & operations lead

Online Therapy

Remote Cardiac Monitoring

Funded by vendor Reduced cost of patient surveillance Championed by cardiac leadership

Funded by vendor Reduced costs Shared financial risk Championed by VP and physician partner

Renal Disease Management

Email: mary.ackenhusen@vch.ca

Tel: 604-875-4721

Blog: http://vchblogs.ca/

Podcast: http://vchblogs.ca/tag/podcast/