Utility of 'Real World Evidence' for Creating Measurable Value: A Provider's Perspective

1. Utility of ‘real world evidence’ in creating and capturing measurable value; a provider’s practical perspective. April 14, 2015 CADTH National Conference Session E6: Panel Discussion The evolving role of real-world assessment to support policy and practice Peter Fenwick, CHE, MBA, BSME Senior Provincial Director, Major Initiatives Research, Innovation and Analytics Portfolio AHS

2. Q: Why live in reality when fiction is so much more appealing? • Real world evidence (RWE) definition inclusive of all clinical, operational, and financial production data (primary and secondary use) that can influence decision making, including that from external sources & research. • Our reality includes global grants, run rate budgets, challenges in measuring service quality relative to transactional costs on frontline of care. • Evidence in literature is only a starting point; it must be supplemented with local jurisdictional RWE. • Traditional ‘cost per’ approach must evolve to measuring value (impact) from cash invested along a patient’s journey. • Benchmarking and setting ‘standards of practice”, combined with clear goals, can close performance gaps. “Albertans must come to realize that health care service delivery has become a zero sum game” Dr. Tom Noseworthy, OC CADTH breakfast, Banff June 2014

3. #accountabilty4results “Premier Jim Prentice described the latest restructuring of Alberta Health Services as an attempt to alleviate concerns about over-centralization — one of several issues highlighted in a new government report on the state of rural health care. “The pendulum is coming back in terms of local input into decision-making to protect the interests of people who live across the province,” he said. Source: Keith Gerein, Edmonton Journal, 19 March 2015 http://www.edmontonjournal.com/Latest+Alberta+health+system+overhaul+aims+allow+more+local+input/10899836/story.html ROI

4. “Needs of the many ...” Mr. Spock affordability (WTP) value

5. In using RWE to support values based and evidence informed decision making do the needs of the many out weigh the needs of the few, or the one?

6. Disseminating Innovations in Health Care: Berwick, JAMA 2004! Lead by example “Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all.” Berwick Our (system wide) goal: “Alberta to develop a sustainable health system that creates the healthiest population and best health outcomes in Canadasupported by (real-world) evidence” We can get there together via .. SPARC! Trust and enable reinvention Find sound innovations 7 recommendations for health care executives who want to accelerate the rate of diffusion of innovations within their organizations Find and support innovators Create slack for change Invest in early adopters Make early adopter activity visible Abstract. Source: http://jama.jamanetwork.com/article.aspx?articleid=196400

7. It’s time to view health care as an economic asset. Dr. Cy Frank. 28 December 2012. http://www.theglobeandmail.com/report-on-business/economy/economy-lab/its-time-to-view-health-care-as-an-economic-asset/article6764431/

8. A means forward to system performance improvement via health research and innovation collaboration

9. Case A: Collaborating with a clinical (provincial) community of practice; a means to leverage RWE and optimize impact • Strategic Clinical Network driven, adopting evidence from abroad. • Clear “measure of better” • Literature guided initial projections. • First two pilots yielded local RWE to allow for a re-forecasting of cost - benefit; process evolving. • RWE proved conditional (notional) break even/ payback in 22 months. • Speed of innovation diffusion can be at odds with research agendas. • Risk free gains, verses practical value creation. [Re-investment algorithm] Source: published and approved ‘14-15 Operational Plan AHS Major Initiatives

10. Case B: Creating a value case for the triple aim approach using RWE; better service for those complex high needs of the system. • Houston, do we really have a problem or is 5/65 normal and acceptable? Reframing our values, preferences, & priorities. • Is this scale-able social innovation? Early evidence from methodology shows (utilization) regression to the mean. • New measurement, evidence creation, and evaluation program to align value case with RWE from across the triple aim triangle. • Community collaborations awesome • Data sharing agreements, systems analytics, shared goals are in place (mostly). • RWE driven predictive modelling is the future!

11. Case C: Capturing value from research: Intellectual Property owned by the public service. A define role in commercialization. • Site specific operational impact assessment. An earlier HTA process that included discounted cash flow (DCF) projections a site level to better understand impact to patient care budgets. Leads into value based pricing and willingness to pay (WTP). • Use of RWE to project the ‘size of the prize’ as a function of health, social and economic gains; policy implications and (re)defining risk. • Discussing the role of service provider in innovation stewardship, licensing, & new company creation. Asking ‘what if?’ • Collaboration with TEC Health Accelerator, Alberta Innovates http://www.mp.med.ualberta.ca/linac-mr/ Clinical Linac-MR Installed in 2013 Proposed commercial version V3