disrupting the game- how charities can get a commercial edge and improve outcomes for their...

Disrupting the

Game – how charities

can get a commercial edge

and improve outcomes for their beneficiaries

Hilary Thomas,

KPMG

Breakthrough Breast Cancer

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Disrupting the Game - Outline

� Context – my journey

� Healthcare globally and in the UK today

� The unique position of Charities

� Why engagement is key

� Examples of public engagement as a disruptive innovation



Disrupting the Game - A personal story

� Age 9

� In my 20’s

� Being a Consultant

� Being a Patient

�Moving to the private sector

� Being a Trustee



Disrupting the Game - Healthcare in the UK todayWorld Economic

Forum, Davos 2012: “The financing of health systems

has increasingly burdened

developed economies, which has

been exacerbated by the fiscal

crisis. Participants agreed on the

drivers of the expenditure growth

and, since many of these factors

are unlikely to recede (e.g. ageing,

lifestyles, public expectations),

there is a clear need to develop a

more sustainable way of

managing health systems. The

magnitude of health financing

challenges suggests that

incremental solutions may not be

enough; however, a shared vision

of new models for health systems

does not yet exist.”

Source: The Great Transformation: Shaping New Models – World Economic Forum Annual Meeting Davos 2012



We are well aware of the challenges...

People and products:

Aging

Multi-morbidity

Rising expectations

Lifestyle diseases

Technology and devices

Process:

Poor system and process design

Specialisation

Organisational culture

Problems with the economic model

Growing complexity



Active strategies to cope are transactional.

Question - Which

strategies are

providers likely to

adopt to respond to

these changes?

Major cost reduction

Lean and improvement methods

More focus and specialisation

Investment in Health IT

New workforce models

Extra income from existing payers

85

%

81

%

82

%

78

%

74

%

44

%

Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012



The problems with hospitals:

Not specialist enough for complex cases.

Not general enough.

Based on some odd design rules.

Not very safe out of hours.



The leadership and governance mechanisms to address all these

problems are poorly developed

The dominance of professional autonomy: the

tendency to reject mechanisms of accountability.

A reluctance to give or receive feedback or

to share information about performance.

Emphasis on individual judgment and knowledge

rather than on the value of teams.

Reluctance to accept the idea that clinical decisions

have resource consequences.

A paternalist approach to care and inadequate

involvement of patients in their own care.

Undervaluing and under investment in management and

a divide between clinicians and managers.

The problems

with the

organisational

culture:

Leadership not just better management.



The design rules need

to change.

■ Treat each episode as a single event.

�� Anticipate need and manage years of

care■ Treat patients as though their time is free.

�� Eliminate wasted time and travel

■ Move patients.

��Move staff and information

■ Batch and queue.

�� Patients flow through the system

■ Patients are passive recipients of care.

�� Patients actively manage their own care.



Disrupting the Game - Healthcare in the UK today

� The Health and Social Care Act 2010

� Putting patients at the heart of the NHS - no decision about me without me

� Focus - improving outcomes, emphasis on high quality care and not on process

� Empowering local organisations and professionals

making NHS services more directly accountable to patients and communities than they

currently are



Disrupting the Game - Value Based Reimbursement

.

:

Focus - on a process,

on a procedure or on a disease area.

Channel shifting - move services

to online, telephone and other modes.

Patients and their networks as a source of value -

co-producing or even co-designing the product or service.

Disintermediation - Taking out steps in

the supply chain to reduce costs or increase value.

Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.



Disrupting the Game – Focus on WellnessDisrupting the Game -

.

:

Move from a National Sickness Service ,

To a National Health Service.

Consider Prevention as today’s problem

Not something to be deferred until tomorrow

Incentivise the right behaviours

Build on behavioural economic understanding

See the patient as a source of value

Support and foster self care and better understanding

Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.



Disrupting the game – Segmentation, Stratification and Personalisation

.

:

Segmentation

Define the most important segments

Stratification - who

Agree principles to risk stratify populations

Personalisation

Build on voluntary sector experience/ expertise



Summary

�There is a huge opportunity

�Be ambitious – identify value added opportunities which are scaleable

�Work with new commissioners of care to disrupt the system

�Ensure you measure your impact – Porter principles -

Value = Appropriateness x (Outcome)Cost

�Engage the public and use the new world order – social media – to advantage



Disrupting the Game

Hilary Thomas

Partner and Industry Expert Global Health Practice

KPMG Health Advisory

Vice Chair

Breakthrough Breast Cancer

disrupting the game- how charities can get a commercial edge and improve outcomes for their...

Documents

kpmg llp

kpmg international cooperative

subsidiary of kpmg europe

swiss entity

united kingdom

uk todayworld economicforum

financing of health

game healthcare