Focusing on Patients’ Health and Health Care Outcomes
35th Annual Health Policy Conference | March 9-10, 2023
The movement to increase value from health care is gaining momentum and related initiatives are flourishing. For many, value from health care means measuring patients’ health relative to the costs incurred to achieve their outcomes. However, this concept over-simplifies the complex processes of generating or maintaining health. Focusing on patients’ health and health care outcomes means improving access and quality of care, appropriately targeting interventions, and understanding the effects of health inequities, social determinants of health, and systems of health care delivery. Over 1.5 days, the 2023 CHSPR Health Policy Conference explored these different lenses of measuring value.
CHSPR’s long-standing conference promotes discussion between policy-makers, academics, providers, patients and national organizations on timely issues shaping health systems in Canada. The 2023 conference brought together research and policy experts, students, patients, and care practitioners from across the health care system.
Download the conference summary report | Read more about value-based health care
Program
Day 1: Thursday, March 9
8:45 am | Welcome Remarks
Jason Sutherland, Director, UBC Centre for Health Services and Policy Research
Aslam Anis, Director, UBC School of Population and Public Health
9:00 am | Keynote Address
The Value Institute for Health and Care is at the forefront of developing, measuring and evaluating value-based health care through leadership in scholarship, patient-centred engagement, and education. The efforts of Managing Director Scott Wallace, Executive Director Elizabeth Teisberg, and their team, have led to transformations in health care strategy, organizational culture, and measurement around the globe, including in Canada.
Value judgements: Outcomes, populations, and relationships within a value context
Speaker: Scott Wallace, Managing Director, The Value Institute for Health and Care, University of Texas, Austin [Slides]
Followed by audience Q&A
10:25 am | Access to Primary and Secondary Care: A Long-Standing Problem
For decades, provinces have struggled with mixed results to provide timely access to primary and secondary care. These talks will feature cutting-edge research and policy analyses that will shed light on barriers to improving access to care.
Access to primary care – A long journey
Speaker: Mylaine Breton, Associate Professor, Department of Community Health Sciences, University of Sherbrooke [Slides]
25 years on access to scheduled services: Anything learned; anything changed?
Speaker: Tom Noseworthy, Professor Emeritus, Department of Community Health Sciences, University of Calgary [Slides]
Followed by responses from patient partners Bruce Raber and Kent Cadogan Loftsgard and audience Q&A
12:50 pm | An Outsider’s Perspective on the Insider’s Problems in Improving Value in Health Care
The provinces have created frameworks and implemented initiatives to improve value from health care spending. As Health and Welfare Commissioner (Québec), with the dual role of informing government and the public, Ms Castonguay has unique perspectives regarding tensions and opportunities for improving value from health and social care.
Québec’s Health and Welfare Commissioner: a unique role in improving value in health care
Speaker: Joanne Castonguay, Health and Welfare Commissioner, Province of Québec [Slides]
Followed by responses from discussants John Sproule, Senior Policy Director, Institute of Health Economics, and Tom Noseworthy, Professor Emeritus, Department of Community Health Sciences, University of Calgary; and audience Q&A
1:50 pm | Using Evidence to Drive Policy Decision-Making
A rich history of Canadian evidence has highlighted significant opportunities for improving health and well-being. These talks will focus on disparities in health and health care and future opportunities for improving value in our publicly-funded health care system.
Physician and patient sex and impact on outcomes
Speaker: Angela Jerath, Scientist, Sunnybrook Research Institute
Values, value and equity
Speaker: Irfan Dhalla, Vice President, Care Experience and Equity, Unity Health Toronto [Slides]
Followed by responses from patient partners Bruce Raber and Kent Cadogan Loftsgard and audience Q&A
3:30 pm | Mental Health and Policy-Making to Improve Value
There is strong evidence that existing mental health care policies can be strengthened to improve health and well-being and value to the health care system.
Why the value of mental health care often lags below physical health care, and what we could do about it
Speaker: Michael Schoenbaum, Senior Advisor for Mental Health Services, Epidemiology, and Economics, National Institute of Mental Health (USA)
Leveraging an established provincial programmatic approach to support the development of a mental health system in Ontario
Speaker: Paul Kurdyak, Psychiatrist, Centre for Addiction and Mental Health (CAMH) [Slides]
Followed by audience Q&A
4:45 pm | Day 1 Summary
What we’ve learned: How different approaches to value-based health care can lead to change
Speaker: Carly Weeks, Health Reporter, The Globe and Mail
5:00 pm | Poster Session and Reception
Day 2: Friday, March 10
8:45 am | Welcome Remarks
Ian Rongve, Assistant Deputy Minister, Strategic Innovation Division, BC Ministry of Health
8:50 am | Anne Crichton Lecture
Provinces have been halting in their adoption of value-based frameworks that use patient and economic data in their decision-making. In the inaugural Anne Crichton lecture, Dr Clement discussed current decision-making and options for moving value-based initiatives forward.
