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ANNUAL RESEARCH REPORT 2015 VLERICK HEALTHCARE MANAGEMENT CENTRE

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Page 1: VLERICK HEALTHCARE MANAGEMENT CENTRE/media/Corporate/Pdf-knowledge/Vlerick... · 05 Introduction 06 The Oncology Horizon Scanning Project ... 2016, builds further on these streams,

ANNUAL RESEARCH REPORT 2015

VLERICK HEALTHCARE MANAGEMENT CENTRE

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2 / ©Vlerick Healthcare Management Centre, Annual Research Report 2015

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04 About the Vlerick Healthcare Management Centre

05 Introduction

06 The Oncology Horizon Scanning Project

08 On the Design of Custom Packs for Surgery

12 Digital Strategy at Merck Sharp & Dohme

13 Opinions

13 Recent Publications

14 Ongoing Research

15 Further Information

CONTENTS

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ABOUT THE VLERICK HEALTHCARE MANAGEMENT CENTREThe Vlerick Healthcare Management Centre (HMC) is a European, Brussels-based non-profit independent think tank and education provider advancing innovative and actionable management and policy solutions in the fields of healthcare and the life sciences.

The Vlerick HMC research agenda is set by its Director after consultation with the Vlerick HMC International Advisory Board, which is chaired by Prof Dr Leo Neels and is composed of the following members: Prof Dr Richard Barker (CASMI, UK), Mr Jo De Cock (NIHDI, BE), Prof Dr Denis Lacombe (EORTC), Prof Dr Erwin Hans (UTwente, NL), Prof Dr Kjeld Möller Pedersen (COHERE, DK), Prof Dr Maarten Postma (RUG, NL).

Prof Dr Walter Van Dyck, Vlerick Business School Partner and Roche-Chaired professor, serves as the Vlerick HMC’s Director. Prof Van Dyck leads the biopharmaceutical and life sciences innovation & entrepreneurship, medical technology research design and market access research agenda of the Centre. Prof Dr Brecht Cardoen leads its hospital management and health services innovation and operations research agenda.

FINANCIAL AND COMPETING INTERESTS DISCLOSUREVlerick HMC is fully owned by Vlerick Business School, a Public Utility Foundation, and funded by grants from public institutions and private organisations. To conduct its applied business and policy research, Vlerick HMC benefits from a Research Chair from Roche, focusing on patient access to medical innovation, and from MSD as a Knowledge Partner in hospital operations management with ASZ Aalst, AZ Alma, AZ Jan Palfijn, AZ Maria Middelares, AZ Nikolaas, AZ Sint-Lucas, AZ Sint-Maarten, AZ Sint-Maria, Jan Yperman Ziekenhuis, Jessa Ziekenhuis, Maria Ziekenhuis Noord-Limburg, united as MINOZ Research Members.

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INTRODUCTIONAt its creation one year ago, the Vlerick HMC was charged with working on the management game-changers facing the healthcare sector. As the largest employer and a major economic sector in Belgium, and accounting for 1 in 9 jobs in Europe, the health sector was claimed to merit our attention in management research and education.

Also, as medical technology and health services are important for population health and well-being, the right balance must be found between creating business value and societal value. For health technology providers, this implies the increasing need to formulate non-market strategies that complement their traditional market strategy. For budget-constrained healthcare service providers, this means ever increasing attention to running qualitatively efficient processes in ever more networked accountable care network organisations. For payers and regulators in times of austerity, this means organising for early dialogues with innovative medical technology manufac-turers and for clever tabooless budgeting with sufficient foresight (the latter conducted at an international level).

In its first working year, the Vlerick HMC conducted health management and policy research and provided executive education on the game-changers mentioned in its initial White Paper: ‘It’s time to invest more in our health’. Drawing predominantly upon our quantitative decision modelling, operations research and health technology assessment competences, we finished two research studies:

• First, the ‘Oncology Horizon Scanning Project’ studied the challenges and proposed solutions in the domain of access to innovation in the field of cancer treatment. This study received a lot of media attention and led to a parliamentary question to the Minister of Health.

• Second, the ‘On the design of custom packs for surgery’ study examined to what extent the (re)configuration of custom-made packages of disposable medical items can impact operational efficiency in material handling. This study has recently been accepted for publication in an international peer-reviewed academic publication.

In addition to finishing these research studies, we added a case to The Case Centre entitled ‘Digital strategy at Merck Sharp & Dohme’, which is available for international use in educational programmes.

