ANNUAL RESEARCH REPORT · 2019-10-15 · 6 / Annual Research Report 2019 LIES SCHOONAERT & WALTER...

ANNUAL RESEARCH

REPORT 2019

ACHIEVEMENTS & PUBLISHED OUTPUT BY THE HEALTHCARE MANAGEMENT CENTRE

2 / Annual Research Report 2019

04 About the Vlerick Healthcare Management Centre

05 Introduction

06 2019 ACHIEVEMENTS 1 Acting with foresight in times of budget austerity

2 Innovative funding solutions for paradigm changing new therapies

3 The need for a biomedical big data insight-providing federated network to support a sustainable pharmaceutical access policy

4 Multi-product assessment studies in the vendor-competitive environment of pharmaceutical innovation: how real-world evidence can contribute

5 Shedding light on reimbursement practices of companion diagnostics in Europe

6 Measuring the total societal and corporate value of innovative medicines

7 Time-driven activity-based costing applied to cancer treatment

8 Hospital of the future

9 Fostering multidisciplinary collaboration in drug discovery

20 PUBLISHED OUTPUT 1 Recent publications 2 Opinions 3 Ongoing research

25 Vlerick Webinar series

26 Meet the Vlerick Healthcare Management Centre team

CONTENTS

Annual Research Report 2019 / 3


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

The Vlerick HMC is led by Prof Dr Walter Van Dyck, Vlerick Business School Partner and acting Director of the Centre. He leads the Centre’s research on digital transformation, as well as pharmaceutical innovation and policy management. Prof Dr Brecht Cardoen leads the Centre’s hospital management and health services innovation and operations research agenda. As of 2018, Prof Dr Zeynep Erden joined the Centre, coming from ETH Zürich, specialising in pharmaceutical research and development strategy.

FINANCIAL AND COMPETING INTERESTS’ DISCLOSUREThe Vlerick 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 in this period, the Vlerick HMC benefited from unconditional partnership grants from MSD Belgium, and Medtronic, and from contract research funds from MSD, Janssen Pharma-ceutica, Novartis, Pfizer and Agentschap Zorg & Gezondheid. Furthermore, Vlerick HMC collaborates with HHZH Lier, Sint-Franciscus Ziekenhuis, AZ Maria Middelares, Ziekenhuis Netwerk Antwerpen, ASZ Aalst, AZ Alma, AZ Nikolaas, AZ Sint-Maria, Europa Ziekenhuizen, Jan Yperman Ziekenhuis and Jessa Ziekenhuis, and Roche Diagnostics united as MINOZ Research Members.


INTRODUCTIONIn 2019, we conclude the fifth year of Vlerick Healthcare Management Centre’s operations. Building upon a strong MINOZ legacy of studying hospital operations, we continue to expand and deepen our reach into the full healthcare system. We are grateful to the MINOZ hospital members, Roche Diagnostics, MSD and Medtronic for their continued long-term research partnership support. Thanks to contract research conducted for Janssen Pharmaceutica and Pfizer, we have contributed to the public debate in the field of pharmaceutical innovation and policy management. We studied how risk-based Market Entry Agreements can ensure that all patients continue to have access to expensive therapies at a budget society can afford, especially in the field of ground-breaking cell and gene therapies. Also, thanks to MSD, we conducted comparative healthcare systems research, investigating European, Middle-East and African markets’ equitable accessibility to pharmaceutical technology.

Meanwhile, one of our PhD students, who graduated from the KU Leuven Faculty of Pharmaceutical Sciences in June, has explored the use of advanced analytics for pharma innovation: or how Artificial Intelligence/Machine Learning (AI/ML) can be applied to real world evidence (RWE), and, consequently, how regulatory and infrastruc-tural frameworks should be set up to allow for the use of RWE in accelerated market access to innovative medicines.

Finally, thanks to Medtronic and Novartis, we conduct PhD research exploring new financial models geared towards value-based healthcare (VBHC) applied to integrated practice units (IPU) for scoliosis surgery and psoriasis treatments. This will allow for more accurate budget predictions of bundled payments and increased value to the patient. Thanks to MINOZ hospital research members and Roche Diagnostics, then, we studied hospital investment appraisals and executive decision-making.

This year’s highlights include the delivery of the Vlerick Policy Paper ‘Acting with Foresight in Times of Budget Austerity’, based on a research grant from MSD, proposing a demand-driven healthcare concept for use on a Belgian national basis, which builds upon the recently developed international BeNeLuxA horizon scanning system, and the Hospital of the Future report in collaboration with the KU Leuven Institute for Healthcare Policy.

In conclusion, as you will notice reading further, we have a well-filled pipeline of both fundamental and applied research projects covering the interface between health technology, data analytics, and healthcare provider organisational design including regulatory innovation.

Prof Dr Walter Van DyckDirector of the Vlerick Healthcare Management CentreVlerick Business School Partner


LIES SCHOONAERT & WALTER VAN DYCK Health policies strive to achieve maximum health, taking into account medical supply and unmet medical need. In order to be prepared for new therapies coming to market, a systematic screening of pharma-ceutical products that are currently under development is needed. Such a horizon-scanning project is being set up at an inter-national level by the International Horizon Scanning Initiative (IHSI). In this research project, we identified how this horizon-scanning initiative can be implemented on a national level in order to be prepared for what is coming and how it can be used to strive for a demand-driven healthcare system instead of the current supply-driven healthcare system.

The therapies identified by IHSI need to be prioritised based on the effectiveness of the therapy and taking into account the unmet medical need (UMN) and the national health objectives (Figure 1). As a result of this prioritisation process, which involves only academic and clinical experts, therapies will be identified that require priority, advice will be given on adaptations needed to bring this therapy to market (data infrastructure, organisation of care, …), strategic advice will be given concerning therapies still in development, and potential savings will be identified by generics and biosimilars coming to market. The results of this prioritisation

process can be used as input on an national level for the Early Temporary Reimbursement (ETR) Programme and for early dialogue with the Commission for Reimbursement of Medicines (CRM). Collaboration at the international level, such as BeNeLuxA, could provide an advantage at the level of the clinical evaluation of these therapies.