A health economist’s perspective on value-based health care in Canada
Speaker: Fiona Clement, Professor, Department of Community Health Sciences, University of Calgary [Slides] [Video]
Followed by responses from discussants Angela Jerath, Scientist, Sunnybrook Research Institute, and Irfan Dhalla, Vice President, Care Experience and Equity, Unity Health Toronto; and audience Q&A
10:10 am | Adapting Principles of Value-Based Health Care in Provinces
This cross-country panel of speakers will bring their unique perspectives of health care to point to health systems’ opportunities to develop and implement policies to improve value by overcoming persistent barriers.
Deriving value from the hospital electronic patient record
Speaker: Trevor Jamieson, Chief Medical Informatics Officer, Unity Health Toronto [Slides]
Operationalizing value based decision making in the largest health authority in Canada
Speaker: Anderson Chuck, Chief Health Economist, Alberta Health Services
How Pacific Blue Cross works to remove barriers to health equity
Speaker: Sarah Hoffman, President and CEO, Pacific Blue Cross [Slides]
Followed by audience Q&A
11:55 am | Summary and Closing Remarks
Value-based health care: Through an industry lens
Speaker: Neil Fraser, Healthcare Director, Advisor and Consultant, and Former Medtech Executive [Slides]
Followed by audience Q&A
Workshops
In addition to the main program, a series of pre- and post-conference workshops were offered on March 8 and 10.
Home care is a key part of our health care system and affects all Canadians. As care has been provided in the home more and more over the past decade, decision-makers have increasingly sought information to inform policy and drive quality improvement. The Canadian Institute for Health Information (CIHI) has been collecting national home care data using the interRAI-HC tool for over a decade. This data includes demographic, clinical, functional, and resource utilization information for clients who receive care from publicly-funded home care programs across Canada. The information has proven essential in providing decision-makers and administrators with actionable evidence to inform quality and safety improvement initiatives. The information has also proven crucial in studying patient journeys across health care sectors. This interactive workshop will give home care decision makers and researchers a practical walk-through of how to use existing CIHI home care metrics and compare pan-Canadian home care measures effectively.
Objectives
- Address how to assess measures and how to understand contextual client information when working with issues related to the home care client population
- Identify a process for digging deeper into data to find drivers that affect the outcomes
- Discuss possible action plans and explore resources and tools to continue monitoring client outcomes
Who Should Attend
Decision makers, home care administrators, and researchers
Agenda
9:00 am | Welcome, introductions, agenda
9:05 am | Introduction of key concepts: home care metrics from CIHI; data access and linkage information; a case study focusing on caregiver distress and a 5-step approach to identify drivers and actions for change
9:30 am | Time to practice: Discuss a case study, work in small groups to interpret the result and identify areas of focus for change
9:50 am | Wrap up and review of key resources and tools
Hosts
The workshop was led by Helen Wei-Randall and Lili Liu of the Specialized Care Branch, Canadian Institute for Health Information.
With over 15 years in healthcare information, Helen Wei-Randall has worked in the areas of pharmaceutical economics research, health workforce information, population health analysis, and currently leads home care and long-term care related projects. Her work interests include interpreting data into narrative for publication and educational purposes to support the best use of data at all levels.
Lili Liu has over 15 years of health information experience in a number of diverse areas including public health program evaluation, health workforce information and long term and home care. She currently leads and participates in complex data analysis for a number of home care and long term care related projects at the Canadian Institute for Health Information.
This workshop aimed to bring together policy-makers, practitioners, care providers, patient partners, and researchers to discuss how to promote positive healthcare outcomes for those with Long COVID. It shared preliminary findings from the Pacific Institute for Pathogens, Pandemics and Society (PIPPS) Long COVID Research Project and advanced understanding of how to ensure value from care for a relatively new condition.
Objectives
- To map where those with Long COVID access care, as well as barriers to and gaps in care
- To map where those with Long COVID, and those providing care to patients with Long COVID, access information, and current information gaps
- To explore intersections between Long COVID and pre-existing health inequities
Who Should Attend
Researchers, policy-makers, healthcare decision-makers, clinicians, patient partners, students
Agenda
10:30 am | Welcome, introductions
10:35 am | Presentation of preliminary findings from Pacific Institute of Pathogens, Pandemics and Society Long COVID Research Project
10:45 am | Patient, family care provider, healthcare professional, policy, and researcher perspectives
11:25 am | Facilitated small group discussion on equity implications
11:45 am | Large group discussion on practice, research and policy priorities
12:00 pm | Concluding thoughts
Hosts
The workshop was led and facilitated by team members from the Pacific Institute on Pathogens, Pandemics and Society, based at Simon Fraser University, and included speakers from Family Caregivers of BC and the Post-COVID Interdisciplinary Clinical Care Network, among others.
