Professor Hilary Thomas, Public Sector Healthcare Advisory Practice, KPMG and vice chair, Breakthrough Breast Cancer Changing the game: positioning your charity to succeed in the new health service market conference www.charitycomms.org.uk/events

1. A-PDF OFFICE TO PDF DEMO: Purchase from www.A-PDF.com to remove the watermark
Disrupting the
Game – how charities
can get a commercial edge
and improve outcomes for
their beneficiaries
Hilary Thomas,
KPMG
Breakthrough Breast
Cancer

2. Disrupting the Game - Outline
Context – my journey
Healthcare globally and in the UK today
The unique position of Charities
Why engagement is key
Examples of public engagement as a disruptive innovation
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 2
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

3. Disrupting the Game - A personal story
Age 9
In my 20’s
Being a Consultant
Being a Patient
Moving to the private sector
Being a Trustee
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 3
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

4. Disrupting the Game - Healthcare in the UK today
World Economic
Forum, Davos 2012: “The financing of health systems
has increasingly burdened
developed economies, which has
been exacerbated by the fiscal
crisis. Participants agreed on the
drivers of the expenditure growth
and, since many of these factors
are unlikely to recede (e.g. ageing,
lifestyles, public expectations),
there is a clear need to develop a
more sustainable way of
managing health systems. The
magnitude of health financing
challenges suggests that
incremental solutions may not be
enough; however, a shared vision
of new models for health systems
does not yet exist.”
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 4
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in Great Transformation: Shaping New Models – World Economic Forum Annual Meeting Davos 2012
Source: The the United Kingdom.

5. We are well aware of the challenges...
People and products:
Aging
Multi-morbidity
Rising expectations
Lifestyle diseases
Technology and devices
Process:
Poor system and process design
Specialisation
Organisational culture
Problems with the economic model
Growing complexity
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 5
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

6. Active strategies to cope are transactional.
85
Major cost reduction
%
81
Lean and improvement methods
%
82
More focus and specialisation
%
78
Investment in Health IT
%
Question - Which 74
strategies are New workforce models
providers likely to %
adopt to respond to
these changes?
44
Extra income from existing payers
%
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 6
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012

7. The problems with hospitals:
Not specialist enough for complex cases.
Not general enough.
Not very safe out of hours.
Based on some odd design rules.
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 7
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

8. The leadership and governance mechanisms to address all these
problems are poorly developed
The dominance of professional autonomy: the
tendency to reject mechanisms of accountability.
A reluctance to give or receive feedback or
to share information about performance.
Emphasis on individual judgment and knowledge
rather than on the value of teams.
Reluctance to accept the idea that clinical decisions
have resource consequences.
A paternalist approach to care and inadequate
involvement of patients in their own care.
The problems
with the
organisational Undervaluing and under investment in management and
culture: a divide between clinicians and managers.
Leadership not just better management.
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 8
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

9. The design rules need
to change.
■ Treat each episode as a single event.
Anticipate need and manage years of
care
■ Treat patients as though their time is free.
Eliminate wasted time and travel
■ Move patients.
Move staff and information
■ Batch and queue.
Patients flow through the system
■ Patients are passive recipients of care.
Patients actively manage their own care.
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 9
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

10. Disrupting the Game - Healthcare in the UK today
The Health and Social Care Act 2010
Putting patients at the heart of the NHS - no decision about me without me
Focus - improving outcomes, emphasis on high quality care and not on process
Empowering local organisations and professionals
making NHS services more directly accountable to patients and communities than they
currently are
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 10
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

11. Disrupting the Game - Value Based Reimbursement
:
Focus - on a process,
on a procedure or on a disease area.
Channel shifting - move services
to online, telephone and other modes.
Disintermediation - Taking out steps in
.
the supply chain to reduce costs or increase value.
Patients and their networks as a source of value -
co-producing or even co-designing the product or service.
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 11
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.

12. Disrupting the Game - Focus on Wellness
–
:
Move from a National Sickness Service ,
To a National Health Service.
Consider Prevention as today’s problem
Not something to be deferred until tomorrow
See the patient as a source of value
Support and .foster self care and better understanding
Incentivise the right behaviours
Build on behavioural economic understanding
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 12
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Source: ‘Transact or transform? The search for new models’ KPMG international, October 2012.

13. Disrupting the game – Segmentation, Stratification and Personalisation
:
Segmentation
Define the most important segments
Stratification - who
Agree principles to risk stratify populations
Personalisation
.
Build on voluntary sector experience/ expertise
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 13
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

14. Summary
There is a huge opportunity
Be ambitious – identify value added opportunities which are scaleable
Work with new commissioners of care to disrupt the system
Ensure you measure your impact – Porter principles -
Value = Appropriateness x Outcome)
(
Cost
Engage the public and use the new world order – social media – to advantage
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 14
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

15. Disrupting the Game
© 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent 15
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

16. Hilary Thomas
Partner and Industry Expert Global Health Practice
KPMG Health Advisory
Vice Chair
Breakthrough Breast Cancer