The centre’s work at present, and on into 2016, builds further on these streams, extending them beyond decision modelling into hospital (network) IT strategy and into the use of real-world evidence in adaptive development and outcome-based market access for biopharmaceutical drugs in the field of cancer treatment.

Prof Dr Walter Van Dyck, Director Vlerick Healthcare Management Centre

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THE ONCOLOGY HORIZON SCANNING PROJECTWALTER VAN DYCK & TINE GELDOF

In the coming five years, lots of innovative - but often very expensive - cancer medicines will become available on worldwide markets. As recently announced at the annual ASCO (American Society of Clinical Oncology) congress, these will be predominantly personalised medicines and immunothera-pies. As treatments become more and more biomarker-driven, the need for diagnostic technologies is also on the rise, allowing earlier screening, drug-based therapies to be targeted and monitored.

At this moment, 5% of the total medicine budget of €4 billion a year in Belgium is spent on innovative drugs. Given the immediate future pipeline of innovative targeted drugs in the field of oncology, measures ensuring patient access in Belgium will have to be taken. This study investigates what needs to be done.

A very strong pipeline of oncology precision medicines will become accessible to patients now and in the immediate future. Over the next five years, a range of innovative precision medicines or targeted therapies will reach the market, followed by new immuno-therapies. Moreover, taking this growing targeted therapeutics pipeline as a basis, we showed an equivalently growing diagnostics pipeline, not only used for properly targeting precision medicines, but also more and more for screening, monitoring and treatment optimisation.

In this study, we investigated whether Belgium is ready to make this disruptive medical technology available to its citizens. With innovative precision medicines in

oncology currently at 5% of the total Belgian pharmaceutical specialties budget – but forecasted in this study to rise to 8.9-9.5% of the total budget in 2020 – the budget capacity and budgeting process to allow for this innovation to reach the Belgian market is considered to be inadequate and in need of review – especially in these times of austerity characterised by historically stagnating, or even declining, budgets. Second, next to the sheer size of the pharmaceutical specialties budget, access timing is considered to be a key problem to be resolved in the Belgian healthcare system.

To cope with the imminent innovation bubble of precision medicine therapies in the field of oncology, we propose, first, a case-based method to review personalised-medicine-based drug and diagnostic submissions in an EU-National harmonised and synchronised market authorisation and reimbursement process, in which the Drug Reimbursement Committee and the Technical Medical Council act in concert. Doing so will reduce access delays and increase reimbursement decision alignment. Second, to improve foresight and to channel budget means to the most promising innovative therapies becoming available, we propose a horizon-scanning-based transversal 5-year rolling budget forecasting concept and rationale, beginning with pharmaceutical specialties, and later for diagnostics.

As can be seen from the figure on the next page, taking a 3-year planning horizon does not raise a warning about the approaching PMx innovation bubble, whereas a 5-year horizon does warn about the uncertainty and is, hence, preferred.

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As a result for Belgium, from a simulation using the 5-year horizon-scanning-based transversal budgeting methodology we propose, this would mean that, in order to cope with the imminent innovative oncology precision medicine pipeline, the pharma-ceuticals specialties budget should rise by a compound annual growth rate (CAGR) above inflation ranging between 0.89% and 2.05% over the next 5 years, provided the budget for conventional medicine remains constant or grows at its historical rate.

This required pharmaceutical specialties budget growth rate can only be reduced if one decides to take into account possible effects from de-reimbursement or from transversal budget impacts, i.e. by funding pharmaceutical innovation using the savings projected to be made by precision medicine in other healthcare areas. Therefore, to cope with the upcoming innovation pipeline, the

essence of the proposed transversal way of budget thinking, cutting across budget silos, comes down to the choice between growing the pharmaceutical specialties budget by the above-mentioned CAGR of 1.47% ± 0.58% or benefiting from €208 million – €461 million of budget spill-overs and de-reimbursements. However, it should be made clear that, for this transversal budget thinking to work in practice, a real-world data infrastructure integrating scientific and health economic data should be made operational.

REFERENCEDownload the full report on healthcare.vlerick.com.

ACKNOWLEDGEMENTThis report was made possible by an unconditional grant provided by AstraZeneca.

Expected release

Estimated extra sales

Innovation fundable by release

66%

84%

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ON THE DESIGN OF CUSTOM PACKS FOR SURGERYBRECHT CARDOEN, JEROEN BELIËN & MARIO VANHOUCKE

Based on real hospital data, this quantitative research shows that the introduction of custom packs can significantly decrease the points of touch needed to get medical materials ready for surgery. In assessing how these custom packs should be configured to achieve the best returns, we found that a substantial improvement could already be realised using only a few packs. Also, though perhaps counter-intuitive when it comes to efficiency, we showed to what extent the inclusion of redundant medical items can foster the sharing of a pack among procedures, creating economies of scale. Similar to the number of custom packs to be introduced, it appears that a limited budget dedicated to redundant items can already be beneficial for decreasing the points of touch.

