Authors: Isabella Notarangelo, Giovanni Gorgoni and Marco Di Ciano
Value-based (VB) health care is an emerging paradigm that could potentially change European health services and products procurement, while improving the quality of care being offered and incentivizing the industry and other health care stakeholders to act on specific pathways. Given this significant influence, we believe that regional procurement agencies and purchasing bodies should be key players in new services development, leading the effort to focus on health care value.
Regional authorities play a pivotal role in identifying the population’s unmet needs and therefore in creating an impact on investments in innovation. In fact, regions have been fundamental to the European Wide Innovative Procurement of Health Innovation (EURIPHI) project, which aims to support the reform process of European health and care systems by adopting instruments and procedures to embrace innovative solutions that address common unmet needs and shortcomings.
Following is a discussion of our work within EURIPHI’s Health & Social Care Regions Network (Regional Network), including an explanation of ways that regions can engage in VB innovation procurement and how they can get the most out of EURIPHI’s efforts. We also showcase the Puglia region’s experience as a EURIPHI partner.
The Regional Network
The Regional Network was created to help achieve the EURIPHI project’s results by addressing the following questions:
- Are European regions ready to use innovation procurement to innovate care delivery in health systems?
- What are the areas where innovative solutions could respond to health systems’ unmet needs?
- What type of cooperation model can regions use to respond to common unmet needs?
Regions’ readiness to use innovation procurement to innovate care delivery in health systems is a journey aimed at implementing a mix of policy measures to mainstream innovation procurement in health and social care. In our view, the readiness assessment developed within the EURIPHI framework is a good starting point for further actions. The regions targeted as ‘ready’ to use innovation procurement represent an initial group, but additional work needs to be done.
As for identifying areas where innovative solutions could respond to unmet needs, the EURIPHI consortium engaged in the analysis of health care shortcomings to gain a clearer idea about where the unmet needs of the population are. Integrated care raised lot of interest, especially in the areas of stroke, dementia, chronic obstructive pulmonary disease (COPD), multimorbidity, and (valve) aortic stenosis.
However, when it came to defining the procurement demand – which ‘translates’ the unmet needs into technical specifications – cross-cutting topics applicable to diverse clinical areas and across the borders gained attention. Cross-cutting topics relate to the whole path of care, such as the need to introduce integrated risk assessment tools, ensure appropriate information exchange between patients and health care professionals, and adopt remote monitoring solutions.
Regions expressed interest in collaborating across borders to address common unmet needs. In this regard, we believe the most suitable cooperation model for regions is one that requires localized decision making. In a concrete tender process, this involves collaboration during the pre-tender phase, with purchasing decisions made at the local level. Regions must be committed to using cross-border innovation procurement as a means to introduce innovation that responds to unmet needs.
How regions can engage in VB innovation procurement
To implement a VB procurement approach, health outcomes as well as other quality criteria should be considered, along with the total lifecycle cost and long-term costs of care. This ensures the best value for the patient, the medical staff, the entire hospital group, and society. As a first step, regional procurement agencies and purchasing bodies can drive this approach by incorporating selection and awarding criteria on health care quality and longer-term cost impact into procurement decisions.
Defining criteria based on the Most Economic Advantageous Tender (MEAT) approach required a deep investigation of the VB award criteria developed within the EURIPHI project. In terms of procedural approach, one of the proposed criteria was the “early detection of patient risk factors” to be measured based on the number of patients treated in secondary prevention; another one was the “impact on social inequalities” utilizing a patient satisfaction measurement survey. On the other hand, the technological approach was investigated and estimated in terms of criteria like “interoperability and data connectivity” and “support in measuring and reporting on outcomes”.
Stimulating discussion and sharing knowledge, piloting real cases, and experimenting with innovative procurement instruments can also support the process of engaging the right authorities and decision-making actors in the VB procurement paradigms.
How regions can use the EURIPHI tools
Many tools were developed during the project’s lifecycle as a result of knowledge sharing and implementing learning cases. We hope that procurement actors and health authorities will make use of these instruments to develop capacity building in public demand for innovation and new health and care services procurement.
Regional authorities can easily find preliminary building blocks on different procedural aspects such as:
- focusing on unmet procurement needs to implement innovative solutions in health care;
- conducting pre-commercial procurement/public procurement of innovative solutions (PCP/PPI) to drive the shift towards health system reforms;
- learning how to launch Open Market Consultations with the industry on rapid diagnostics and integrated care issues;
- assessing the differences in legal public procurement frameworks for the participating procurers in health and social care; and
- utilizing the most suitable model for collaborative cross-border procurement (e.g., a full joint tender with lots for different localities, respecting local laws and specifications)
There are many other EURIPHI supporting tools and results available to regional authorities and policy makers in the health and care sectors.
