Author: Valentina Polylas
Modernizing the public sector in the EU is a key priority to keep pace with today’s societal challenges. In my view, this is particularly true for the health sector, where improving high quality affordable health care is crucial to cope with an ageing population, chronic diseases, antimicrobial resistance, person-centered solutions, and many other issues.
To address such challenges, we sometimes need technologically demanding innovative solutions that are not on the market yet and require new R&D. Tools such as public procurement of innovation (PPI) and pre-commercial procurement (PCP) can be used effectively to prove that the market can really deliver commercially stable solutions with the desired price/quality requirements before procurers commit to buying large volumes of end-solutions.
Through my work at the European Regional and Local Health Authorities (EUREGHA) network, it has become clear to me that there is a huge role, as demanding first buyers, for regions and local authorities to play in using innovative procurement solutions to foster innovation in their territories. This creates opportunities for companies to take international leadership in new markets as well as investing in highly qualified R&D in Europe.
However, the health sector also requires specific solutions to address a fragmented legal framework and funding, lack of common standards or interoperability, and varying user/patient preferences across the EU. EUREGHA’s participation in the European Wide Innovative Procurement of Health Innovation (EURIPHI) project has helped us to address these challenges while providing practical tools to accelerate a change in procurement practices. In turn, we believe this will lead us to a value-based (VB) approach resulting in most economic advantageous tendering.
VB health care: the perspective of regional authorities
EUREGHA is a Brussels-based network representing 17 regional authorities in 10 countries across Europe whose overarching objective is increasing health system sustainability, through advocacy activities and projects including those influencing European policymaking. It is no surprise that VB health care is one of our top priorities, given its growing popularity as an approach to enhance sustainability. To further this agenda, we are participating in the EURIPHI project to explore how to use innovative procurement to foster the change towards VB health care.
This approach has, at its core, maximizing value for patients, moving from a supply-driven healthcare system towards a patient-centered system organized around what patients need. To achieve high value, we must deliver the best possible outcomes in the most efficient way – outcomes that matter from the perspective of the individual receiving health care.
From my standpoint, however, this is only one piece of the puzzle. Indeed, the European Commission’s Expert Panel on Effective Ways of Investing in Health (EXPH) recognized that value has different meanings in its Opinion on Defining Value in “value-based healthcare”. It therefore formed a comprehensive concept built on four value pillars:
- Appropriate care to achieve patients’ personal goals (personal value)
- Achievement of best possible outcomes with available resources (technical value)
- Equitable resource distribution across all patient groups (allocative value)
- Contribution of healthcare to social participation and connectedness (societal value)
For regional authorities, allocative value is particularly important because it determines how equitably resources are distributed to different subgroups in the population (e.g., people with diabetes or people over 65 years old). When we decide to allocate resources, it is extremely important for public administrations to take into consideration the needs of patients first, but also to weigh up the benefits that we can achieve when allocating resources on a population subgroup basis.
Thus, besides the idea of technical value (outcomes/costs), regional authorities are focussing on allocative value, encouraging shared decision making, individual preferences for care, and ensuring that resources are allocated for maximum value at the population subgroup level.
VB health care provides a very useful set of tools with which to tackle some of the fundamental problems of sustainability in delivering high quality care. Above all, VB health care is pushing public administrations to overcome a ‘siloed’ mentality in terms of policymaking and budgeting, shifting towards a multi-stakeholder dialogue.
Using tools at the regional level
PCP/PPI are tools that regional public authorities can utilize to align all the players in the chain towards VB health care. However, some regions are more ready to embrace this than others.
For example, in Catalonia, Spain, the conditions of procurement are carefully designed to drive stakeholders in the direction of a VB health care approach. One way in which the Agency for Health Quality and Assessment of Catalonia (AQuAS) is doing this is by setting requirements that must be met in order to have access to tenders. This includes linking some of the awarding criteria to societal value, environmental value, etc. It is important to note that this is a journey that does not happen overnight.
Many regions that are still not very familiar with PCP/PPI, or that lack the technical knowledge to apply these tools, can benefit from sharing information with the more advanced regions such as Catalonia through projects such as EURIPHI. In this regard, EUREGHA was pleased to support the creation of EURIPHI’s Health & Social Care Regions Network (HSCRN), comprised of representatives of (regional) health authorities, policymakers, and payers who, in collaboration with other key stakeholders, further prioritize investments and foster the deployment of value-based PPI/PCP.
The fragmented legal framework across Europe is another reason why regions may choose not to pursue relatively new but potentially advantageous concepts such as cross-border procurement of innovation. EURIPHI has addressed this by proposing alternative methods such as pre-tendering collaboration that allow regional authorities and procurers to explore whether it could be a suitable tool to meet their objectives.
What does the future hold?
Seeds of public-private positive dialogue have been planted since the launch of the EURIPHI project, responding to the common needs of health systems throughout Europe. But this is just the beginning of a journey towards a health system with a true value for patients and citizens.
It takes time to implement such an approach in procurement and more generally in health care, and I feel positive that EURIPHI was the initial step. HSCRN meetings were the first real opportunity for a group of public administrations to gather and have in-depth discussions on the topic of innovation procurement and VB health care.
Although the project may be coming to an end, my partners and I are committed to continuing the internal debate within the context of the HSCRN to provide knowledge and information to those that are interested, to see whether there is room for influencing EU policymaking, and to determine whether we can also propose further projects on these topics.
Valentina Polylas joined the European Regional and Local Health Authorities (EUREGHA) association on January 2018 as Director. She leads and manages the Secretariat and provides strategic advice to the Chair, the Executive Board and the General Assembly. She is responsible for the strategic planning process and advocacy campaign of EUREGHA. She also coordinates the network’s commitments within the European projects, BOOST (H2020) and EURIPHI (H2020). Valentina represents EUREGHA externally by liaising with members, EU institutions, European networks and other relevant stakeholders. Prior to EUREGHA, she was Senior Policy Officer at the Emilia-Romagna Delegation to the EU. Valentina holds a law degree from the University of Bologna as well as a LLM in International and European law from the University of Bologna and a M.A in European Studies from the University of Louvain-la- Neuve – Université Saint Louis.