Building further on this list of candidate therapies prioritised according to the therapeutic and societal need, a 3-year forecast will be made for therapeutic domains that require special attention, such as immuno-oncology, for which many new expensive therapies have come to market over the past few years. Based on this forecast, different pharmaceutical budget scenarios will be made, taking into account national health objectives and national financial objectives. These budget scenarios can provide the Minister of Health with information on possible scenarios for the pharmaceutical specialties budget in order to be better prepared for the future.

ACKNOWLEDGEMENTThis research project was made possible by our research partner, MSD Belgium.

The full report can be downloaded on: healthcare.vlerick.com

2019 ACHIEVEMENTS

1 ACTING WITH FORESIGHT IN TIMES OF BUDGET AUSTERITY

IHSI

Horizon scanning

Budget evaluation MOH

ETRCRM

Healthcare system preparation

Early dialogue

BENELUXA/NATIONAL LEVEL NATIONAL LEVEL

Scientific evaluation

Figure 1. Flowchart indicating how horizon scanning at the international level can be implemented at the national level.

INGRID MAES (INOVIGATE), HAFIDA BOUFRAIOUA (INOVIGATE), WALTER VAN DYCK & LIES SCHOONAERT

This research project by the Vlerick Healthcare Management Centre and Inovigate was commissioned by Pfizer and conducted in close collaboration with the Cabinet of Social Affairs & Public Health and RIZIV/INAMI. This research project explored innovative funding solutions for new, possibly curative, therapies (for example, gene therapy) that have a long-term beneficial effect on society, but do represent an immediate budgetary challenge for national healthcare systems. During a set of round tables with the different health system stakeholders − such as medical specialists, sick funds, health authorities and private insurance companies − we studied the (dis)advantages of the different models and their feasibility within the Belgian context.

Based on international literature, a long-list of solutions has been investigated. The round table came to a consensus conclusion that a funding solution may draw upon 3 preferred building blocks: annuity-based or spread payments; outcome-based Market Entry Agreements, potentially in combination with spread payments, making the latter risk-based driven by real world therapy performance evidence; and finally, transversal or cross-silo pooled budget models could be applicable in the case of well-demonstrated cost-savings on the care side.

In addition, horizon scanning was seen to be instrumental in proactively identifying game-changing therapies eligible for the possible solutions listed above.

A decision tree has been developed to enable assessment of the optimal solution for each eligible breakthrough therapy. The decision tree includes the 3 preferred building blocks in a logical and practical decision process and enables the selection of the optimal (combination) solution for each gene therapy case.

ACKNOWLEDGEMENTThis research project was made possible by Pfizer and endorsed by the Cabinet of Social Affairs & Public Health and RIZIV/INAMI, and delivered in collaboration with Inovigate. The results are described in a joint Inovigate – Vlerick HMC report that will be presented on 6 November during a symposium at RIZIV/INAMI.

2 INNOVATIVE FUNDING SOLUTIONS FOR PARADIGM CHANGING NEW THERAPIES



TINE GELDOF, ISABELLE HUYS (KU LEUVEN) & WALTER VAN DYCK

Moving towards new adaptive pathways for the development of, access to, and reimbursement for innovative medicines, implies that real-world data (RWD) collected throughout the medicinal product life cycle is becoming increasingly important. In addition, applying big data analytical methods on such RWD may support the intelligent use of such data in these adaptive pathways, as these methods can provide new and powerful insights into the effectiveness of medicines.

However, the healthcare data ecosystem still faces many sector-specific challenges that hamper the use of big data analytics delivering real-world evidence (RWE). In this perspective paper, we distinguish between exploratory (ExTE) and hypotheses-evaluating (HETE) treatment

effectiveness studies to identify the data necessities for the smart use of RWD. From our experience, and in the context of the 4 Vs of data management (Volume, Variety, Velocity and Veracity), we show that data Variety and Veracity are needed to get meaningful results, regardless of the type of study conducted. Moreover, for ExTE studies, high data Volume is needed, while high Velocity becomes essential for HETE studies.

To satisfy these criteria of the 4 Vs of data management to support data-driven research, 3 important aspects will require attention: (i) international data reusability based on interoperability; (ii) real-time RWD processing information systems; and (iii) longitudinally-oriented RWD (Figure 2).

3 THE NEED FOR A BIOMEDICAL BIG DATA INSIGHT- PROVIDING FEDERATED NETWORK TO SUPPORT A SUSTAINABLE PHARMACEUTICAL ACCESS POLICY

Figure 2. Visualisation of the current healthcare data ecosystem (left) and the underlying, federated, data provider infrastructure, based on a common data model, needed to ensure a smooth transition from real-world data to real biomedical big data (right) characterised by (A) interoperable databases with international data reusability (high volume and variety), (B) real-time RWD processing information systems (velocity), and (C) longitudinal data (variety).


To fulfil these 3 criteria whilst respecting patient privacy laws and data ownership, this paper proposes the development of an underlying, federated, healthcare data provider infrastructure based on a common data model (CDM), such as the Obser-vational Medical Outcomes Partnership (OMOP) CDM. As it is capable of bringing the centrally-conducted big data analysis to the de-centrally stored biomedical data, we believe that such an insight-providing Federated Network will stimulate collabo-ration and data-science-based innovation, therefore enabling a sustainable pharma-ceutical access policy.

ACKNOWLEDGEMENTS This research was funded by the Vlerick Academic Research Fund.

The full paper can be retrieved via: https://www.frontiersin.org/articles/ 10.3389/fmed.2019.00043/full

An overview and summary of Tine’s PhD research can be retrieved via: healthcare.vlerick.com

TINE GELDOF, SMITA RAWAL, WALTER VAN DYCK & ISABELLE HUYS (KU LEUVEN)

To achieve therapeutic innovation in oncology, already expensive novel medicines are often concomitantly combined to potentially enhance effecti-veness. While this aggravates the pricing problem, comparing effectiveness of novel yet expensive (concomitant) treatments during multi-product assessment studies is highly needed for healthcare decision-making to deliver effective but affordable treatments.

