“More dialogue and access to patient-oriented innovation”

Source: Actualcare (16/09/2015); Author: Wieland De Hoon

The second Vlerick Healthcare Conference, to be held in Ghent on 29th October, promises to spark off exciting debates on a tricky aspect of healthcare reform: the need for access to patient-oriented innovation and networking. A conversation with Professor Walter Van Dyck, Director of the Vlerick Healthcare Management Centre, on the importance of best practices from business management to make our care sector both economically healthier and more accessible.

Why don’t we start with a quick look at the role of Vlerick Business School in healthcare management? From what perspective are you organising this conference?

“Over 10 per cent of our GNP goes to healthcare, making it a major area of interest for in-depth specialisation. This also applies to research, such as our recent study of market access for oncological precision medicine that we published this summer. How are negotiations conducted? How do you combine the profit-making nature of the provider with the budgetary limitations of governments, patients and hospitals? This is a social debate that is particularly animated at present. As a business school, we play an independent role. The pharmaceutical industry, as well as hospitals, doctors and customers – governments and patients – are our target groups. This neutrality makes us an especially attractive partner when it comes to building bridges. We do not just back one party.”

Just like a hospital manager who has to try and balance all those different interests.

“To repeat: our mission is ‘making connections’. That is the basis of our programmes. The ‘Management for the hospital professional’ programme is aimed at managers and doctors in a hospital environment. We mainly attract doctors who are members of a medical council, for example, and want to brush up on their business skills. The programme is supported by research at our MINOZ research centre, into subjects including operational issues. Take the management of a hospital pharmacy: what flows are there and how can we rethink them? We also carry out research into the operational planning of operating theatres. Clearly a hospital is a typical service environment. We model processes to determine the most efficient form of organisation. This also means introducing parameters such as the human factor or financing. We map out the whole package, both quantitatively and qualitatively. We are now also applying this process modelling to healthcare innovation, in the form of Health Technology Assessment (HTA). To develop cost-effective medicines, we use fundamental research by our two mentoring universities Leuven and Ghent, where there are a number of doctoral students at work on this issue. These lead in turn to new programme modules. Our growing programmes are the MBA and Master’s courses in which we are introducing specialist tracks. Within the master’s programme, we are planning three-week boot camps where a given problem relating to the integration of different domains must be solved, such as a problem relating to running clinical trials or setting up a business plan for a new medicine that has an impact on hospital budgets. To calculate a business case involving medicines, you need to take into account the population, budgetary impact, need for research etc.: a fascinating challenge for professionals with a biomedical background. In executive programmes, we have been running our hospital management programme for a long time. Belgium has an excellent reputation worldwide in hospital management and pharmaceuticals. So creating international research links with academic institutions is also part of our mission.”

You have given a clear picture of the aspects of healthcare in which Vlerick is active. How does the conference reflect that?

“Our DNA as an international business school already offers a lot of clues about where we want to go with this Health Care Conference. In fact pretty much all the subject areas of a business school are relevant, such as strategy IT, Operations and Supply Chain Management, innovation, and people management. However there are also the things we call non-market strategy. How do you deal with relevant parties such as patients’ organisations, for example, that are increasingly getting a say in healthcare, and rightly so? The medical sector has a definite need for this. Pharmaceuticals, biotech and medical technology, as well as the interaction between producers and the healthcare system are my areas of research within this field. This variety of activities reflects very well which topics will be looked at during the conference. What is more, we set up the Healthcare Management Centre last year with the aim of bringing together the different parties and healthcare professionals on issues such as the patient-centred organisation of care institutions, the financing of expensive medicines and so on. The Centre’s activities are also reflected in the conference programme.”
 