Value in health is created when care improves meaningful health outcomes for the individuals and populations being served. Value-based health care (VBHC) focuses on measuring and achieving these health outcomes relative to the cost along a care continuum for a given medical condition. In practice, successful implementation of VBHC requires attention to strategy, culture, and measurement. A shared understanding of VBHC and its benefit to clinical practice is essential to effectively integrate health policy, service delivery, and health care research. Using local (Providence Health Care) and global examples (Value Institute for Health and Care), this workshop discussed the concept of value and showcased how to identify, reliably measure, and make optimal use of outcomes that matter to patients.
Objectives
- Define value for patients
- Discuss how to identify and measure meaningful patient outcomes
- Discuss how high quality patient outcome data can inform health policy, clinical research, and clinical practice for both individuals and patient populations
Who Should Attend
All are welcome. This workshop is relevant to patient partners, clinicians, policy- and decision-makers, researchers, and students.
Agenda
2:00 pm | Welcome, introductions, context, background
2:20 pm | Interactive group discussions (case study)
3:20 pm | Break
3:30 pm | Large group discussion
3:50 pm | Large group & panel discussion (local examples)
4:30 pm | Wrap-up
5:00 pm | Close
Hosts
The workshop wasled by Drs Alice Andrews and Scott Wallace from the Value Institute for Health and Care and Drs Shannon Jackson and Jeffrey Pike from Providence Health Care.
Alice Andrews, PhD, is Director of Education at the Value Institute for Health and Care and faculty at Dell Medical School and McCombs School of Business at the University of Texas at Austin. Her research focuses on the implementation of health care solutions designed around outcomes that matter to patients and the development of integrated learning teams to lead this change. Dr Andrews has taught graduate and executive programs worldwide on implementing high-value health care and health care transformation and has twice received a Dell Medical School Academy of Distinguished Educators Excellence in Teaching award. She is an advisory board member for the Welsh Value in Health Centre (NHS), and for several years has served as juror for the Value-Based Health Care Prize offered by the Value-Based Health Care Center Europe. Dr Andrews holds a PhD in Organizational Behavior from Cornell University and an MS in the Evaluative Clinical Sciences from Dartmouth College. In addition to the University of Texas, she has served on the faculties of The Geisel School of Medicine at Dartmouth and the Owen Graduate School of Business at Vanderbilt University.
Associate Professor Scott Wallace, co-founder and managing director of the Value Institute for Health and Care at Dell Medical School, leverages his business, health care IT and health policy background to work with students, employers, health care leaders and other stakeholders to transform health care delivery in the U.S. and around the world. Wallace recently served as the Interim chief business officer of Dell Medical School and is an integral member of the Dell Medical School faculty. Prior to joining The University of Texas at Austin, Wallace helped to create Dartmouth College’s Master in Health Care Delivery Science program, an innovative course for midcareer executives and clinicians. He served on the faculty for Harvard Business School’s executive education program on health care strategy. He is also a Batten fellow at the University of Virginia’s Darden School of Business and was a distinguished fellow at the Geisel School of Medicine at Dartmouth.
Dr Jackson is a hematologist primarily interested in non-malignant blood conditions including inherited and acquired bleeding disorders. She obtained her medical degree, internal medicine, hematology and hemostasis training at the University of Calgary and moved to Vancouver in 2009. She is a co-founder of West Coast Hematology, practices at St. Paul’s Hospital and is a Clinical Professor of Medicine at UBC. She is Medical Director of the Adult Provincial Bleeding Disorders Program. Dr Jackson is passionate about measuring health outcomes that matter to patients and transforming to a Value Based Health Care model of care. She has completed her Masters in Health Care Transformation at the Value Institute for Health and Care, at the University of Texas Austin, further training at Harvard University, and obtained her Green Belt VBHC Certification from the Value Based Health Centre of Europe. Currently Dr Jackson is working as the Physician Lead for Value Based Health Care at Providence Health Care and active with the PHC Value Team and several committees related to Health Systems Redesign.
Dr Pike is an orthopaedic surgeon with subspecialty training in wrist, elbow, and shoulder surgery- adult and pediatric. He is a Clinical Associate Professor in the Department of Orthopaedics at UBC. Dr Pike completed his undergraduate degree at the University of North Carolina at Chapel Hill as a Morehead Scholar and subsequently returned to Canada and completed both his medical degree and orthopedic surgery residency at UBC. He subsequently completed a Master of Public Health degree at Harvard University and two clinical fellowships in upper extremity surgery at the Hand and Upper Limb Center in London, Ontario and Washington University in St Louis. Most recently he completed an MBA in Health Care and Life Sciences at the Rotman School, University of Toronto. Dr Pike is on active staff at Providence Healthcare (St. Paul’s Hospital) and BC Children’s Hospital, and is currently Executive Medical Director, Medical Staff Development and Engagement, for the Provincial Health Services Authority.