In its strict sense, a custom pack is defined as a single, sterile, customised, disposable pack that contains all the supplies or items needed for a particular surgical procedure. It is usually assembled by a vendor to the specifications of the healthcare facility. However, custom packs may also include only a subset of the supplies needed for a specific surgery. In this case, single-item picking or even a selection of other custom packs may complete the required set of medical items for the surgery. Moreover, custom packs do not have to be developed for a single surgical procedure: they can be used for a set of surgical procedures, or for a specific surgeon instead of a specific procedure.

Although custom packs are becoming well-established in hospitals because of their potential benefits in reducing surgery setup times, little is known about methodo-logies to configure them, especially if the number of medical items, procedure types and surgeons is large. We developed an algorithmic approach to guide hospitals in

developing or reconfiguring their custom packs. In particular, we minimise points of touch – which we define as a measure of physical contact between staff and medical materials – during setup of the surgery. Interviews with field experts from multiple hospitals in Flanders indicate that estimating the true economic value of time or resources in the operating theatre or perioperative setting (e.g. storage processes) – and especially clinical outcome measures – may be difficult in practice. Using points of touch as a performance measure provides a means of impacting many objectives at once. In defining the packs, it is obvious that the minimum number of medical items required for a procedure using a pack should be present at the time of surgery (i.e. included in the custom pack or picked additionally). Also, the number of custom packs to be configured should be limited, and therefore they should be shared among different surgeons and/or procedures as much as possible.

We obtained data from a medium-sized Belgian hospital that provides a wide range of medical disciplines. We limit the scope to orthopaedic surgery types for which a pack is currently used or viable (i.e. standardised procedures for which many medical items are required). The main problem consists of 16 different procedures, which we define as different “surgeon-surgery type” combinations. In total, 4 surgery types (hip replacement, knee replacement, arthroscopy knee, arthroscopy shoulder), 7 surgeons and 137 different medical items with associated unit prices are incorporated. The annual total number of cases incorporated by the test problem equals 2715, which represents about 18% of the total surgical volume of the hospital, leading to a maximum of 83100 individual items needed to be picked for surgery.

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As it indicates the number of points of touch for a given number of custom packs to be introduced, Figure 1 summarises some important findings of our study. Logically, when custom packs are not used, one has the single-pull solution in which all items are picked individually. In the other extreme, there is the case in which all procedures have their own dedicated pack (so 16 packs to be defined in the example).

If we now focus on the curve that depicts the points of touch under the no waste policy (Opt 0%, meaning that we do not include redundant or excess items in the custom packs), we clearly see that the introduction of custom packs decreases the points of touch, though at a decreasing or non-linear pace. In other words, with only a few packs the points of touch can already be significantly reduced. From scenario analyses, it appears that the gain of the first few custom packs is even more explicit and steeper when procedures have a lot of medical material in common and when procedures exhibit an unequal annual volume of items. If there are already many

packs in place, the marginal gain of adding one more seems almost negligible.

Since Figure 1 reflects the real data settings, we are able to compare the outcome of the Opt 0% curve with the current hospital result. The room for improvement is apparent: either the hospital should keep its 9 packs but reconfigure the content – which would lead to a reduction of more than 40,000 points of touch – or it should reduce the number of custom packs from 9 to 2, resulting in the same points of touch but with far fewer packs.

In addition to the optimal solution found by the algorithm, we also tested two priority rules that are easy to implement in practice. The first rule (Rule 1) sequences the procedures in decreasing order based on their annual volume of surgeries. If a custom pack is introduced, it will be assigned to the first procedure of the list and the contents of the pack will exactly match the material requirements of the particular procedure. If a second pack is introduced, it will be assigned to the second procedure on the list, and so

Figure 1

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forth. The second rule (Rule 2) is similar to Rule 1, except for the sequencing system. In Rule 2, procedures are sequenced in decreasing order of the multiplication of the annual volume by the total number of items required for that procedure. In other words, the order is determined by the annual volume of items needed for a particular procedure. Comparing the optimal results to the priority rules, which also do not allow for the use of waste, we clearly see that Rule 2 outperforms Rule 1, though they are far off the optimal points of touch that could be reached.

