世界经济论坛-医疗保健价值：动员医疗卫生体系转型合作（英文）-2018.1-30页.pdf

Insight ReportJanuary 2018Value in Healthcare Mobilizing cooperation for health system transformationIn collaboration with The Boston Consulting Group(BCG)World Economic Forum 2018 All rights reserved.No part of this publication may be reproduced orTransmitted in any form or by any means,including Photocopying and recording,or by any information Storage and retrieval system.REF 1412173Value in Healthcare:Mobilizing cooperation for health system transformationContents4 Foreword5 Preface6 The imperative of cooperation9 New models for multistakeholder cooperation The Atlanta Heart Failure Pilot Lessons from the Atlanta pilot13 New standards for health informatics Healthcares information revolution Standards for data capture:The measures library Standards for data mapping:Semantic and data models Standards for data access:Data security,privacy and transparency The importance of effective governance21 New directions for leadership Industry leadership Government leadership Global leadership24 Appendix:Next steps for the Value in Healthcare project Creating a network of value-based healthcare pilots Accelerating the development of informatics standards26 Acknowledgements28 References4Value in Healthcare:Mobilizing cooperation for health system transformationForewordThe World Economic Forum is pleased to share details of the progress being made on how stakeholders in the healthcare industry are mobilizing to transform health systems so that they deliver better value to patients.In the first year of the Value in Healthcare project,we presented an overarching framework comprising the key foundations and enablers vital to the recalibration of global healthcare systems towards value that is,delivering outcomes that matter to patients at a sustainable cost.Frameworks mean little,however,if they are not tested in the real world.That is why we have spent the past year working with stakeholders across the care chain to begin the translation of the theory into practice.For example,the World Economic Forum acted in leading the Atlanta Heart Failure Pilot in which more than 40 stakeholders in the Atlanta metropolitan area in the United States have come together to transform the way in which care for congestive heart failure is delivered to patients.This report highlights the initial results of this effort,shares learnings and methodology,and puts forward recommendations on how we can continue to mobilize and scale cooperation for health system transformation.The work thus far is just the beginning of a journey towards building more sustainable health systems globally.The commitment of the projects executive board and steering committee,and our knowledge partner,The Boston Consulting Group,has been critical to the successful progress to date and to the work in the coming years.We are thankful to all of the healthcare stakeholders who have devoted their efforts and resources to this project.We cannot underestimate the depth of this task.Together,however,we can transform health systems globally.Join us and we can translate our ideas into action and improve outcomes that matter to patients.Cheryl Martin,Head of Industries,Member of the Managing BoardVanessa Candeias,Head,System Initiative on Shaping the Future of Global Health and Healthcare5Value in Healthcare:Mobilizing cooperation for health system transformationPrefaceby the Executive Board,Value in Healthcare projectWe live in challenging times.Current political,economic and social narratives are divided.Communities are dismantling.The focus is on the self.And yet,if there is one topic that unifies populations around the world,it is the desire for better health and healthcare.Value-based healthcare puts the health outcomes of individuals at the very centre of care delivery.This people-centred approach emphasizes the delivery of health outcomes that matter to patients in a financially sustainable manner.We have been delighted by the response of the global healthcare community to the challenge and opportunities of this paradigm shift.In the past year,our initial report,“Value in Healthcare:Laying the Foundation for Health System Transformation”,was released in English and Mandarin Chinese,and our framework for a value-based health system has re-focused the vision and the mission of many stakeholders,ranging from individual healthcare organizations to national ministries of health.Ultimately,realizing the full potential of value-based healthcare requires moving from fragmented healthcare systems to unprecedented cooperation among all stakeholders.This has been our focus for the past year.We have identified three key elements of this transformation:New models for multistakeholder cooperation.The experience of the Atlanta Heart Failure Pilot,acomprehensive example of value-based healthcareat a municipal level,highlights what is possible.Approximately 40 healthcare stakeholders operatingin the Atlanta metropolitan area providers,payers,patient advocacy groups,public-sector organizations,academic institutions and pharmaceutical and medical-device companies have united to focus on heart failurepatients.The vision is bold:to make Atlanta a nationalleader in the heart failure survival rate by 2022 whilesignificantly improving quality of life and reducing theaverage cost per capita.The Atlanta pilot offers a modelfor organizing similar initiatives in other parts of the world.New standards for health informatics.Transformationtowards a value-based,people-centred health systemsimilarly demands an integrated approach to the captureand use of health data what we call health informatics.More precise and personalized healthcare requires moreadvanced informatics,with broad access to disparatedata sources in order to generate statistically significantfindings.Individuals also expect access to a holisticview of their own health data.Many recent technologydevelopments are now making it possible to meet theseinformatics needs.However,global standards are aprerequisite to enable providers,payers,researchersand policy-makers to learn from each other about whatworks and what does not.In this report,we outline theminimum sufficient set of informatics standards requiredto deliver the value-based healthcare revolution.New directions for leadership.System transformationrequires transformative leadership.Although healthcareleaders,of course,need to play an active role intransforming their own organizations to improve value,this is only the first step.Leaders also need to articulatea vision that looks beyond the interests of their individualorganizations in order to transform the system as awhole.Government leadership creates the broaderpolicy and the regulatory and legal framework necessaryto make it easier for stakeholders to cooperate ondelivering healthcare value.Leadership on a global scalewill ultimately create a healthcare community in whichbest practices can be shared and innovation can driveimprovement of patient outcomes across nations.In 2018,the Value in Healthcare project will continue to apply these principles to additional system-level pilots around the world.We also plan to develop a common data model for the structured exchange of information on patient care pathways and outcomes,as well as a reference implementation for a global set of outcome measures.In conclusion,we would like to acknowledge the dedication and contribution of the many healthcare leaders in our steering committee as well as the vision and ambition