Trained as a physician and molecular oncologist, Jens Deerberg-Wittram is president of the International Consortium for Health Outcomes Measurement (ICHOM), an organization that BCG cofounded with Professor Michael Porter of the Institute for Strategy and Competitiveness at Harvard Business School and the Karolinska Institutet in Sweden.
On the occasion of ICHOM’s first anniversary, BCG editor-in-chief Simon Targett spoke with Jens about the organization’s first year and its immediate and long-term goals for improving the value of health care delivery around the world.
Would you explain how and why ICHOM was conceived?
The theoretical background of ICHOM is in value-based health care, which started as a framework developed by Professor Michael Porter of Harvard Business School. One very important aspect of value-based health care is the need to measure outcomes, which comprise the numerator of his famous ratio: value is outcomes per dollar spent.
A few years ago, Michael Porter and Stefan Larsson of BCG met and shared their value-based health-care views and experiences. The two of them decided that they wanted to do something more pragmatic to change the world in this area. They also brought in the third founding partner, the Karolinska Institutet in Stockholm, a world-famous medical-research institution. To really get value-based health care moving, they needed to establish outcomes measurement more systematically, which led to ICHOM, an independent nonprofit that is open to everyone, with the goal of improving health care.
Why is it important that ICHOM involve a broad network of health care leaders that includes health care providers and representatives of disease registries, payers, suppliers, and governments?
The ultimate goal of ICHOM is to ensure that value-based health care becomes a reality, and this can happen only if all the system participants are committed to health outcomes measurement. This is relevant to everyone in the health care industry. It makes a difference to a supplier, for example, that can demonstrate that not only is its new product safer or less expensive but also that it provides better outcomes to patients over a long period of time. If you make this a core principle of new-product development, then you are contributing to the idea of value-based health care.
If a health plan is choosing its providers by looking at the outcomes they achieve for their clients, it is moving from being an organization that reimburses providers equally for a given treatment and becoming a value-contributing organization. That’s a huge strategic shift. If health care policymakers can make these aspects part of new legislation, it will be another huge step in fostering value-based health care. We know that in countries such as Sweden, new reimbursement models approved by the government are paying for outcomes rather than volume.
We believe that all these system participants should be involved in ICHOM’s work because they are the ones who are using outcomes measurement. However, in our daily work, defining what matters to patients, we are basically working, by medical condition, with three groups: patients, who define what matters to them; registry leaders, who have a lot of experience deciding which standardized and validated measurement instruments to use; and physicians, who are approving these outcomes sets and applying them in their own organizations.
Would you explain how ICHOM partners directly with clinicians to generate success?
It’s not difficult to find the right and enthusiastic people to work with, but we need to develop the best process for facilitating agreement among our ICHOM working-group members, and we also need the funding to support these groups. For example, our working group on prostate cancer is funded by the Movember organization, which is providing money because its leadership believes that standardized outcomes measurement is an important element in improving prostate cancer care around the world.
For us, it often starts very pragmatically. I recently spoke to an executive at one of the leading hospital systems in the U.S., who said that we have to define a meaningful set of outcomes for Parkinson’s disease patients. He also said that he could bring the leading experts from around the world together to help do this. There is clearly a strong need for this from the physician side, so we are trying to secure funding to start additional disease-based working groups.
What tools will ICHOM use to standardize outcomes measurement?
There is a relevant number of registries around the world that are organized around medical conditions. Many are set up for research purposes, but some of the data inside these registries are very helpful when it comes to outcomes measurements and ICHOM’s overall mission. When ICHOM launched in 2012, we helped bring these great institutions and their outcomes-measurement tools together, but we didn’t want to simply put them on the website. We evaluated each registry on key dimensions that are important for ICHOM. Basically, we are directing the public to great existing registries in specific areas of health.
But this is not the end goal. What we need for each medical condition is a very simple set of outcomes—not more than 10 to 15—on one page or website so that everyone who wants to measure in a meaningful way can have quick access to the set. A metrics repository was our first step in building ICHOM’s credibility with registry leaders, who are a very significant partner group for us, and who will continue to drive our medical-condition working groups.
What’s next in the value-based health-care movement?
At the moment we see great momentum in value-based health care. From the government side, there is clear interest in learning where the long-term patient benefit is and how to measure it. If you want to prove that there is a true benefit over a long period of time, you need these outcomes measures, and they need to be standardized.
National health authorities and health plans are also desperately seeking value-based health-care providers, so I’m pretty sure that we will see widespread adoption of the movement. But this depends greatly on the extent to which organizations such as ICHOM push it.
We think we have started at the right time, and now it will be interesting to see how the rest of the world responds.
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