Preventing illnesses to generate large savings in healthcare
Pascale Richetta, vice-president at AbbVie, western Europe and Canada, reveals how AbbVie has been working with hospitals to improve efficiency and why we must change the way we think to make healthcare more sustainable.
Prevention and early intervention are crucial if governments want to tackle the rising costs of healthcare systems, according to Pascale Richetta, vice-president at AbbVie, western Europe and Canada. Funding for healthcare systems is under severe pressure as governments struggle with tight national budgets, while Europe's ageing population increases the cost of care.
Richetta explains that taking action to prevent conditions occurring and intervening early can generate large savings in the cost of healthcare systems when made in combination with other actions. "Unless there is early intervention, there is an exponential cost curve the later you intervene", she says. Richetta gives the example of a clinic in Spain that deals with the early stages of back pain and other inflammatory conditions. Through early intervention, the clinic has been able to enable patients to continue working and not take sick leave. Richetta says that "€1 invested in the clinic has generated €11 in savings".
She also emphasises that prevention and early action are one part of a set of changes needed on healthcare. The others are citizen empowerment and resdesigning healthcare delivery. Healthcare is too reliant on a system where care is primarily delivered in hospitals. This system worked when acute conditions dominated healthcare needs. Nowadays, when chronic conditions account for 70% of healthcare needs, the challenge is to move away from hospital-based systems, which take up 40-50% of costs, towards a system where care is delivered at home or at least outside hospitals, she says. “We need to transfer the expertise of staff working in hospitals towards outpatients”, she says.
The Spanish clinic is one example of healthcare best practices that Richetta says are crucial to help governments cope with the challenge of ensuring that sustainable healthcare.
The general economic situation in Europe is very difficult at the moment because of deflation. This creates additional pressure on government funding for healthcare. Richetta says that this obviously creates lots of tension as healthcare spending is one of the “top lines” in government spending. The current economic difficulties come on top of Europe’s demographic challenges. In 2050, around 35% of Europe’s population will be aged 60 or older, Richetta says. This raises the question of whether healthcare systems are sustainable in the long-term.
While the challenge of sustainability is acknowledged, people see the problem as so broad that they find it hard to come up with solutions. AbbVie has identified three areas where action can be taken to provide solutions to the problems. The three areas are: prevention and early intervention; citizen empowerment; and redesigning care delivery.
Unless there is early intervention there is an exponential cost curve the later you intervene, she says. On citizens’ empowerment, Richetta says that there is an increasing problem of a shortage of doctors in many western countries. The answer is to transfer responsibility to other healthcare professionals such as nurses and pharmacists. She gives the example of Canada where pharmacists have private rooms for consultations. They also prescribe some types of drugs, she says, “because there are simply not enough physicians to cover the population”.
AbbVie has been working on a framework to address these challenges and has been supporting a number of pilot projects in EU countries to provide pragmatic approaches to tackling the three challenges they have identified. The framework will be outlined in a white paper that will be presented to healthcare stakeholders at an event in Brussels this month.
Richetta gives the example of a rheumatology department in a hospital in Spain which has set up an early action clinic for back pain and other inflammatory problems. Through early intervention, the clinic has been able to reduce sick leave. This has saved government money.
As an example of a project which has shifted responsibility to different groups of healthcare professionals, she cites a project in Ireland based on appointment angels. These are nurses who work with patients to prepare appointments with consultants. Patients often fail to turn up for appointments or come without the correct documentation such as x-rays or other images. This reduces the effectiveness of the consultation. Appointment angels work with patients to ensure they have the right documents. Richetta says that the close contact between the nurses and patients increases trust and confidence.
In Greece, AbbVie has been working with hospitals to improve efficiency through the application of techniques from manufacturing. Richetta says that this has improved efficiency by up to 30%.
Normally healthcare professionals are resistant to change. Richetta says that there is a territorial attitude where people are used to certain groups doing certain tasks, but she says that the changes can save physicians spending time on paper-based tasks so they can concentrate on spending time with patients.
Richetta says small pilot projects can demonstrate savings or improvements of efficiency or patients benefits. The challenge is scaling up the results of the projects. This is not always easy, she says, because of the difficulty of moving from a small environment working with people of good will. A European steering group headed by Mary Harney, a former health minister of Ireland, aims to highlight the results of the pilot projects and the potential for Europe-wide action. The results will be presented at an event in Brussels today (19 March).