Our fund invests in healthcare companies with innovative solutions that focus on improving patient outcomes while driving down the cost to the healthcare system and making it more accessible, affordable, efficient and effective.   We focus on healthcare productivity with investments in companies like Milestone Pharmaceuticals and Circle Cardiovascular.  Milestone is developing a product that allows the patient to better manage their paroxysmal supraventricular tachycardia (PSVT). The company’s lead product, etripamil, is in phase 2 and designed as a nasal spray for rapid systemic drug delivery to be used by ECG-diagnosed patients to terminate PSVT episodes, at-home, in an unmonitored setting instead of having to be treated in hospital. Circle is providing the cardiologist with resources to better analyze MRI and CT imaging that allows more efficient and effective patient care.  Both companies are expected to have a positive impact on healthcare productivity.

Addressing inefficiencies within the hospital environment is necessary for many reasons including the opportunity to free up time for the healthcare professional.  But freeing up time for the healthcare professional is not only about seeing more patients; it’s also about providing quality time and education to the patient so that they can better manage their illness and better manage their health after discharge.

“At the most fundamental level, better quality lowers cost in healthcare because better health is inherently less expensive.  Maintaining health is the ultimate cost saving”

……Michael Porter

If the impact of quality time and education is to better prepare the patient to manage their health, we should pay more attention to patient interaction and how to leverage the relationship between patient and medical professional. Not all productivity issues are able to be addressed at the technology interface.

Having medical caregivers focus on the patient relationship is not just a nice-to-have but a “key driver” of many economic elements, according to Tim Jackson of the University of Surrey.

Unfortunately, with the fee-for-service (FSS) model (or volume model), incentive is to provide more healthcare, not better healthcare and it is one of the drivers for escalating healthcare costs. The trending concept in the healthcare industry is now shifting away from volume to a value-based care (VBC) system. This includes many VBC initiatives with the US Centers for Medicare and Medicaid Services (CMS).  Value-based payment models change incentives to focus on value by rewarding better outcomes and lower spending.

 However, in his book “If Disney Ran Your Hospital”, Fred Lee points out that patients don’t measure clinical outcomes. Patients judge the hospital based on how they were treated. Their relationship with their medical professional is amongst the highest issue of concern.

I recently spent some time with a friend at David S. Mulder Trauma Centre at the Montreal General Hospital (MGH). Privacy and discretion were the most disappointing aspects of the experience; do not expect either when under observation in the monitored area of an emergency room department.   In fact, whenever any staff member walks past a cubicle, they deliberately pull open the curtains so that there is full line-of-sight on all beds.  The only time curtains are drawn is when there is a healthcare professional or hospital employee in with the patient.  At times, you can find two patients squeezed into the small space intended for one with not even the flimsy curtain between beds.  It wreaks havoc on a person’s dignity. On the positive side however, expectations were exceeded whenever the patient interacted with any of the many medical professionals and hospital employees, from orderly to Department Head. Although not quite Disney-esque in costumes and design, all interventions I observed with patients were delivered with a smile, a gentle touch and a warm demeanor.  When the nurse or doc is with the patient, they act as if they have all the time in the world, respecting the dignity and privacy of the patient and their family, taking time to answer all questions and communicate what is happening or about to happen. And yet, as soon as leaving the patient’s side, they break out into a sprint to attend to the next patient or deal with the next crisis.  It was fascinating to watch.  Looking at wait times and the frenetic pace in the corridors, you can sense that there is never enough time for each patient but that the hope is to shield the patient from that reality.

The answers to optimizing healthcare still elude us and the final model may blend both VBC and FSS elements…. and maybe something from Disney.  Mitchell Morris, MD with Deloitte, recognizes that success for the move from volume to value-based care relies on physicians “due to their integral role in health care delivery.” In any final iteration, it seems clear that physicians, along with other medical professionals, need a model that is aligned with delivering better health outcomes – the ultimate goal for increasing productivity in a very complex system, while ensuring that each patient is treated in a manner that allows them to believe that the care received was the best care possible.

Ela Borenstein

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    March 10, 2016 at 5:47 pm

    This mirrors the feedback I get from healthcare customers all the time. The family health team model in Ontario, a one-stop medical shop, like the GMFs in Quebec, have been shown to improve patient care and push patients to the professional who can help them, not necessarily the GP in the clinic. Patients really like this model but it is expensive for the government. Much cheaper to push patients through a mill in 5 minutes.

    • Ela

      March 11, 2016 at 10:45 am

      Thanks, Robin, for your insight and pharma perspective. Patients should like this model since it helps empower them. With current trends in “patient power”, gov’t needs to consider the long game. I’d love for us to move away from a “penny wise,pound foolish” mentality.