Finally, we also studied to what extent the inclusion of redundant items – i.e. medical items that are needed only by a subset of procedures using the particular pack – might impact the points of touch. Therefore, we added scenarios in which we allow 1% and 2% of the total annual item cost to be spent on redundant items. The results show that allowing for redundant items in packs can significantly reduce the points of touch for the same number of custom packs, especially when the number of custom packs is limited. From scenario analyses, it appears that the impact of waste seems to be bigger when the cost of medical items is highly variable (both very cheap and very expensive items) and when procedures share many items (high

commonality). Regardless of the waste policy (0%, 1% or 2%), having high commonality among the procedures increases the impact of custom pack usage, so it is key for hospitals to standardise the usage of their medical items over different procedures and surgeons.

Although standardisation seems viable and advantageous to all stakeholders, this is often a cumbersome exercise in practice and difficult to achieve when dealing with medical responsibilities. Is a compress of size 10x20 really different from a compress of size 10x25? Is a compress of size 10x20 of brand X really different from one of brand Y? Although this standardisation effort should be executed prior to the actual custom pack configuration, it should be clear that our algorithm can help in assessing the potential gain of such actions. Furthermore, Figure 1 shows that the return of adding more waste – i.e. shifting from the 1% waste to the 2% waste policy – is positive but decreasing. This implies that even a limited budget for waste could already bring substantial gains in terms of points of touch. Note that the inclusion of redundancy implies that we can already achieve minimal picking (i.e. 2715) with less than 16 custom packs.

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From Figure 2, we see that one can foster the sharing of packs significantly by adding redundant items, even for low commonality settings. In line with the findings on the number of points of touch, waste seems to be especially beneficial for sharing packs when a limited number of custom packs is used and the waste cost is unequal (many cheap items can cover the item gaps within the limited budget). Although not visible in the figures, we should add that our scenarios hardly return solutions in which more than one custom pack is simultaneously used for one particular procedure. As such, the concept of modularity is far from dominant based on our data settings.

REFERENCECardoen B., Beliën J. and Vanhoucke M. Forthcoming. On the design of custom packs: grouping of medical disposable items for surgery. International Journal of Production Research.

Taylor and Francis Online (publisher) provides free access to this otherwise licensed full paper for 50 readers via http://www.tandfonline.com/eprint/6Ggu4J3zjbHXv5AAhDRp/full on a first-come first-served basis.

ACKNOWLEDGEMENTWe would like to thank all hospital members of MINOZ and our Knowledge Partner MSD. We are particularly grateful to the hospital for being willing to share their data and for the particular efforts to improve its quality. The authors furthermore acknowledge the support of the Vlerick Academic Research Fund, partially subsidised by the Flemish government, for their financial support to execute this research project.

Figure 2

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12 / ©Vlerick Healthcare Management Centre, Annual Research Report 2015

DIGITAL STRATEGY AT MERCK SHARP & DOHME STEVE MUYLLE & AMIT BASU

This case takes us back to October 2009, and presents a key strategic challenge facing the senior management at Merck Sharp & Dohme (MSD) BeLux: crafting the organisation’s digital strategy for the marketing and sales of its human health products in Belgium and Luxembourg.

In order to address this issue, the case describes MSD and its products, the MSD BeLux organisation, the BeLux market for pharmaceuticals and vaccines, and the MSD BeLux approach to sales and marketing, including a detailed account of its use of digital channels. In addition, the case outlines the key developments in the pharmaceutical industry in that period, in both Europe and the USA.

This case provides a basis for discussions on digital strategy planning, and its use in the pharmaceutical industry. In a classroom setting, the case discussion can be centred around the relationship between an organi-sation’s strategic priorities and its digital strategy.

REFERENCEThis case is available at The Case Centre with reference no. 315-044-1.

ACKNOWLEDGEMENTWe express our gratitude to our Knowledge Partner MSD, for their contribution and cooperation on this project.

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OPINIONS• Expensive medicines… Confrontation or solutions? Neels L. 2015

• The future of M&A in the pharmaceutical industry: promoting or stifling innovation?

Neels L. and Van Dyck W. 2014

• Free trade in medicines: a fixed price for the whole of Europe? Neels L. and Van Dyck W. 2014

REFERENCEYou can retrieve the full opinion articles and other press releases in the domain of healthcare management on healthcare.vlerick.com

RECENT PUBLICATIONSCARDOEN B., GEMMEL P. AND ROBBERECHT R. 2014. Breaking down the silo of the hospital pharmacy. British Journal of Hospital Medicine, 75(9), pp 486-487.

VAN DYCK W., CARDOEN B. AND NEELS L. 2014. It’s time to invest more in our health. White paper Vlerick Business School, 21p.