of the Value in Healthcare project team.This journey is just beginning,but the momentum continues to build,and we are excited to see the global community come together and cooperate for better health outcomes,putting people back at the centre of health systems.6Value in Healthcare:Mobilizing cooperation for health system transformationThe imperative of cooperationThe$8 trillion global healthcare sector is at a critical juncture.Costs are growing at roughly double the rate of GDP growth,putting severe pressure on healthcare budgets.1 Reimbursement mechanisms based on volumerather than on value cause substantial waste in health systems and contribute to an underinvestment in prevention.Despite rapid advances in medical science and a revolution in health technology,a lack of global standards remains an obstacle to taking full advantage of the explosion in health-related information.And an exponential increase in system complexity has led to increasing fragmentation that makes it easy too easy for health systems to lose their focus on the patient.In response to these challenges,more and more leaders in the industry are embracing an alternative strategy for the organization and delivery of care known as value-based healthcare.According to this strategy,the delivery of improved health outcomes for the same or lower cost is or ought to be the primary objective of global health systems.Value-based healthcare is founded on the systematic measurement of health outcomes and on the costs required to deliver these outcomes for clearly defined population segments.Interdisciplinary teams of clinical specialists use this data to develop customized interventions or treatment pathways to improve the value delivered to each patient group over time.(See the sidebar,“What value means in healthcare”.)7Value in Healthcare:Mobilizing cooperation for health system transformationWhat value means in healthcareIn the first year of the Value in Healthcare project,we developed a comprehensive framework for a value-based health system.(See Figure 1.)Value-based healthcare puts the individual patient at the centre of the health system through the systematic measurement of the health outcomes that matter to patients and the costs required to deliver those outcomes across the full cycle of care.The relevant outcomes tracked for any individual patient depend on their profile matching a specific population segment for example,all patients suffering from a specific disease such as type 2 diabetes or groups that share a similar risk profile such as all newborn infants.Tracking outcomes and costs by population segment makes it possible to compare clinical units or locations and,thus,to identify clinical best practices,reduce outcome variation across providers,and develop increasingly customized interventions and ever more precise treatment pathways to improve value for each segment over time.This ongoing cycle of continuous improvement ultimately leads to what clinical experts term precision medicine.Four enablers support this value-based delivery model:An integrated informatics infrastructure that permits the routine capture,sharing and analysis of health outcomes andother relevant data for each population segment New analytical tools for benchmarking and research,including sophisticated decision-support tools for clinicians andpatients New forms of value-based payment that create incentives for continuous improvement in patient value New roles and organizational models that allow networks of providers and suppliers to deliver better access toappropriate care,engage clinicians in continuous improvement,and adapt to new opportunities and innovations.Finally,the entire value-based system requires public policies and a legal and regulatory environment that support and accelerate the transition to a value-based health system.(For a more detailed description,see“Value in Healthcare:Laying the Foundation for Health System Transformation”,World Economic Forum,April 2017;available at:http:/www3.weforum.org/docs/WEF_Insight_Report_Value_Healthcare_Laying_Foundation.pdf.)Policy Payments Delivery organization Benchmarking research&tools Informatics Outcomes Costs Figure 1:A Comprehensive Framework for a Value-Based Health System 8Value in Healthcare:Mobilizing cooperation for health system transformationAlthough leading stakeholders around the world are embracing elements of this value-based model,the challenge,and the opportunity,lies in unlocking the potential of this approach at the level of entire health systems regionally,nationally and internationally.Aligning all stakeholders in the health system around the shared objective of improving healthcare value brings important collaborations,with the potential to deliver substantially enhanced health outcomes at lower costs than are currently being achieved.The approach also improves access to appropriate care,creates an environment that encourages innovation in treatment and care delivery,and provides new opportunities for healthcare organizations in both the public and private sectors.To make value-based healthcare a reality,however,will require significantly higher levels of cooperation and alignment among stakeholders than is the rule today.2 For example,specialists in key disease areas need to agree on the most important outcomes to measure for each subpopulation.Then,they need to come together in interdisciplinary teams and work with patients and patient advocacy groups to create more integrated,customized care pathways to achieve the outcomes most important to patients.Payers also need to work closely with providers,pharmaceutical companies and medical-device manufacturers to create the right incentives for value and develop the most cost-effective modes of treatment.And governments need to create legal,regulatory and financial incentives to encourage greater cooperation.In 2016,the World Economic Forum launched the Value in Healthcare project to help achieve these goals.In the first year of the project,we created a compelling vision for value-based health systems and brought together a breadth of case-examples to build the case for change and document the feasibility of the vision.In the second year,we have focused our efforts on three critical mechanisms for accelerating the cooperation and alignment necessary to make this vision a reality.These three mechanisms are the focus of this report.New models for multistakeholder cooperation.Improving healthcare value requires system-widetransformation.Every aspect of a local or national healthsystem how outcomes are tracked,how research andbenchmarking are conducted,how clinicians are paid,how care is organized and delivered needs to change,with value delivered to patients as the central focus.Tobegin this transformation,the Value in Healthcare projecthas initiated a series of pilots around the world,workingwith local stakeholders to transform their abilities tojointly deliver improved healthcare value.The followingsection of this report describes one such pilot in detail:the Atlanta Heart Failure Pilot.We draw lessons from theAtlanta pilot for organizing similar initiatives in other partsof the world.New standards for health informatics.Thecornerstone of a value-based health system is thesystematic measurement of health outcomes and costsby population segment.The routine collection of detailedinformation on health outcomes makes it possible toidentify variations in outcomes across clinical sites,analyse the root causes of th