What is outcomes-based healthcare and how can we achieve it in Europe? Thomas Allvin, executive director of strategy and healthcare at the European Federation of Pharmaceutical Industries and Associations, shares his thoughts with Health Europa.
Against a background of spiralling healthcare budgets, rapid population ageing, and rising numbers of chronic diseases, the European Federation of Pharmaceutical Industries and Associations (EFPIA) is committed to outcomes-based healthcare as a means of realising a more sustainable, healthier future for Europe.
Speaking to Health Europa, the EFPIA’s executive director of strategy and healthcare systems, Thomas Allvin, reflects on the importance of patient-centric data, the need for new funding models, and the measures necessary to make outcomes-based healthcare a reality in Europe.
In what way does the EFPIA believe outcomes-based healthcare will contribute to a more sustainable future in Europe?
Many healthcare systems have traditionally been very focused on what they deliver in terms of how many doctors they have per person, how many hospitals they encompass, how many procedures and screenings they perform and so on – things that are easy to measure and to hold up as examples of investment.
At the EFPIA, we believe that in order to take Europe to the next level of quality in healthcare we need to start focusing in a more structured way on the actual health outcomes that are produced in the systems and to start measuring them. Healthcare systems in Europe and elsewhere are facing a sustainability crisis: an ageing population will place a much higher demand on healthcare than we’re seeing even today, but health budgets will not grow to match, so we need to make sure that the money we invest in healthcare is invested in the right way.
Healthcare budgets today are to some extent a black box, and there is a lot of waste. According to one OECD report, around one-fifth – no-one knows the exact figure – of healthcare expenditure is wasted. Some of that might be attributed to too much administration or even downright fraud, but a lot of money is also wasted on low-value care, i.e. healthcare interventions that don’t necessarily result in the best health outcomes for patients.
It’s vital not only for Europe’s patients but also for the sustainability of healthcare systems that we can move towards a model where every euro spent goes towards producing the best outcomes. To do that, we need to start thinking about and measuring outcomes in a much more structured, systematic way than we do today.
Is this view one that’s shared by other players in the healthcare space?
To different extents, yes. This is certainly a debate that is ongoing in Europe right now and elsewhere, as well. Different stakeholders are approaching the discussion in different ways and use different terminology – we talk about outcomes-based healthcare; other people talk about value-based healthcare or integrated care models – but, overall, more and more stakeholders are coming onboard.
In November, DG SANTÉ published the State of Health in the EU report alongside a companion report describing trends in European healthcare. Chapter five is dedicated to patient-centric data and notes that while we’re very good at measuring processes and how many patients get into hospitals and are released etc., we’re not as good at measuring the actual end result for the patients, which is the very data healthcare systems will need in order to become more patient-centric. So, this is a conversation that’s certainly being had.
How will healthcare systems need to adapt to facilitate an outcomes-based approach and to take full advantage of the opportunities afforded by pharmaceutical innovation and related progress?
We need to start to measure outcomes in a standardised way across the system. First we need to define what, exactly, we are actually going to measure – what outcomes are we looking for? Then we need to find a common way of measuring the same things, because if we aren’t measuring the same things, then we can’t make any comparisons. Only once we begin to collect outcomes in the same way will we be able to compare different providers, doctors, countries, and regions etc. and analyse variations. We’ll then be able to see which are doing better than others, and we can then start to explore why that is and how different hospitals set up different patient pathways or treatment options.
Within individual healthcare organisations themselves, outcomes data can be used to promote a continuous cycle of improvement. You can use data to create a feedback loop that allows you to see almost in real time what’s happening when you do different things, which establishes a learning healthcare system. Having that culture of measuring outcomes and being transparent about benchmarking and making comparisons is incredibly important and requires political leadership.
We also need to think about how healthcare is funded. Today, a lot of healthcare funding is siloed, which means having small budgets dedicated to different things. Instead, we need to have holistic budgets that allow us to reallocate funding to where it will produce the best outcomes. In other words, we need to find payment models in healthcare that reward outcomes rather than interventions made. A lot of payment models in healthcare services today are based on how many procedures are performed or how often a patient sees a doctor; they reward the volume of things being produced rather than the end results. This translates, again, to a lot of waste because it encourages overconsumption by rewarding a hospital for, for instance, performing more hip and knee replacements than are actually medically necessary. Healthcare funding models should be aligned to what we want to achieve rather than counteracting it.
How is the e-health/data revolution hindering or helping the transition to
an outcomes-based healthcare model?
The development of e-health and health informatics is absolutely necessary to make outcomes-based healthcare a reality at scale. If you’re a small clinic you can start measuring outcomes using pen and paper, but if you want to do it at scale you need an informatics system and you need a data governance model that allows you to share and link data between registries and systems, etc. The implementation of the GDPR (General Data Protection Regulation) will be critical for how that will work.
The challenge is that a lot of things are happening at once. A side effect or drawback of things moving so fast is that we now have a proliferation of different systems and standards and activities, which can make it difficult to create interoperability.
Are the political will and commitment from healthcare providers there to make outcomes-based healthcare a reality?
Some hospitals and organisations are fairly far ahead and are working actively on this, but others are lagging behind. The extent to which the commitment is there varies a lot. At the end of the day, it comes down to leadership – both in the healthcare systems themselves and on the political side. Change won’t happen by itself. It will take time to see tangible results, and sometimes in the political world it’s easier and more tempting to fix a short-term problem.
What role does the European Federation of Pharmaceutical Industries and Associations play in this landscape?
The EFPIA is obviously just one stakeholder among many, and to create outcomes-based healthcare, all stakeholders will need to work together. For our part, one of the very concrete things we’re doing is supporting an IMI programme called Big Data for Better Outcomes (BD4BO), which comprises a number of disease-specific projects on Alzheimer’s, cardiovascular disease, prostate cancer, and haematologic malignancies. That programme is focused on using data to standardise outcomes measures and to begin comparing treatment pathways so as to get a better understanding of how different treatments and healthcare interventions work in real life on patients.
This year we have also entered into a partnership with ICHOM – the International Consortium for Health Outcomes Measurement. Their mission is to create global standards for outcomes measures for every disease condition, which is something we very much want to encourage. Our partnership is intended to give their work more awareness, so this year we’ll be organising a number of workshops with ICHOM in different European countries to talk about what they’re doing, why it’s important to measure outcomes, and how to implement outcomes-based healthcare.
Executive Director of Strategy and Healthcare Systems
This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.