How strategic public-private partnerships could revolutionize healthcare

When we’re sick, we go and see a doctor. If we’re really sick, we go to the hospital. That’s just the way healthcare works, isn’t it? But what if we turned this on its head? What if the doctor, hospital or health system reached out to us before we needed them?

It’s an approach that could shift healthcare on its axis. We’re not talking about tested preventative approaches, such as anti-tobacco legislation. Rather, we are seeing targeted approaches, where individuals are identified as high risk of a disease and are steered through clinical pathways to prevent it or reduce its impact.

The rationale behind this is clear. First, individuals can live longer, healthier lives, with benefits for family and wider society. Second, there is an opportunity to relieve the burden on healthcare systems and develop sustainable solutions for the future.

Healthcare systems are at a crisis point, fuelled by ageing populations, acute workforce shortages, and increases in long-term chronic disease, such as cardiovascular disease and diabetes.

In Latin America, cardiovascular disease accounted for 1.09 million deaths in 2019, corresponding to 38% of all deaths from non-communicable diseases. The number of deaths and the resulting economic burden of the disease are expected to increase, up from an estimated $30.9 billion in 2015.

For cardiovascular disease, where the vast majority of cases could be prevented, there is a tremendous opportunity to make a difference for millions of people by identifying them before they need urgent care, while relieving the burden on healthcare systems.

How can we drive meaningful change with such complex healthcare systems?

Public-private partnerships (PPPs) were a vital component during COVID – from providing capacity to shift medical services to creating a fully digitalized environment.

Inspired by COVID PPPs, strategic PPPs have emerged for chronic disease management, designed to achieve impact at scale and with the ability to measure outcomes.

With a view to accelerate change, the Collaborative on Strategic PPPs to Transform Cardiovascular Health, launched at the 2022 World Economic Forum Annual Meeting by Novartis, Novo Nordisk and the Harvard Health Systems Innovation Lab, aims to set new standards to advance solutions and measure impact through target population outputs (TPOs).

TPOs measure the number of people with a condition at specific stages in the healthcare journey, and are used to assess the impact of strategic PPPs at population level.

There are usually no symptoms of high low-density lipoprotein (LDL) cholesterol. But, left untreated, it can lead to heart attacks and stroke. For many, it’s a hidden ticking time bomb.

High LDL cholesterol can be treated, if those at high risk are identified at the right time. Cholesterol levels are checked through a blood test called a lipid panel. But the way lipid panel results are presented is dated, and the level of risk is often unclear.

In response, Novartis collaborated with stakeholders and the healthcare system to co-create Athero Alliance, the first strategic PPP to revolutionize cardiovascular care in Colombia.

Athero introduced a harmonized way of presenting cholesterol test results that makes it much clearer for primary care practitioners (PCPs) when there are potential red flags for cardiovascular risk, empowering them to start their patients early on the right personalized treatment path.

It has been designed with ACMI (Colombia Society for Internal Medicine) and SCC (Colombian Society of Cardiology) and implemented by one of the country’s largest laboratory networks, Synlab.

Thanks to its simplicity and systemic approach, this new measurement protocol is easily scalable and has the potential to impact the medical decisions of 125,000 PCPs – Synlab has a presence in 80% of the territory, reaching as many as three million patients and delivering more than 12 million lipid panels per year.

Progress is being assessed by the percentage of primary care practioners using lipid assessments for patients in their clinic (the target population output). After only six months since its introduction, about one in five PCPs have adopted this new approach.

The potential impact on cardiovascular health in Colombia could be profound, providing a simple but effective solution to alleviate the burden of cardiovascular disease and establishing a healthcare legacy for the future of cardiovascular care.

Risk factors for cardiovascular disease include metabolic issues such as obesity and diabetes. These conditions are especially prevalent in urban areas and often attributed to the way people live, move, play, work and eat there.

Through its Cities Changing Diabetes initiative – a global strategic PPP with city leaders, health authorities, community groups and more – Novo Nordisk is seeking to drive preventative action against type 2 diabetes and obesity in cities around the world.

In Colombia, the Cities Changing Diabetes Bogotá programme responded to the lack of data on disease prevalence by spearheading a first-of-its-kind population research study on the prevalence and vulnerability of type 2 diabetes and metabolic disease.

The study showed that about 11% of the population live with diabetes, 65% with overweight or obesity, with many unaware of their condition. All estimates were higher than previously reported, indicating a clear need for action to prevent the increasing burden.

Meanwhile, a public space intervention pilot tested how to increase healthy behaviour by improving environmental conditions and access to health information and physical activity opportunities for the residents of San Luis, a region in Bogotá.

As a result, the intervention area saw a rise in healthy behaviour and people experienced more positive attitudes towards themselves and felt empowered to introduce changes to their lifestyles.

It’s an approach that is both targeted and yet easily scalable to positively impact more people's health and well-being.

We have reason to believe momentum on preventing cardiovascular disease is building.

By scaling interventions and assessing their progress with instruments such as targeted population outputs, strategic PPPs can make strides in improving health and generating efficiencies of our health systems, so that they continue to meet the expectations of people and the needs of society.

This will be our collective contribution to building a sustainable healthcare legacy for the future.