“The need to reform our healthcare is great, and just as Peter Degadt, Director of Zorgnet, believes, information technology is the basis for transforming our hospitals into a more efficient network structure. IT is a prerequisite for innovation and new technology with which we can guarantee that our system remains affordable. Therefore the first section of the conference is entitled ‘Managing information technology in an evolving care landscape’. ICT benchmarking, along with digitalisation and data exchange for patient files are absolutely crucial. We are on exactly the same wavelength. The second section of the conference is about the need for greater accessibility in order to be able to innovate. This is also IT-driven, because it is about infrastructure and monitoring that enable decisions to be made on the basis of as much real world evidence, i.e. concrete data, as possible. The degree to which information is available has a huge influence on the affordability of new technologies, because it determines who pays for the risk. Therefore Health Technology Assessment needs to play a major role in the development process and in correcting market prices. To give an example: Article 81 of the Belgian Royal Decree from 2010 offers access to a medicine at an early stage. But the risk is high, the health insurance authority wants it to be monitored and you do not know if you will get the effectiveness you require. Internationally, we see that risk-based entry agreements make expensive medicines available to patients earlier and also keep the higher risk under control. We also broach the issue of silo-busting here: breaking down the barriers between all the different stakeholders. Society, health insurance and innovative pharmaceutical companies all need an IT infrastructure that enables claims to be verified. The government wants to use it to be able to correct prices, whereas the pharmaceutical company needs it to be able to estimate pricing correctly.
 
In concrete terms, this means that health insurance bodies need to make their data available to stakeholders such as the pharmaceutical industry, and this is a delicate issue. Conversely, doctors also need to enter data systematically in patient files, which is not self-evident either.  Or take an example from our research: precision medicine is a combination of a therapy and a diagnosis. However, the test and the medicine are not approved by the same committee. And what do you know: there is no systematic consultation between the Technical Medical Council and the Committee for Refunding Medicines as to the medicines or tests they approve respectively. What is more, social experts should also be able to contribute to the evaluation. Concepts such as transversality or portfolio management that are commonplace in the private sector need to become equally familiar in healthcare. Improved accessibility also requires better alignment to one another and a turnaround in the way that all stakeholders think. It will only really happen if it benefits everyone. We have to walk on eggshells to reconcile all those so-called opposing interests, but Vlerick is willing to facilitate the debate – as well as to report on it in order to keep people informed, and to lobby for changes in policy as well.”

What do you believe is the essence of reforming the healthcare sector?

“On the health provider side, I think network management is becoming essential, and thus the IT structures that make that possible. People are often convinced that this is true in theory, but it stops there (laughs). On the medical technology side, I think the main thing there is to improve the alignment between industry and government in order to keep medicines affordable. The government needs to be able to plan for the long term and budget more effectively, and the industry needs to work with the government better and earlier. Thus working together for greater efficiency is the key. More dialogue, with a single goal: getting medical innovation to the patient as fast as possible whilst keeping it affordable.”

Which speakers or topics are you looking forward to most?

“At the end of the third section, there is the explanation of ‘Healthcare provider-based innovation’. It is about the vision of the hospital – or more generally the healthcare of the future – by Professor Jan Kimpen, President of Utrecht MC and healthcare manager of the year in the Netherlands. Although he works in the Netherlands he is actually Belgian (laughs). The key thing in this phase is to look at everything that is going on over the border in terms of the operation of hospitals and the health sector in general. We have scheduled Jan Kimpen at the end of the conference as the keynote speaker, so he is absolutely not to be missed. It will certainly be interesting to hear from Jan Kimpen how hospitals can not only be organised more efficiently but also introduce business thinking and an innovative, competitive mindset. Personally, I also think Panos Kanavos (London School of Economics) will make a very interesting contribution about risk-based market entry agreements from a pharmaceutical and economic perspective. Italy is a leader in real world evidence, so I am also looking forward to Dr. Paolo Sivieri Daniele’s contribution. The vision of innovative healthcare in other countries – the Netherlands, Great Britain, Italy – is really exciting. And to find out the state of affairs in policy and reform in Belgium itself, the opening speech by the Minister of Health, Maggie De Block will of course be very interesting.”

A final question: what is the main difference between this second edition and the first?

“The first edition was about listening to each other for the first time. At that point, our central theme was to take a more in-depth look at financing. My colleague Katrien Kesteloot also brought up the importance of networking then. The idea was to make pharmaceutical companies fully understand the needs of hospitals and vice versa. Following on from that exploratory phase, we are now going to offer one other concrete levers for working in a more patient-oriented way through cooperation. So it really is all about making connections.”

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