This study reviewed published multi-product studies of innovative targeted and/or immune therapies which were conducted to compare and/or combine these therapies. In total, 48 studies compared and/or combined multiple novel products on breast cancer, colorectal cancer, lung cancer and melanoma. To a great extent, comparison studies were led by one manufacturer, while studies evaluating novel products for combination treatments primarily included medicines owned by one manufacturer.

The results of this review indicate lost opportunities to conduct cross-manufactu-rer assessments. However, next to costs and intensive market competition, the absence of a regulatory framework enforcing such

multi-product assessment studies prevents these from being conducted. Additionally, since it is difficult to test all comparisons and/or combinations of novel (competitive) medicines during clinical development studies, multi-product assessments in real-life clinical practice will become absolutely necessary. Moreover, if done within new adaptive pathways for the development, access and reimbursement of novel medicines, comparative and/or combined effectiveness may be evaluated during competitive development races, while promising manufacturer-collaboration paths may be identified. Trusted third parties could facilitate such real-world studies, for which appropriate and efficient data access is needed.

ACKNOWLEDGEMENTS This research was funded by the Vlerick Academic Research Fund.

The full paper can be retrieved via:https://www.futuremedicine.com/ doi/abs/10.2217/cer-2018-0131

An overview and summary of Tine’s PhD research can be retrieved via: healthcare.vlerick.com

4 MULTI-PRODUCT ASSESSMENT STUDIES IN THE VENDOR- COMPETITIVE ENVIRONMENT OF PHARMACEUTICAL INNOVATION: HOW REAL-WORLD EVIDENCE CAN CONTRIBUTE


LAURENZ GOVAERTS, STEVEN SIMOENS (KU LEUVEN), ISABELLE HUYS (KU LEUVEN), & WALTER VAN DYCK

Ensuring patient access to the practice of precision medicine has been an issue due to desynchronised reimbursement decision-making between the medicine and the companion diagnostic in some European countries. This has resulted in cases where the precision medicine is reimbursed whereas the companion diagnostic is not. In overcoming this issue, alignment of the decision-making process for reimbursement between the two entities should be considered. As pharma-ceutical reimbursement procedures are well covered in literature, we set out to map in vitro diagnostic reimbursement procedures and potentially identify emerging solutions for aligning both procedures.

We selected 8 European countries for this analysis. For each country, we characterised the national benefit basket entailing the in vitro diagnostic medical acts, mapped the procedure for inclusion, and identified alternative reimbursement practices for companion diagnostics. In order to accumulate this information, targeted searches were conducted to identify relevant health insurance policies and laws using publicly accessible sources.

All countries selected specified a national benefit basket containing in vitro diagnostic medical acts, except for England which does so through NICE technology guidance. Amendments to the conventional reimbursement procedures to

accommodate for the practice of precision medicine were identified for England and Italy, and alternative procedures for companion diagnostics were identified for France, Belgium and Germany. Some countries have adapted their reimbur-sement procedures to accommodate for synchronised decision-making or have facilitated patient access to novel companion diagnostics via coverage with an evidence development programme.

HIGHLIGHTS • A systematic mapping of in vitro

diagnostic reimbursement practices was conducted for 8 European countries.

• Solutions for synchronised reimbur-sement decision-making between the companion diagnostic and the medicine are emerging across Europe.

• Cost-based reimbursement practices for some in vitro diagnostics might be rendered obsolete as innovative diagnostics leverage their unique market positions and push reimburse-ment practices towards value-based assessments.

ACKNOWLEDGEMENTS This paper benefitted from the members of the Personalised Medicines Strategies (PROMIS) Fund.

Academic paper submitted for publication.

5 SHEDDING LIGHT ON REIMBURSEMENT PRACTICES OF COMPANION DIAGNOSTICS IN EUROPE



ERIN ROMAN & WALTER VAN DYCK

The Vlerick Healthcare Management Centre collaborated with the Janssen Pharma-ceutical companies of Johnson & Johnson on a research project centred around the total societal and corporate value created through the introduction of new innovative medicines. Following the approach of defining elements of value in healthcare set out in the academic literature published by Lakdawalla et al. (2018), we focused

on creating a methodological approach in which the early value teams link their innovative medicine to one or more elements of the Elements of Value wheel (see Figure 3 below). The objective of this approach is to allow these teams to identify ways in which they can create more value for society and their company through the introduction of the new drugs being brought to the market.

ELEMENTS OF VALUE

6 CREATING A VALUE NARRATIVE FOR INTRODUCTION OF INNOVATIVE MEDICINES

VALUE

Quality- adjustedlife-yearsgainedScientific

spillovers

Equity

Real option value

Value of hope

Severity of disease

Adherence-improving

factors

Productivity

Net costs

Insurance value

Fear of contagion

Reduction in uncertainty

Figure 3: Elements of value. Green circles: core elements of value; light blue circles: common but inconsistently used elements of value; dark blue circles: potential novel elements of value; blue lines: value element included in traditional payer or health plan perspective; and red lines: value element also included in societal perspective.1

1 Source: Lakdawalla et al. A Health Economics Approach: An ISPOR Special Task Force Report [3]. Value Health. 2018;21(2):131-139.


ERIN ROMAN, BRECHT CARDOEN, JAN DECLOEDT (AZ SINT-BLASIUS) & FILIP ROODHOOFT

Globally, the cost of healthcare has increased significantly in the past decade. A number of factors such as the growth in the aging population, the advancement in technology and the current reimbursement system have contributed to this rise. Having said that, it has been noted that, in conjunction with these factors, substantial variation in treatment costs exists within medical domains across hospitals. Curbing higher healthcare expenditure and grasping a better understanding of the costs associated with medical treatments have become increasingly important. Many initiatives worldwide are being explored in order to obtain greater knowledge of how to handle surging healthcare costs. For our academic study, we provide an alternative perspective in which we examine several disease- and patient-related factors to understand how they drive differences in treatment costs. Through this lens, we provide a platform for physicians to anticipate costs for treatment upfront, which is currently not being explored in the academic literature.