“As a collaborator in healthcare I have worked as an executive director, program manager and facilitator. I was passionate about bringing organizations and partners together to find solutions through collaboration as described in healthcare policy. However, when collaborative outcomes were harder to achieve than desired, and relationships were strained at times, I was surprised. Why was it so challenging to collaborate?” (Walsh, personal reflections)
In my professional experience working with primary care providers and administrators, the policy direction for primary care planning and delivery to increase collaboration with other partners can be challenging. Although counter-intuitive, understanding where and how we create, interact, and cross boundaries provides a new way of thinking about collaboration, including insight into who and what is involved. In this workshop I elaborated on how to approach collaboration differently based on research I undertook for my doctoral dissertation. I documented how collaboration shifted and changed in primary care collaborations experienced within a specific region of Interior British Columbia across three different time periods that COVID-19 punctuated: pre-Wave 1 (January-March 2020), Wave 1 (March-May 2020), and post-Wave 1 (June-August 2020)
Objectives
Participants were introduced to four theoretical concepts: (1) boundary construction, (2) embeddedness, (3) decision-making, and (4) performativity, each demonstrated through examples provided in healthcare literature and data collected from my own research.
- By the end of the workshop participants were able to reflect on and apply each concept through structured short activities.
- By the end of this workshop, participants were able to question their own collaborative process and take steps to revise their collaborative approach.
By increasing our understanding of the process of collaboration we may be able to change our collaborative approach and be in a better position to deliver on collaborative healthcare policy direction.
Who Should Attend
This workshop was designed for those working in healthcare, such as policy-makers, academics, healthcare providers and administrators. Reflective exercises and small group sessions were designed to have individuals engage in their own reflections of collaboration and share across colleagues. We specifically looked at collaboration that occurs in healthcare workplaces; however, participants will be able to apply what they learned to other collaborative environments.
Agenda [Slides]
1:30 pm | Welcome and Land Acknowledgement
1:40 pm | Why healthcare collaboration?
1:50 pm | Introduce concepts and reflective exercises through a mix of individual and small group work
2:45 pm | Summary activity
Hosts
The workshop was led by Monique Walsh, an internationally certified facilitator and consultant with a background in healthcare leadership. Walsh’s work supports experienced healthcare leaders and their collaborative teams navigate complex challenges and move their mission forward with intention, buy-in and success. Walsh is an Interdisciplinary doctoral candidate with University of British Columbia Okanagan. Her research focuses on collaboration in healthcare workplaces. www.moniquewalsh.com
Canada’s health systems are currently in crisis. Citizens in all parts of the country are experiencing long wait times in emergency rooms, delays and cancellations of procedures and diagnostics, and a lack of access to new medicines and primary care. Total health spending in Canada is expected to reach $331 billion in 2022, representing 12.2% of Canada’s GDP. Provincial health budgets are close to 50% of total government spending. At the same time, we are seeing new, promising medical innovations and technologies, such as cell and gene therapies, that show incredible potential to transform patients’ lives who otherwise would be left with few options. How do governments assess new, emerging therapies and technologies under current policies and processes and make the necessary shift from containing costs in the short-term to investing in long-term value for patients?
Objectives
- Explore how value-based healthcare frameworks can be applied to the assessment and procurement of emerging therapies, such as those for rare diseases and cell and gene therapies.
- Discuss how VBH can help Canadian healthcare systems address health outcomes, cost per capita and the experience of care.
- Identify gaps and opportunities that exist in adopting new medical technology in Canada.
- Explore health technology assessment processes in other jurisdictions, and their applicability within the Canadian context.
Who Should Attend
Policy makers, decision makers, clinicians, patient groups, industry, academics.
Agenda
1:30 pm | Welcome remarks
1:40 pm | Why does VBHC matter to patients?
1:50 pm | A global perspective on the future of medical innovation
2:00 pm | International best practices and approaches to assessing health technology (pre-recorded presentation)
2:10 | Q&A
2:20 pm | Breakout session
2:40 pm | Group presentations and discussion
2:55 pm | Summary
Host
The workshop was facilitated by Fred Horne, Former Alberta Minister of Health. [Slides]
Speakers
- Eva Villalba, Executive Director, Quebec Cancer Coalition
- Annette Lam, Senior Director, Global Market Access (Myeloma), Janssen / Johnson & Johnson
- Tara Cowling, President and Managing Principal, Medlior Health Outcomes Research Ltd. [Watch pre-recorded presentation using passcode o&&dw4vu]
[Slides]