The Puglia region: mutual benefits of EURIPHI partnership
The Puglia region, through the Regional Strategic Health and Social Agency (AReSS), InnovaPuglia (the region’s in-house purchasing body), and other regional actors that constantly carry out research, has promoted many projects aimed at improving therapies and treatments for the benefit of its population. It has done this by stimulating local healthcare companies and hospital companies to experiment with processes, methods, and technologies that represent a high level of innovation.
Among other initiatives is Care Puglia 3.0, which rethinks the management and delivery methods of services for chronicity while taking advantage of ICT solutions. This was developed to address a prevalence of chronic patients in Puglia which is around 40% of the population and absorbs around 80% of the regional healthcare budget.
Exchanging information with other purchasing bodies in the EURIPHI consortium has provided added value to the Puglia region in addressing chronicity as well as other issues (e.g., stroke), where we have been able to find common ground on unmet needs. These interactions can dramatically impact how regions engage in innovation procurement, for instance by opening up the possibility to form a buyer’s group that benefits both the procurers and the market.
Interactions with EURIPHI partners have also fostered a higher quality of discussion around procurement that takes a MEAT approach instead of a lowest price approach. This means using awarding criteria that consider more medium- and long-term outcomes affecting all stakeholders and responding to wider issues of socioeconomic impact and sustainability. This paves the way for future innovative procurement actions in the Puglia region.
In our opinion, the Puglia region, supported by AReSS and InnovaPuglia, played an active role in the EURIPHI project by acting as a ‘broker’ for innovation at the local level, where VB innovation procurement is seen as a strategic tool to enable VB health care.
By sharing its innovative procurement strategy and approach, including award criteria and functional specifications, the region has embraced the changing health care paradigm by giving a role also to small- and medium-sized enterprises (SMEs), which may not always be market ready, but which have the innovative solutions to address unmet needs.
Moreover, the region has contributed its hands-on experience to EURIPHI in the development of collaborative models for cross-border VB innovation procurement.
Chronic diseases are progressively increasing, requiring continuity of assistance for long-term periods as well as a strong integration with social services, which commits a large portion of resources to the regional health system. Furthermore, the particularly critical period due to COVID-19 has led Puglia and other territories to assume a higher level of responsibility in managing the doctor-patient relationship through the adoption of innovative public procurement.
Naturally, it is not easy to change the approach as we face the paradigm shift from cure/care to prevention/prediction, from disease treatment to health promotion, from doctor driven care to patient self-management, etc. But we have seen, especially with the current pandemic situation where finding a response to our needs was challenging, that policy makers must drive the market, also at the local level.
If procurement is used in a smart way (e.g., PCP/PPI), it is possible to boost research and innovation in territories without always relying on the high competitiveness that the European programs entail, and which can inadvertently exclude SMEs. This will further support the reform of the European health system.
Isabella Notarangelo joined MedTech Europe in August 2019 as Market Access & Economic Policies Manager, after having held the position of Health Economist at HOPE (European Hospital and Healthcare Federation). During her professional career, Isabella developed a strong understanding of European health systems functioning, including reimbursement and funding. As WP leader of several EU funded projects promoting the development of solutions enhancing value-based healthcare, Isabella has experience in interacting with several stakeholders, including procurers, healthcare providers and regional authorities. She holds a MSs in Management & Economics of Public Administrations and International Institutions at Bocconi University in Milan.
Giovanni Gorgoni is an economist with a university degree in Business Economics at Milan Bocconi University, master’s degree in healthcare management at Milan Bocconi School of Management and master’s degree in Facility Management at Rome Campus Bio-Medico University. From December 2016 up till now he has been Chief Executive Officer of AReSS (Agenzia Regionale Strategica per la Salute e il Sociale Puglia), the Puglia government agency for strategic planning in health and social policies and for exploration in healthcare processes and technology. During his current appointment he designed and developed four clinical networks (cancer, stroke, heart, and trauma), implemented three value-based labs for the Puglian Health System (lean healthcare, activity-based funding, integrated clinical pathways), and started the regional project for chronic care (Care Puglia 3.0). Currently he’s a member of the Executive Board of the National Program for Chronic Diseases and professor in Public Management at Bari LUM University. He’s been included in the national register of eligible Healthcare CEOs since February 2018.
Marco Di Ciano is Manager of the Research and Innovation Office at InnovaPuglia the In-house Company of Puglia Region committed, as regional purchasing body, for territorial digital transformation and innovation development. He is in charge of research, innovation and cooperation projects boot at European and Regional level and since 2012 he has managed programs and pilot actions implementing innovative procurement procedures at regional level. He has been involved in the definition of the Puglia Smart Specialization Strategy “SmartPuglia2020” with expertise on digital innovation, public demand engineering, e-health living labs co-creation, pre-commercial public procurement implementation.