The disease we choose to base this academic study on is breast cancer, given its prevalence and the sheer impact it has on society. With the help of the medical staff, we were able to develop a generic treatment pathway followed by patients. This allowed us to identify all the relevant activities needed when treating breast cancer patients. Using the perspective of molecular sub-types – luminal A, luminal B, HER2-enriched and triple negative – we classified patients into one of these 4

groups. Through further examination of the medical literature, we identified several relevant patient- and disease-related characteristics that potentially impact the treatment path followed by patients. The cost of treatment was measured through the implementation of Time-driven Activity-based Costing. Thus, we were able to accurately measure the cost impact of these characteristics on the overall treatment pathway.

Through our analysis, we were able to generate insights into which specific patient and disease characteristics lead to the greatest drivers of cost variability. We were able to identify how costs varied within each of the molecular sub-types by highlighting the relevant factors contributing to treatment cost changes. Additionally, our analysis indicates what factors lead to major cost differences between the molecular sub-types. Through our research, by using the medical focus of the disease and linking it to costs and understanding the drivers of cost, we aim to move one step closer to making more sound cost reduction decisions.

ACKNOWLEDGEMENTSWe are grateful to Xperthis for their uncon-ditional grant in funding this research. In addition, a word of thanks goes to Sabine Verhofstadt (CFO AZ Sint-Blasius) and Marc Muylaert (Finance Department of AZ Sint-Blasius) for their contribution in obtaining all the relevant financial data.

Academic paper submitted for publication.

7 VARIABILITY IN HOSPITAL TREATMENT COSTS FOR PATIENTS WITH EARLY STAGE INVASIVE BREAST CANCER


ESTER VAN HAUTE, REINI MERTENS (KU LEUVEN), BRECHT CARDOEN & DIRK DE RIDDER (KU LEUVEN)

Our healthcare is constantly evolving so as to meet the changing demands of patients. What does the hospital of the future look like? What is the future role of hospitals in the healthcare system? And how can all stakeholders prepare for it? The Flemish government entrusted researchers at the Leuven Institute for Healthcare Policy (LIGB) of KU Leuven and Vlerick Business School with finding an answer to these questions. The findings of their study were published in a green paper that serves as support for future policy decisions.

LITERATURE REVIEW AND SURVEYBased on a thorough literature review, the researchers gained an insight into the challenges in healthcare, as well as the national and international trends in tackling those challenges. A large-scale survey among the Belgian population shed light on the opinions of all stakeholders on those trends. Which aspects should policy-makers focus on more and which ones are less important? We refer to the green paper for more information on the literature review and the analysis of the survey. Below you will find an overview of the main challenges and recommendations.

TECHNOLOGY: A BLESSING OR A CURSE?Digital and technological developments are occurring increasingly fast throughout the entire healthcare process, from research to diagnosis, treatment and aftercare. The focus is no longer merely on tablets and data mining. Robots, artificial intelligence, and virtual and augmented reality are not science fiction anymore. However, oppor-tunities and risks are two sides of the same coin. New technologies are often expensive. How do we avoid a two-speed healthcare

system? And how do we guarantee data privacy? Technology is everywhere and anyone who is keeping abreast of the latest developments expects the healthcare sector to make use of it too. However, we need to ensure that technology does not hinder access to healthcare for users who are not tech-savvy. Moreover, new technologies have a major impact on the job descriptions of healthcare professionals. Therefore, a good framework is a must.

CHANGING HEALTHCARE DEMANDS DUE TO THE AGEING POPULATIONThe ageing population has resulted in more chronically ill patients and persons with multiple pathologies (co- and multi-morbidity) and/or mental health problems. Thanks to progress in medicine, degenerative diseases no longer lead to a rapid death, but they do still affect patients’ quality of life. How can the healthcare sector respond to the ageing population and the changing demand for healthcare services through an integrated offering of prevention, education, care and well-being?

HOW CAN WE PUT PATIENTS CENTRE STAGE?Patients want to play an increasingly active role. They now also demand to be involved in their treatment and they expect personalised care. A good information exchange between hospitals on the one hand, and between hospitals and other healthcare providers on the other is essential. However, for patients to become fully-fledged partners in the healthcare process, we need more than a well-thought-out development of electronic patient case files. We actually need a significant cultural and organisational shift. How do we deal with empowered

8 HOSPITAL OF THE FUTURE


and well-informed patients, and offer a low-threshold, nurturing environment to more vulnerable patients? The keys to success are highly flexible healthcare professionals.

FINANCIAL CAPACITY UNDER PRESSURE Lastly, the ageing population and the increasing demand for chronic care have put pressure on the financial capacity of the healthcare system. Smaller hospitals are no longer financially viable, so colla-boration through networks has become a must. Hospital admissions are becoming increasingly short and there is a growing trend towards outpatient care.

A SMALLER ROLE IN THE HEALTHCARE CONTINUUM Both the literature review and the survey show that the role of hospitals in healthcare has become smaller and more targeted. The increasing professionalism in healthcare and technological progress have allowed different players to take on parts of the healthcare package. The result? Specia-

lisation, more efficiency and higher quality levels in all links of the healthcare chain. Hospitals are no longer the integrated healthcare providers they used to be, but rather high-tech specialist or standard technological (possibly specialised) knowledge hubs for the healthcare process, in collaboration with other healthcare providers and patients.

INFORMATION EXCHANGE MUST BE STIMULATEDHospitals can only take on their respon-sibilities in the healthcare process if the different stakeholders are connected virtually and the patients’ care process is transparent. Nowadays, there are various information platforms in Belgium for the exchange of medical data, but they are not used efficiently. Sumehr, for example, is not systematically integrated. Vitalink is insufficiently completed and the electronic patient case file has only recently been extensively introduced and rolled out in all hospital wards. The government must stimulate the interconnectivity and use of these platforms for the benefit of patients.


