ISPOR 2020 – inside the first plenary: both necessity and science give rise to invention
What does it mean to ‘reshape’ healthcare systems for the future in an era of COVID-19 when that future has itself been transformed? Here, I share my takeaways from the first plenary session at Virtual ISPOR 2020 (18–20 May).
Due to the COVID-19 outbreak, the 2020 ISPOR Annual Meeting, due to be held in Orlando (FL, USA) over 18–20 May 2020, is instead taking place virtually over these same dates!
Plenary sessions at ISPOR always feature in-depth discussions between experts from across the entire health economics and outcomes research ecosystem. Kicking off the first full day of the newly redesigned virtual meeting, the first plenary session, moderated by Dana Goldman (University of Southern California, Los Angeles, CA, USA), explored what health policy of the future may look like and what steps must be taken to make decision making more efficient, patient-centric and transparent.
The session featured Margaret Anderson (Deloitte Consulting, DC, USA), Andrew Dillon (National Institute for Health and Care Excellence, London, UK) and Tomas Philipson (White House Council of Economic Advisers, DC, USA) as panelists.
Redesigning health policy in a redesigned world
A key point raised during the session was that it is simply impossible to have a conversation about what health systems of the future may look like, outside of the context of the COVID-19, which is transforming healthcare and policy decision making and will have a lasting impact on these and the global economy.
However, as Dillon commented, prior to the pandemic, there were various issues identified with health systems and healthcare decision making that will need to be addressed when we return to our new ‘normal’ after COVID-19. In many ways, the pandemic has highlighted several of these issues further, making it even more important that critical steps are taken to progress the field to make policy decision making a more efficient and collaborative effort.
Regarding the potential of cross-border collaboration to help tackle novel diseases with pandemic potential, Dillon raised the point that key to this is use of standing arrangements for data sharing about emerging and potential infectious disease threats; this can only be achieved through a unified, strengthened World Health Organization – now is not the time to be turning away from this because of associated challenges.
What reassessment is needed for health policy? According to Dillon, we need to converse with payers of healthcare to determine what our health systems are for, what their priorities are and how they must be payed for. Such multi-stakeholder collaboration does not come without challenges; this is far easier said than done. However, as Dillon stressed, health is more than a cost issue; it is an investment and a fundamental aspect of a functioning society.
Sir Andrew Dillon @NICEComms collaborations between #lifesciences industry, donors and governments will be essential. Engineer a conversation with those who fund the #healthcare system about what the system is for, the priorities, and how they should be organized. #ISPORAnnual— ISPOR (@ISPORorg) May 18, 2020
Anderson discussed some of her work concerning Deloitte’s ‘The Future of Health’ paradigm, to paint a picture, of sorts, of the state of health 20 years in the future. Anderson remarked on the drastic shift in model predictions in just the past few weeks and months alone, as the COVID-19 pandemic has manifested.
Quoting Danish economist Ester Boserup: “Necessity is the mother of invention,” Anderson commented that perhaps, in the context of COVID-19, both science and necessity give rise to invention, as, as a result of the pandemic, we have seen great advancements in the use of apps, digital health technologies and value-based care initiatives, progress in which had previously been far slower.
However, Dillon stressed that though we are likely to see increasing use of these new technologies, these need to be rigorously tested and undergo risk evaluation. New regulatory frameworks for these will need to be developed, which, again, calls for stakeholder collaboration to achieve.
Nevertheless, if there are positives to derive from the situation, these are those; COVID-19 has spearheaded immense interdisciplinary collaboration between stakeholders of the life sciences and pharmaceutical communities and this must be capitalized on. Perhaps, Dillon commented, this can serve as a springboard for the necessary conversations about what our health systems are for.
@MargaretAinDC of @Deloitte intense collaboration has come out of the #coronavirus #pandemic. Life sciences are coming together to decide what we have, what needs to be de-risked, and how to move forward to help mitigate #COVID19. #ISPORAnnual— ISPOR (@ISPORorg) May 18, 2020
Telemedicine is here to stay
Many of the panelists also attested that the shift in healthcare provision to greatly rely on digital health technologies and telemedicine protocols is likely here to stay for the foreseeable future, though this will require optimization to ensure their lasting effects, as Dillon pointed out.
Plenary 1 #ISPORAnnual: A rapid move to #telehealth and more #digitalhealth options - this is no temporary blip, there will an enduring #impact of remote working, privacy info with smart phone apps. #Digitaltech needs to be held to rigorous #testing and #valueassessment. #COVID19— ISPOR (@ISPORorg) May 18, 2020
However, perhaps the advancements COVID-19 has spearheaded will help set a new precedent for more rapid decision making and progress in other fields too. Anderson highlighted how, before the pandemic, there were no curative therapies available for more than 90% of classified rare diseases. The innovation that COVID-19 has spearheaded may allow for similar progress in other fields.
Transparency is key
Another critical point raised during the session concerns the fundamental nature of transparency and openness in all aspects of decision making – transparency equates to trust.
Sir Andrew Dillon @NICEComms transparency is essential to delivering health care. #Healthcare is a complex ecosystem with a great amount of risk and reward. We have a shared interest to improve #outcomes and ensure #sustainability. #ISPORAnnual— ISPOR (@ISPORorg) May 18, 2020
Dillon emphasized that without transparency – which admittedly requires great persistence and courage – there may be mistrust of whether access decisions are made in individuals’ best interests, as well as poor understanding between health systems and their staff, and health systems and the life sciences industry.
The public: an essential stakeholder
Philipson described how, in the USA, it has been interesting to observe how the public – the private sector – has responded to the pandemic, often ahead of the government passing laws. With COVID-19, Philipson explained, the public and the risks they are willing to take, will be a key driver of rebound to the pandemic.
@TomPhilipson45 of @WhiteHouseCEA mandates are forcing all to operate the same which is not necessarily optimal. The American people will drive the rebound, but if people still perceive the risks to be high it will be hard to start the rebound economically. #COVID19 #ISPORAnnual— ISPOR (@ISPORorg) May 18, 2020
In the future, public and patient engagement will remain of great importance. Anderson commented that, in particular, it will become increasingly key to engage patients who are not covered by existing patient advocate organizations or who have multiple chronic or co-morbid conditions, who require more targeted engagement.
#ISPORAnnual @MargaretAinDC @Deloitte— PRMA Consulting (@prmaconsulting) May 18, 2020
75% of patient organizations are impacted by reduced donations in this pandemic. These organizations are lifeblood to many conditions. What about patients who are not represented by an organization - how can we get their needs recognized? https://t.co/sAIioJK41W
This extends to members of the general public too, as Dillon stressed. Who could have predicted that the R number and general epidemiology would have become such mainstream topics of conversation amongst the general public? Going forward, we need to capitalize on this, to ensure the public’s interest is continually captured.