MOVING ONTO A SUSTAINABLE HEALTHCARE MODEL:

Evidence-based Health Care Reform

October 20th, 2015

Haseeb Ahmad

President of the Pharmaceutical

Companies Committee

Managing Director Greece, Cyprus, Malta

14th Annual Healthworld Conference

Does Health Matter?

The Greek health care maze is delivering suboptimal

outcomes

Primary Care Doctors Specialists Diagnostic Imaging

PayersPharmaciesHospitals

Limited access to relevant

information at point of care

Operate in silos Overuse/Underuse/Misuse

Mired in administrative

complexity

Not integrated in to care

delivery system

Rewarded for

volume not value

Patients experience a highly fragmented system

fraught with challenges

Patients do not receive best available care

The Greek Healthcare System

Since 2011, for pharmaceuticals, almost every cost-

containment measure has been attempted…

29 price reviews, each with new rules

More than 30% average price

reductions

Increasing rebates

Stricter reimbursement rules (2/3rds of EU countries)

Therapeutic reference

pricing

JUMBO groups

3 years without new product

launches

Primary care expenditure

caps at 1% of a falling GDP

New hospital budget caps

New nationalpayer

Electronic prescription mechanisms

Introduction of INN

prescription

Implementation of therapeutic

protocols

Hospital Tenders for off – patent medicines

Three-fold Increase in

patient copayments

Individual physician

prescription cap

Clawback mechanism

We need a Vision & Roadmap to an efficient and sustainable

health care system

Patient centric system

Focus on health outcomes

Financial sustainability

Silo based

Expenditure focused

Horizontal measures

MSD Vision: Combine and Prevention, Quality and Efficiency

Prevention &

Primary Care

Efficiency through

Funding Choices

Quality &

Innovation

Step 1: Define Health Care Priorities based on burden of

disease evidence

The initial 1996 set

of NHPAs included

cardiovascular

health, cancer

control, injury

prevention and

control and mental

health. Diabetes

mellitus was added

in 1997, followed by

asthma in 1999,

arthritis and

musculoskeletal

conditions in 2002

and obesity in 2008.

AsthmaArthritis &

Musculoskeletal

problems

Diabetes

Mellitus

Cardiovascular

Health

Cancer

Control

Mental

Health

Injury

Prevention

& Control

Obesity

Australian National Health Priority Areas

The launch of a UK CHD National Service Framework contributed to almost

a 50% reduction in CV mortality over a ten year period….

8

Step 2: Focus on Prevention and Primary Care

As severity increases amongst patients with chronic conditions,

hospitalisation costs escalate, driven by admissions and referrals

Step 2: Focus on Prevention and Primary Care

Primary Health Care Networks

Patient Literacy

Self Monitoring/Management

Care in the Community

Obesity

Unhealthy lifestyles

Smoking

Alcohol and drug use

Accidents

Exp

an

d

Fig

ht

10

Step 3: Data as an enabler for integrating care

UK study demonstrates the overall value of an integrated remote

management solution (Closercare- NHS CCG)

Project independently evaluated

* Before Intervention is calculated as the mean of Q1 and Q4 (all-cause) Admissions COPD; n=98; HF; n=30

• Objective : Reduce COPD/HF related avoidable admissions, support patient confidence in self management,

independence and quality of life, support the community service productivity by reducing travel time and frequency

Established an active care plan for 120 patients with COPD or HF monitored from 1st April 2014. 134 patients monitored

during Feb-Sept 2014 (64% COPD/ 36% HF).

Mean admissions PMPM Average Bed days per admission

Metric Per Member per Month (PMPM)

Monthly monitoring cost £181

Gross

saving

Net saving (Y1)

Gross-Mon. Cost

Year 1

ROI

Net Saving

(Y2)

Year 2

ROI

All-cause admissions (ALL patients) £198 £17 saving 9% £33 saving 20%

Cardiorespiratory admissions (ALL patients) £192 £11 saving 6% £27 saving 16%

Patients with at least 1 cardiorespiratory

admission in the year before intervention (61 pt)

£468 £287 saving 159%

Reduction in demand :

50% in Admissions

66% in Bed-Days

12% in A&E attendances

Step 4: Establish Greece as a World Class Excellence Center for Real World Evidence

RWE Strategy

Analyze

Healthcare

Utilization &

Expenditure

data

Attract

Healthcare

Services

Research &

Clinical Studies

Assess

Value of

different

treatment

options via

RWE

Align

Among different

stakeholders (e.g.,

Patients, Payers,

Providers, Gvt.

Officials)

Step 5. Establish and Review Quality Indicators

14

NHS Quality Framework

Step 6: Focus on value and innovation: The case of pharmaceuticals

Source: Simon-Kucher & Partners,

Focus on clinical

and societal benefitsFocus on cost effectiveness

Rating of product value Cost per QALY

Application of pricing rule

Budget impact analysis

and/or Negotiation

Value vs. threshold

YES or NO

Cost

Effectiveness

Patient-

Centered

Comparative

effectiveness

Innovation-

Integrated

VALUE

Towards a sustainable pharmaceutical pricing and

reimbursement system

Delayed Access

Low Innovation

External Ref.

Pricing

Narrow Use

of HTA

Parallel

Trade

Therapeutic

Ref Pricing Clawbacks

Price Cuts

Sound Value

Assessment

Transparent and

Predictable Decision

Making Process

Generic Price

Competition

Access, Innovation and

Affordability

Differential

Pricing

16

Short-sighted and

arbitrary decisions

Sustainable and

Sound P&R Policy

NEW WORLDOLD WORLD

Physician-centric

Relying on subject matter experts

Emphasis on highly specialized care

Payments largely based on fee-for-

service model with no alignment

among healthcare participants

Focus on innovation, blockbuster,

quantity and convenience of care

delivery

Patient-centric

Leveraging information technologies

Emphasis on coordination/ integration

Payment systems focusing on outcomes,

with alignment of incentives for relevant

stakeholders (patients, payors, providers)

Focus on risk stratification, case

management, real-world evidence

Innovation = Push Boundaries Innovation = Better Care at Lower Cost

Overall : Lead the change to a patient centric system

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