This would also meet one of the major issues pointed out by the respondents to the survey: for patients to be able to freely choose their physician, the latter needs to have access to their file, which is currently not the case.

FROM A TRIPLE TO A QUADRUPLE AIMChanges in healthcare also bring about changes for staff. The reorganisation of hospitals in networks will require healthcare professionals to serve different players. How this exchange between players will concretely be set up is unclear at this stage. This uncertainty definitely does not benefit the well-being of healthcare professionals. Yet respondents ranked attention to the well-being of healthcare professionals high in terms of importance. To avoid these stakeholders suffering, policy-makers should focus on four dimensions rather than three: public health, patient experience, healthcare costs and the well-being of healthcare professionals. The white paper ‘Flexibel werken in ziekenhuizen’ (‘Flexible working in hospitals’) explains how this can be achieved.

EVOLVING HEALTHCARE INFRASTRUCTUREThe changing role of hospitals will have an impact on the required infrastructure. Given the evolution ahead, a division into healthcare components seems the most logical option. Moreover, not all healthcare activities should take place within the hospital walls.

• Wards The wards include the traditional hospital

rooms with one or more beds, as well as the technical equipment, such as sanitary facilities, compressed air and oxygen instal-lations. The size and set-up of the rooms should be adapted to the duration of the admission and the type of patient. A rehabi-litation ward, for example, requires more space for wheelchairs to manoeuvre, while rooms for a one-night stay could easily

become smaller.

• Transitional care facility A transitional care facility hosts patients

who are not healthy enough to return home or head to an assisted living facility following their hospital stay. These facilities free up beds in hospital wards and temporarily relieve caregivers. In Flanders, several ‘care hotels’ are now operational. They profile themselves as hotels that also offer care services. The difference between these ‘care hotels’ and ‘transitional care facilities’ abroad is that they facilitate these patients’ return to their homes or their move into an assisted living facility through patient education and by actively involving social services and the patients’ relatives in the process. However, the precise role of these entities merits further analysis.

• Centres for chronic care This includes rehabilitation hospitals,

assisted living centres and psychiatric institutions. The architectural infrastructure of these three types of facilities may be similar, but rehabilitation hospitals require more extensive rehabilitation facilities than the other two, which focus more on accom-modation and care services.

• Outpatient centres Outpatient hospitals specialising in surgery

and internal medicine, polyclinics and local clinics provide outpatient care. Whether or not they are part of a hospital depends on the technical and medical support required. Although we are noticing a shift to more outpatient care, specialised medical care would still benefit from being offered within the hospital walls in the future.

TECHNOLOGICAL PLATFORMS Operating theatres, medical imaging, laboratories, radiotherapy, intensive care and emergency services require complex and often expensive technology. Currently, these services are integrated into the hospital infrastructure. However, in the future we will not be able to head to just any hospital for all treatments. Therefore, it would be more useful and more affordable to make a distinction between two types

of technological platforms: (1) a standard platform that must be available in all hospitals, consisting of operating theatres and standard imaging technology, such as CT and MRI scans, and (2) an advanced platform that also offers PET scans, radiotherapy and intensive care. Those advanced technological platforms would then be shared by various hospitals within one and the same network.

WHAT ABOUT LOGISTICS AND OTHER SERVICES? At the moment, most hospitals organise their logistics and support services themselves, while some outsource them in part. However, for these services, collabo-ration could result in considerable savings. Despite several joint purchasing initiatives, to date purchases are stored in a decen-tralised way, which leads to larger safety stocks than actually required. Centralised stocks could bring about additional savings. Logistics platforms could offer their services to technological platforms, wards, transitional care facilities, as well as centres for chronic and outpatient care. Ideally, hospitals in one and the same network would also have a centralised sterilisation unit, laboratory and hospital pharmacy to optimally benefit from economies of scale.

FOCUSED FACTORIES Gathering expertise by centralising operating theatres, surgical outpatient clinics and wards focusing on a specific pathology would be beneficial both in terms of quality and cost efficiency. The question is whether such ‘focused factories’ are best set up at a local and/or regional level, or at a supra-regional level. Their optimal scale still needs to be analysed.

FINANCING AND LEGISLATION: TIME FOR CHANGE The organisation of hospitals is currently determined by the Royal Decree of 30 January 1989. However, the accreditation standards in this decree are not in line with future developments in the sector. We need a separate accreditation for each care component or function (wards, transitional care facilities, surgical outpatient hospitals, focused factories, technological platforms etc.). Technological platforms, a gathering of expertise and collaboration in terms of logistics and other services call for shared investments between different hospitals and/or networks, and for a review of certain accreditation conditions. As for investments in infrastructure, it is probably worthwhile to look into public-private partnerships and new subsidy schemes based on surface area, types of activities and the required equipment to replace the current VIPA fund (Flemish Infrastructure Fund for Matters relating to Individuals). Moreover, we need to consider the financing of hospital activities through the Financial Resources Budget (BFM) and physician fees. If we want to keep part of the outpatient services intra muros, public funds need to be made available to ensure the costs are not at the expense of the fees.

NETWORKS: THE STATE OF AFFAIRS There have been a number of developments since the publication of this green paper. On 14 February 2019 the House of Representatives approved the draft law on local and regional hospitals . As a result, from 1 January 2020 onwards, Belgian hospitals will be grouped in a maximum of 25 networks: 13 in Flanders, 8 in Wallonia and 4 in Brussels.