VAN DYCK W. AND NEELS L. 2014. The future of M&A in the pharmaceutical industry: Promoting or stifling innovation? Finance Monthly, (June): 26-27.

VERLEYE K., GEMMEL P. AND RANGARAJAN D. 2014. Managing Engagement Behaviors in a Network of Customers and Stakeholders: Evidence from the Nursing Home Sector. Journal of Service Research, 17(1): 68-84.

VAN DYCK W., CARDOEN B. AND NEELS L. 2015.It’s time to invest more in our health. The Clinical Services Journal, editorial February edition.

VAN DYCK W. AND GELDOF T. 2015. The Oncology horizon scanning project, Vlerick HMC Report 2015-1. Brussels: Vlerick Healthcare Management Centre.

MUYLLE S. AND BASU A. 2015. Digital Strategy at Merck Sharp & Dohme. Case added to The Case Centre with reference no. 315-044-1.

CARDOEN B., BELIËN J. AND VANHOUCKE M. Forthcoming. On the design of custom packs: Grouping of medical disposable items for surgeries. International Journal of Production Research.

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ON-GOING RESEARCH REAL WORLD EVIDENCE ENABLED DECISION MAKING IN ADAPTIVE DRUG DEVELOPMENT AND ACCESS Contact: Walter Van Dyck and Tine Geldof

Doctoral research project in collaboration with KU Leuven (Prof Dr Isabelle Huys), UGent (Prof Dr Lieven Annemans), Roche, the European Organization for Research and Treatment of Cancer (EORTC) and the Belgian Cancer Registry.

FUTURE OF ACCESS TO INNOVATIVE MEDICINES IN CANCER TREATMENTContact: Walter Van Dyck

White Paper providing recommendations on the execution of the Minister of Health’s Future Pact with the pharmaceutical industry, to be delivered in Spring 2016 and in close collaboration with the Belgian Society of Medical Oncology (BSMO), the Belgian Hematological Society (BHS), and Institut Bordet.

DUE TIME-DRIVEN SURGERY SCHEDULINGContact: Brecht Cardoen

Doctoral research project on the evaluation of different scheduling policies to minimize the number of patients receiving surgery late, by means of discrete event simulation modelling. This research track is in colla-boration with KU Leuven (Prof Dr Erik Demeulemeester and Michael Samudra) and UZ Leuven (Prof Dr Frank Rademakers and Nancy Vansteenkiste).

ACCESS BLOCKING: DELAYED TRANSFERS OF PATIENTS FROM EMERGENCY TO THE WARDContact: Brecht Cardoen, Paul Gemmel and Rein Robberecht

Research project within MINOZ and in collaboration with MSD so to identify the root causes of and workable solutions to access blocking. Next to the operational point of view, attention is directed towards issues like poor communication and information sharing and a lack of collaboration (silo-mentality). A maturity assessment model helps to benchmark results and position the organisa-tions in the field of change management.

TOWARDS AN IT ROADMAP FOR BELGIAN HOSPITALS: CHALLENGES AND OPPORTUNITIESContact: Bjorn Cumps, Brecht Cardoen and Mathias Boënne

Research project in collaboration with Belgian Association of Hospital Directors and Xperthis. By means of expert interviews and case studies among Belgian hospitals, we aim to see how the changing eco-system and the changing business capabilities of hospitals impact the ICT challenges and strategy, and vice versa.

PROCESS PERFORMANCE AND SERVICE QUALITY IN CHEMOTHERAPY DAY UNITSContact: Brecht Cardoen, Paul Gemmel and Rein Robberecht

Research project within MINOZ and in collaboration with MSD and HEC Montréal (Prof Dr Sylvain Landry). A comparative benchmark study is used to compare the process of chemotherapy in multiple different Chemotherapy Day Units (CDUs) and to learn how the process characteristics have an impact on the time efficiency and the perceived service quality.

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FURTHER INFORMATIONPROF DR WALTER VAN DYCKDirector of the Healthcare Management CentreProfessor in Technology & Innovation [email protected]

PROF DR LEO NEELSChairman Advisory Board Vlerick Healthcare Management [email protected]

PROF DR PAUL GEMMELVlerick Research [email protected]

PROF DR BJORN CUMPSProfessor in ICT & Business Process [email protected]

PROF DR STEVE MUYLLEProfessor of Marketing & Digital [email protected]

PROF DR BRECHT CARDOENProfessor in Service Operations [email protected]

REIN ROBBERECHTSenior Research [email protected]

TINE GELDOFResearch [email protected]

MATHIAS BOËNNEResearch [email protected]

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