What does it take to be a leader in innovation? How do you enable a positive environment which encourages innovation for the benefit of patients? Those and other questions were the focus of a one-day roundtable session about procurement hosted by Eastern Health in January 2019.
Over 122 participants representing regional health authorities, the Government of Newfoundland and Labrador, patient advisors, industry partners, Newfoundland and Labrador Association of Technology Industries (NATI), Memorial University and many others discussed how to shift to a value-based procurement strategy that would enhance health outcomes for patients. Medtronic Canada defines value-based procurement as making purchasing decisions that consider how a product or solution can best deliver the outcomes being measured and reduce the total cost of care — rather than focusing exclusively on purchasing a specific product at the lowest possible price.
The Innovation Journey
Over the last two years, Eastern Health has been embarking upon an exciting journey of innovation. It all started with participation in Hacking Health cafes, a forum which brings together key groups of stakeholders to help find solutions to health-care challenges. Then, in April 2017, the first ever Hackathon was held which had resounding success and was the starting point to developing MyCCath, a secured, web-based pilot IT solution for clinicians at the Health Sciences Centre, that aims to facilitate the referral process for Newfoundland and Labrador patients requiring cardiac catheterization (cath) laboratory services.
Other innovations have included SurgeCon, a digital solution and application designed to improve patient access to emergency medical care by calculating patient flow through the emergency department and providing real-time information to ensure that surges are most appropriately managed and dissipated. This application received widespread recognition and received a $100,000 grant from the Canadian Institutes of Health Research in February 2018. Eastern Health is also at the forefront of health care innovation like telehealth and Remote Patient Monitoring.
There’s no denying that Newfoundland and Labrador is on the cusp of change when it comes to how we develop and think about health innovation.
In fact, Eastern Health President and CEO David Diamond noted in his presentation at the roundtable session that there is “no shortage of innovative thinkers in this province and the time is right to enhance and formalize infrastructure that will support growth of the innovation sector in Newfoundland and Labrador and beyond.”
The ultimate benefit from this innovation thinking is for patients and clients but there are other important factors to consider as well. It’s no secret that Newfoundland and Labrador must look to other industries than the traditional oil and gas, fishery or forestry sectors in order to boost the economy. We have an aging population and our birth rate is not keeping pace. This means that there are increased health and hospital expenditures per capita which are not sustainable. Health-care costs amount to 40 per cent of the overall budget for Newfoundland and Labrador.
Eastern Health has taken the position that these challenges present opportunities. It’s where innovation and medical technology, or medtech, should and can be encouraged and supported.
“Eastern Health and our innovation partners are on a mission to improve the health status of Canadians through innovation,” said Mr. Diamond. “We believe Atlantic Canadian entrepreneurs are critical to driving the innovation journey. Medtech start-ups will create high value jobs in Newfoundland and Labrador and keep health spending in the province and in the country under control.”
That support at the executive level is crucial to growing innovation and it’s something the Eastern Health Board of Trustees has adopted as one of its broad priorities.
In fact, Chair of the Board of Trustees, Leslie O’Reilly, whose background includes merging various stakeholders to collaboratively work together to creative innovative strategies in the marine sector, co-moderated part of the roundtable session.
Mr. O’Reilly focused on the need for strategic partnerships and patient and stakeholder engagement. It’s about bringing in vendors early and presenting them with the outcomes we want to achieve in health-care which is a dramatic shift from current practices. It’s about shifting to a value-based procurement strategy from the more traditional procurement process.
“We believe that by coming together and collaborating, we can make a difference,” said Mr. O’Reilly. “We believe the activity we are engaging with our partners will impact policy development and organizational decision making. We want to build transparency and inclusiveness which means we also have to understand our respective roles. We must forget boundaries and talk about how we can work together and that can sometimes be challenging.”
What is Value-Based Procurement?
To help the participants understand value-based procurement, Dr. Anne Snowdon, Academic Chair of the World Health Innovation Network at the Odette School of Business, delivered the keynote address, “Innovation Procurement: A Strategy to Achieve Value-Based Healthcare.”
Dr. Snowdon noted that she had never seen a province map out an innovation strategy as future-oriented and forward-thinking as the Eastern Health presented.
“Just based on a very quick survey of the Canadian provinces that I do work with and seven or eight countries globally, Eastern Health is very well positioned to lead the innovation agenda,” said Dr. Snowdon.
