Nuevos medicamentos y tratamientos de alto
costo: proyectos de riesgo compartido
Jose F Tomás MD PhD
Medical Director BUPA-ELA
Santiago de Chile Junio 2017
Foro “Juntos por la Salud de los Chilenos”
¿Es todo innovación? Costo/beneficio
Innovación terapéutica
Beneficios marginales para muchos de los nuevos
tratamientos, con algunas innovaciones relevantes o
excepcionales
Costes de los nuevos tratamientos con incrementos
exponenciales
JAMA Otolaringology 2014 epub
BUPA Overview
Keeping you informed, keeping us connected 7
Introduction to Bupa Cancer Data
Keeping you informed, keeping us connected 8
PMI
Expenditure
UK Australia Spain Global
Cancer spend £ 248,401,000 £95,794,000 £86,482,000
Total spend £1,200,000,000 £1.995,700,000 £710,700,000
% of spend on
cancer
21% 4.8% 12% 24%
PMI Cancer spend trends:
1. We spend about 28% of our total claims expenditure on cancer and this is rising at a CAGR of around 6%
2. There are some start differences in the profiles of cancer spend across market unit
3. Overall Bupa spends the most on breast cancer (£90m) which represents 30% of total spend, with prostrate (£65m),
colon (£30m), skin (£30m) and lung (13.5m) being the next largest spend area – these largely accord with global
epidemiological data
Cancer provision:
1. We have a growing cancer provision in Spain, Poland (LuxMed) , Chile and the UK,
2. The contribution to total provision revenue from oncology services is significant. Particularly in the UK where it
oncology makes up 20% of total revenue and 50% in LuxMed
3. The cancer specific diagnostic pathways and self referral are USPs in market in LuxMed
Cancer drugs:
1. We estimate that our spend on cancer drugs globally is about ~ £200m.That represents around 24% of our total
expenditure on drugs ~ £825m
2. The top ten drugs represent around 45% of total expenditure
Bupa´s Control of Cancer Delivery
1.- Classical checking (BAU)
. Evaluation of Centers ( Law Requirements,, Evaluation of Quality and Safety
programs, Medical Results,)
. Prestige
. Claims
2.- Spain
. Benchmarking of our UCCO with other providers
. A “fast track” pathway for rapid diagnoses
. Innovation ( liquid biopsy, genetic profiles , new therapies)
3.- UK
. Bupa Cancer Promise
4.- Australia
.Goverment PolicyKeeping you informed, keeping us connected 9
Hacia donde vamos?
1.- PROVISION (Providing access to advice and care that´s right for me)
.Corresponsabilidad
.Identificación de procesos
.Programas de previsión de gasto
.La especialización como una oportunidad
.UCCO
“The Strategy that will fix Health Care” Harvard Business Review October 2013
Hacia donde vamos?
2.- INDUSTRIA FARMACEUTICA (Obsessive about making quality healthcare affordable and accessible)
.Acuerdos de colaboración en Investigación , Formación Continuada , I+D (Acceso a la innovación)
.Programas de previsión y seguimiento del gasto
.Programas de personalización del costo
-Riesgos compartidos
-Tratamientos combinados
-Tratamientos crónicos
-Costos por unidad de tratamiento (viales, presentaciones…)
.Compartimiento del know-how
Objetivo y estructura del acuerdo
Generación de un marco de colaboración permanente articulado
mediante la creación de un comité de seguimiento estratégico y un
subcomité para cada uno de los pilares del Acuerdo
Formación
científica y el
fomento de la
I+D
Colaboraciones
comerciales e
institucionales
Acuerdo Marco Roche-Sanitas
Introducción y
acceso a la
innovación
Comercial y
financiero
Comité de seguimiento estratégico
Áre
as d
e
trab
ajo
Objetivo y estrutura del acuerdo marco Roche-Sanitas
RWD/RWE: Resultados en Salud
Previsibilidad y estabilidad presupuestaria
Modelos personalizados de reembolso
Minimización de la incertidumbre de gasto
Optimización de la adecuación del coste al beneficio
Maximización de la eficacia
Iniciativas para favorecer el acceso
de manera sostenible
Ejemplos1
2
3
Hacia donde vamos?
3.- ORGANIZACIONES SANITARIAS, CIENTIFICAS Y DE PACIENTES RELACIONADAS CON EL
CANCER
(Obsessive about making quality healthcare affordable and accessible)
.Papel de liderazgo
.Crear opinión
.Colaborar en foros de expertos
.
Hacia donde vamos?
4.- PACIENTES
(Obsessive about making quality healthcare affordable and accessible)
.
.
NUESTRO COMPROMISO ES PODER OFRECER AL PACIENTE :
EL MEJOR TRATAMIENTO ( patient-centeredness)
CON LA MAYOR SEGURIDAD
ABORDABLE y GARANTIZE SOSTENIBILIDAD
EN UN FUTURO TRABAJAR CON:
CLINICAL OUTCOMES
PRONS
BUPA UK
Keeping you informed, keeping us connected 16
Bupa’s Cancer Promise
OUR QUALITY ASSESSED NETWORKS OFFER
THE BEST OUTCOMES
18
Bupa’s unique5 Cancer Provider Quality
Assessments
We are the only insurer to conduct quality
assessments on our cancer centres and their
clinicians to ensure best outcomes
Bupa Approved Diagnosis and Treatment Units
• Breast Cancer Diagnosis and Treatment Network
• Bowel Cancer
• Prostate Cancer
Networks provide access to:
• The latest evidence-based pathways and
technology
• Specialist consultants
• Advanced therapies for all indicated conditions
• Surety that they will be reviewed at MDT (multi-
disciplinary team meetings) to ensure peer-
reviewKeeping you informed, keeping us connected
Links to expert external cancer
organisations
Over 20,000 undergoing some
form of treatment per year
Over 3,000 inbound calls per
week, 1000 + outbound calls
SPECIALIST ONCOLOGY SUPPORT TEAM
45 trained advisers and
experienced oncology nurses
Over 11,000 newly diagnosed
cancer patients per year
19Keeping you informed, keeping us connected
Breast and Bowel Direct Access
20
Over 2300 calls
0ver 600 referrals
18 customers with a cancer diagnosis
PPV - Positive Predicative Value 3%
Wait for GP Referral 14 days
Wait for Consultant Referral
No Waiting
5.3 - 7.3%
5 - 11 days 14 days
Wait for Treatment following
Diagnosis23 Days* 62 days**
*From first contact with Bupa **From date received by hospital ie 93
days from symptoms recognised
Not Achieved
Bupa
IN HEALTH CARE, THE DAYS OF BUSINESS AS USUAL
ARE OVER
Obsessive about making quality healthcare affordable
and accessible
Keeping you informed, keeping us connected 21
Top Related