ACKNOWLEDGEMENTSThe full report can be retrieved via:

https://www.zorg-en-gezondheid.be/groenboek-hospital-of-the-future



ZEYNEP ERDEN, SHIKO BEN-MENAHEM (ETH ZÜRICH), GEORG VON KROGH (ETH ZÜRICH), ANDREAS SCHNEIDER (YPSOMED), GUIDO KOCH (TOPADUR PHARMA AG) & HANS WIDMER (NOVARTIS)

Drug discovery teams combine specialists with in-depth knowledge from a variety of scientific disciplines. Such diversity in thought worlds poses a challenging exercise in cross-disciplinary collaboration and project coordination. What makes it particularly challenging for drug discovery teams is the extreme uncertainty they face. To understand how successful drug discovery teams coordinate their complex knowledge creation activities, and which organisational structures foster and facilitate progress, we interviewed members of 5 drug discovery projects in a global pharmaceutical company. The project teams and sub-teams were also observed during meetings, lab work and informal discussions for a period of more than 18 months. Afterwards, the interview transcripts and field notes were analysed by axial coding using specialised software. Finally, the findings of this study were summarised in 4 insights and recommenda-tions:

1. Strike the right balance: Just like every organisation, pharmaceutical

companies have both formal and informal coordination mechanisms in place. Formal coordination is based on formal decisions and regulations about how the work within the organisation should be organised, whereas informal coordination cannot be pre-defined or imposed but emerges out of the daily informal relations between individuals. One important finding of our study is that formal and informal coordination mechanisms are not substitutes but complements to each other. Therefore, managers should find

a balance between them by providing initial structures around project teams and then letting the teams self-organise team restructuring around emerging interdepen-dencies and the interactions between the scientists.

2. Anticipate the needs and timing of others

Interdisciplinary collaboration in drug discovery requires specialists to be constantly aware of the implications of their domain-specific knowledge creation activities for other specialists. To prevent cross-domain inconsistencies, team members should have a forward-looking approach in which specialists anticipate the procedures, requirements, and expectations of the other domain. This means that the domain-specific activities should primarily be valuable in answering the scientific question and progressing in the discovery of a new drug, rather than just yielding interesting insights for the scientists’ own domains.

3. Triangulate assumptions and findings across disciplines.

Given the demands on a compound’s safety and efficacy profiles, drug discovery specialists need to establish the reliability of the knowledge they create not only within, but also across, knowledge domains. At each point in the process, scientists should scrutinise the findings and assumptions in their own work by going back and forth across disciplines to ensure that their output constitutes useful input for others.

9 FOSTERING MULTIDISCIPLINARY COLLABORATION IN DRUG DISCOVERY


4. Invite the devil’s advocate We found that it is not only important

to optimise the coordination within the discovery teams and sub-teams, but that it is also extremely useful to regularly involve outsiders who will challenge the team’s assumptions, and, by bringing a new perspective, may get a project back on track and drive its progress.

ACKNOWLEDGEMENTSThe full paper can be retrieved via:

https://www.ddw-online.com/business/p322924-fostering-multidisciplinary-collaboration-in-drug-discovery.html


1. RECENT PUBLICATIONSSchoonaert L., Van Dyck W. (2019) Acting with foresight in times of budget austerity. Vlerick Policy Paper #9

Van Haute E., Mertens R., Cardoen B., De Ridder D. (2019) Hospital of the future: the future of hospitals.Agentschap Zorg en Gezondheid Z&G/2018/GEZ/1

Erden Z., Ben-Menahem S., Von Krogh G., Schneider A., Koch G. & Widmer H. (2019) Fostering multidisciplinary collaboration in drug discovery. Drug Discovery World, Spring: 58-62

Geldof T., Huys I., Van Dyck W. (2019) Real-world evidence gathering in oncology: the need for a biomedical big data insight-providing federated network. Frontiers in medicine, Volume 6

Geldof T., Rawal S., Van Dyck W., Huys I. (2019) Comparative and combined effectiveness of innovative therapies in cancer: A literature review. Journal of Comparative Effectiveness Research, Volume 8

Van Dyck W., Schoonaert L., Geldof T., Govaerts L. (2018)Access decision-making in the Belgian commission for reimbursement of medicines 2010 – 2017: Investigating the readiness for value-based pricing. Vlerick Policy Paper #8

Schoonaert L., Gemmel P., Cardoen B. (2018)Flexibel werken in het ziekenhuis: OM en HRM perspectief. Vlerick HMC White Paper

2. OPINIONSVan Dyck W., Verdonck P. (2018) Setting priorities in healthcare. Vlerick HMC White Paper

Murthy A., Van Damme B., Van Dyck W. et. al.What European patients need: a shot of some good old Belgian surrealism. Euractiv

Roodhooft F.Healthcare cost structure can be tightened up significantly. Management Scope 12 2018

You can retrieve full reports, opinion articles and other press releases via: healthcare.vlerick.com.

PUBLISHED OUTPUT

3. ONGOING RESEARCHHealth policy narrative on the future direction of sustainable healthcareContact: Lies Schoonaert and Walter Van DyckContract research project in collaboration with Prof Dr Jeroen Luyten (KU Leuven, LIGB) for MSD EURAM (Europe, Asia, Middle-East). Country-specific reports describing the current state of health are composed based on data from IHS Markit and publicly available sources such as OECD, UNICEF, WHO, and IHME. Starting from the healthcare challenges identified in these reports, a health policy narrative on the future direction of sustainable healthcare will be developed with a special focus on healthcare systems’ predictability and sustainability.

Funding ‘cost-effective but unaffordable’ gene & cell therapy-based curesContact: Walter Van Dyck, Lies SchoonaertBuilding upon the Pfizer and INAMI-suppor-ted Round Tables on Gene Therapy funding this research project is conducted in collabo-ration with Prof Dr David Veredas, Professor of Financial Markets (Vlerick Business School) and Prof Dr Jeroen Luyten (KU Leuven, LIGB). The purpose of this fundamental health economic research project is to develop a conceptual economic model for outcome- and annuity-based financing of cost-effective but short-term unaffordable advanced gene and cell therapies. The model can be used by both innovative industry, insurers and health payers to evaluate affordability and value at risk for parties involved in future market entry agreements.