That’s because there is no province or health system today that is leading the value-based procurement agenda and Newfoundland and Labrador is small enough and flexible enough to create this capacity at a system level that others just haven’t done yet.
Dr. Snowdon defines value-based health care as the health outcomes that matter to patients divided by the cost of delivering those outcomes. But it’s crucial to nail down value for all stakeholders, which she includes as clinicians, physicians, the organization, health system leadership, vendors, industry team and procurement team, to make that value possible.
“Innovation procurement is bringing in vendors and asking them to help us deliver a program better with better outcomes for patients,” Dr. Snowdon explained to the participants of the session. “You’re not procuring products but procuring a set of outcomes. Vendors become a more important part of the process to discuss how to achieve the outcomes, including how to design something that may not exist today. You need to define those outcomes and what the success you’re looking for is for something like lower wait times or lower infection rates, as examples.”
Learning from the Celtic Tiger and Others
Value-based procurement may be new to Canada and Newfoundland and Labrador but there are other places around the world where it has been used for many years.
For instance, Ireland has become a hub for innovation especially in the med-tech industry. Ireland is the largest employer of that industry in Europe. With so many similarities between Ireland and Newfoundland and Labrador, it’s only natural that Eastern Health looks to Ireland for inspiration.
Enterprise Ireland’s Neil Cooney and Marianna Costello gave a presentation on the Irish innovation story which was enlightening for participants at the roundtable.
Many people may not realize just how successful Ireland has become in the med-tech industry. Some examples include:
- 30 million diabetes patients rely on injectable devices manufactured in Ireland;
- 33 per cent of the world’s contact lenses are made in Ireland;
- 75 per cent of the world’s replacement knees are Irish-made; and
- 80 per cent of cardiovascular stents used worldwide are made in Ireland.
One of the key takeaways from Neil and Marianna’s presentation, and in fact from the entire roundtable session, is that collaboration makes innovation happen.
“One of the benefits we’ve seen in Ireland and which I can see for Newfoundland and Labrador is that being small can bring a lot of advantages. There are benefits from a very integrated cluster. We benefit from our higher education institutions, our researchers and our multi-national community right down to our small start-ups and entrepreneurs. It really is highly integrated and there is a real collaborative effort,” said Marianna.
“There is a lot to learn about the Irish model because they’ve been able to navigate through challenging and prosperous times, but they’ve been able to change their focus on how they approach their economic development and a different thought process on how they work together. It’s a knowledge-based economy. It’s very instructive for how we want to proceed,” said Board of Trustees Chair, Mr. O’Reilly.
Roundtable participants also heard from Dr. Gabriela Prada, Director of Health Systems Policy at Medtronic, one of the world’s largest medical technology, services and solutions companies and dedicated to advancing value-based procurement.
Dr. Prada spoke about advancements in Catalonia, a small region located in Spain. Catalonia’s health-care system was a significant employer and the region wanted to make it an economic generator as well. What ensued was a very successful economic and innovation agenda.
Dr. Prada reiterated the key theme of the day – that value-based procurement is about focusing on outcomes.
“It’s difficult to specify innovation,” said Dr. Prada. “You need the right specifications or innovations and you might not know what they are so there are many unknowns. In Catalonia, they no longer have conversations about gadgets but on outcomes.”
And she noted it’s important to think about the role clinicians and patients have with value-based procurement. When thinking about outcomes, patients and clinicians can and should contribute to the overall understanding of the problem.
All the speakers and presentations framed four discussion topics of patient engagement, stakeholder engagement, managing risk and strategic partnerships. Participants were polled and discussed the challenges and opportunities of these topics at their individual tables.
It was clear at the end of the day that participants of the roundtable session are supportive of value-based procurement and would encourage Eastern Health and its partners to explore this innovative strategy further. And by bringing a broad spectrum of individuals together, Eastern Health now has a collaborative hub which will identify the challenges moving forward and look for the opportunities in those challenges to move forward on the innovation journey.
Eastern Health is highly supportive of innovation and how it can change the way we look at delivering health-care. The benefits are tremendous both economically and socially but ultimately patients and clients must be at the heart of this journey.
As Board of Trustees Chair, Leslie O’Reilly, best said: “everything we do must include how we improve the quality of health-care for our patients.” ■
This story was written by Vanessa Colman-Sadd, communications manager with Eastern Health.