Discovering multi-product effectiveness using Bayesian network-based causal inference and application to adaptive pathways to medicinesContact: Walter Van DyckDoctoral research project in collaboration with KU Leuven (Prof Dr Isabelle Huys, Prof Dr Geert Molenberghs) and the Belgian Cancer Registry (Nancy Van Damme). To deliver effective but affordable treatments in

oncology, multi-product assessment studies investigating comparative and/or combined treatment effectiveness of the multitude of available, novel targeted therapies are becoming increasingly important. However, the high (combinatorial) complexity of real-world clinical practice makes such assessments anything but a straightforward task.

In this study, Bayesian networks (BN) are applied to investigate multi-product effectiveness given their higher flexibility and their abilities to manage uncertainty, handle variable interdependencies, and infer causality. In a case study of metastatic colorectal cancer including 4 targeted therapies, the proposed BNs are explored for their suitability within this highly complex context with, as possible, application to adaptive pathways for the development of, access to, and reimbursement for innovative medicines.

Evaluation of health technology assessment practices for precision medicine of the Belgian public health insurerContact: Laurenz Govaerts and Walter Van DyckDoctoral research project in collaboration with KU Leuven (Prof Dr Isabelle Huys and Prof Dr Steven Simoens). Precision medicines (PM) rely on companion diagnostics to identify patient sub-groups eligible for receiving the pharmaceutical product. Until recently, due to divergent procedures, the Belgian public health insurer (RIZIV-INAMI) assessed both entities separately for reimbursement decisions. However, as both components are considered to be co-dependent technologies, their assessment should ideally be conducted jointly from a health technology assessment (HTA) perspective. As of July 2019, a novel procedure was implemented at the level of the pharmaceutical assessment committee (CTG) at RIZIV-INAMI accommodating for this joint assessment practice. In order to facilitate the implementation of this novel procedure, this research evaluated the assessment reports formulated by the CTG for precision



medicines. Domains for improvement were identified and amendments to accommodate for companion diagnostics assessment and reimbursement decision-making were formulated.

This retrospective study evaluated the precision medicine assessment reports of RIZIV-INAMI of the last 5 years. The HTA framework for co-dependent technologies of the Australian Pharmaceutical Benefits Scheme was used as a reference standard in this evaluation and consisted of 5 domains. Criteria were scored as either ‘present’ or ‘not present’.

Hospital innovation priorities within the health continuumContact: Brecht Cardoen and Walter Van DyckWith this teaching case, developed in collabo-ration with Prof Pascal Verdonck (UGent), we invite hospital professionals to think about an innovation governance structure that enables the many technological advancements the sector is facing to be dealt with, while considering changes to, and limitations of, the healthcare system. Focus and discussion points should not be directed only towards one hospital’s internal governance. The evolution towards collaboration and networks also necessitates creating a joint innovation governance and the resulting decision-making process.

Value–based healthcare in psoriasis: study of the benefit of a psoriasis integrated practice unitContact: Erin Roman, Filip Roodhooft and Brecht CardoenThis doctoral research project forms part of the Novartis collaboration agreement ‘Value-based healthcare in psoriasis’. The academic study uses the ‘Value-based healthcare’ framework developed by Porter and Kaplan, in which medical outcomes are compared to the cost of treating a patient for his/her full cycle of care.

The aim of this study is to determine the value provided to psoriasis patients treated by the integrated practice unit that has been formed

at the UZ Gent Dermatology Department. This is done through accurate measurement of the cost, using an accounting technique known as time-driven activity-based costing and linking it to appropriate and relevant medical outcomes. The intention of this study is to then perform a benchmarking analysis, whereby we aim to investigate the value provided to psoriasis patients treated within this integrated practice unit and compare the value obtained to a conventional dermatology department. Our objective is to generate insights into whether or not the integrated practice unit approach provides greater value for patients.

This research project is a result of a collabo-ration between the Dermatology Research Unit of Ghent University, the UZ Gent (Ghent University Hospital) Dermatology Department, and Vlerick Business School.

Value-based healthcare in psoriasisContact: Niels Hilhorst and Filip RoodhooftThis doctoral research project forms part of the Novartis collaboration agreement ‘Value-based healthcare in psoriasis’. Psoriasis is a chronic inflammatory skin disease associated with psoriatic arthritis and numerous other comorbidities (such as hypertension, metabolic syndrome and diabetes). Psoriasis significantly impacts a patient’s quality of life. This specific component of the project focuses on the outcomes measurements of the value-based healthcare equation. To date, there is no core outcome set available that defines which outcomes should be measured in clinical trials – and this despite the many attempts already undertaken to identify one. Usually outcome sets are solely defined by clinicians rather than by patients, or in conjunction with patients. As this disease has such a significant social impact, it is essential that the patient’s voice is also being heard. Therefore, we aim to develop a patient-centred core outcomes set for psoriasis. We intend to measure these outcomes during a trial period and compare them to other dermatology departments across Belgium through a benchmarking analysis. Our objective is to use these outcomes, compare them to the


cost of treatment, and identify whether the integrated practice unit at UZ Gent generates greater value for patients. This research project is a result of a collaboration between the Dermatology Research Unit of Ghent University, the UZ Gent (Ghent University Hospital) Dermatology Department, and Vlerick Business School.

Value-based healthcare of state-of-the-art care pathways for adult spinal deformity in University Hospitals Leuven.Contact: Karel Jacobs, Filip Roodhooft and Brecht CardoenIn this doctoral research project, with unconditional support from Medtronic, we will develop a refined activity-based costing (ABC) model, based on Time-Driven ABC principles, to support value-driven treatment choices for adult spinal deformity (ASD) patients. In the year ahead, we will focus on further refining the hospital’s current costing model and calculate the costs of actual hospital care for the ASD population. This research project is a result of a collaboration between management and clinicians of University Hospitals Leuven and Vlerick Business School.

Optimising the decision-making process of innovative investmentsContact: Ester Van Haute, Paul Gemmel and Brecht CardoenDeciding whether or not to invest in innovations is not an easy decision, and it is preceded by a whole process involving multiple levels throughout the hospital. This decision-making process is the focus of this study with our 11 MINOZ member hospitals, which is being supported unconditionally by a grant from Roche Diagnostics. In addition to mapping the decision-making process in every hospital, we are going to investigate how the context and people’s behaviour can influence this decision-making process.

Is there empirical evidence for including surgery-dependent changeover times for surgery scheduling? Contact: Brecht CardoenThis academic research project is being conducted in collaboration with Mehmet Begen (Ivey Business School), Carla Van Riet (KU Leuven) and Johannes De Smedt (University of Edinburgh Business School). When scheduling surgeries in the operating theatre, the changeover time is often included in the procedure time. However, the time needed to set up for a new surgery might depend not only on the successor surgery, but also on the predecessor, and therefore can be sensitive to the sequence in which different surgery types are scheduled in the same operating room. By means of an empirical data-driven study, we will investigate whether it is worth a hospital’s effort to think about this sequence-dependency, in both inpatient and outpatient settings.

The importance of knowledge networks for university spin-offs in the life sciences industry Contact: Zeynep Erden This academic research project is being conducted in collaboration with Dr Elvira Haas from the University of Zürich. Although much is known about the positive impact of networks on the success of start-ups, it remains unclear how each network partner helps university spin-offs (USOs) gain follow-up funding beyond seed funding. We have conducted a case study of 6 USOs in the life sciences industry in Switzerland to provide contextual insights into the different categories of networks used by those USOs. Our study provides an overview of networks available to USOs, suggestions for when it might be reasonable to engage in a specific network, and 3 specific networking strategies that USOs use to access follow-up funding.


Digitisation of primary care delivery: consequences of EHR usage for physicians’ professional identitiesContact: Zeynep ErdenThis academic research project is in collabo-ration with Melike Findikoglu from Ozyegin University. An integral part of a physician’s professional identity is associated with information management. In the process of providing patient care, the physicians perform key information activities such as information retrieval, information synthesis and analysis, and diagnosis or decision-making (Clayton, et al., 2005). In this study, we investigate how Electronic Health Records (ERH) influence the care delivery practices and the professional identities of the physicians.

Social evaluation of biopharmaceutical companiesContact: Zeynep ErdenThis academic research project is in collabora-tion with Ted Khoury from Portland University and explores how the social evaluation of a firm through the media and third-party stakeholders (like drug-approval administra-tion agencies) influences the technological reputation of biopharmaceutical firms among particular stakeholders such as scientific (i.e. represented by academic publishing activity) and business communities (i.e. represented by patenting activity). In essence, we propose that the qualitative character (i.e. positive and negative tenor) and level of attention/ visibility (Deephouse, 1996) are capable of shaping the subsequent quality evaluations of firms.


VLERICK HEALTHCARE WEBINAR SERIESThrough our Healthcare Webinar Series, we will keep you abreast of innovative ideas and opportunities in the healthcare sector. The series will focus on different stakeholders across the healthcare eco-system, and will offer a broad range of topics over the year - culminating in the Vlerick Healthcare Conference 2.0.

WEBINAR: HOW AI AND MACHINE LEARNING CAN IMPROVE THE HEALTHCARE DELIVERY PROCESS05/11/2019Today’s health care providers are becoming more and more aware of the revolution caused by big healthcare data. A leading voice like Scripps Research’s Eric Topol even asks whether artificial intelligence (AI) can help rescue healthcare’s economic crisis. Big Data, AI and Machine Learning are claimed to perform at par with – or even sometimes to out-perform – a physician’s medical decision-making. In any case, it is acknowledged that these advanced analytics can eliminate organisational bottlenecks and accelerate patient pathways in the modern healthcare system.

In this Vlerick webinar, we want to explore where and how AI and Machine Learning can be valuable, and increasingly necessary tools to improve the quality and speed of the healthcare delivery process. We invite Erik R. Ranschaert, MD, PhD, radiologist at The Netherlands Cancer Institute Antoni van Leeuwenhoek, and a pioneer and visionary in EU teleradiology, to enlighten us on the benefits and challenges of the use of AI and imaging informatics.

NEXT ON THE AGENDA:

29/01/2020 Webinar: Improving your negotiation skills in a healthcare environment

FALL 2020 Vlerick Healthcare Conference 2.0Stay tuned via the programmes overview on healthcare.vlerick.com

MORE INFO:Contact: Annelies ClaeysT: + 32 9 210 98 04 E: [email protected]


MEET THE HEALTHCARE MANAGEMENT CENTRE TEAM

PROF DR WALTER VAN DYCKDirector Vlerick HMCProfessor of Technology & Innovation [email protected]

PROF DR ZEYNEP ERDENProfessor of Strategy and [email protected]

ANNELIES CLAEYSProduct [email protected]

ANNE SALENBIENBusiness Manager Vlerick [email protected]

PROF DR DAVID VEREDASProfessor of Financial [email protected]

PROF DR BRECHT CARDOENDirector MINOZ Hospital Research Network Professor of Management [email protected]

PROF DR FILIP ROODHOOFTProfessor of Management [email protected]

PROF DR PAUL GEMMELVlerick Research [email protected]

MANAGEMENT

RESEARCH FACULTY

HEALTHCARE PROGRAMME MANAGEMENT


Gaëtane BeernaertHead of Areas Service [email protected]

Cloé De MoorTeam [email protected]

Niels Hilhorst MDPhD [email protected]

RESEARCHERS

ADMIN SUPPORT

Dr Lies SchoonaertSenior Research [email protected]

Ester Van HauteResearch [email protected]

Erin RomanPhD [email protected]

Tine GeldofPhD [email protected]

Laurenz GovaertsPhD [email protected]

Karel JacobsPhD [email protected]

Discover how we put our research activities into action on:

HEALTHCARE.VLERICK.COM

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ANNUAL RESEARCH REPORT · 2019-10-15 · 6 / Annual Research Report 2019 LIES SCHOONAERT & WALTER...

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Transcript of ANNUAL RESEARCH REPORT · 2019-10-15 · 6 / Annual Research Report 2019 LIES SCHOONAERT & WALTER...