On July 17, 2015, the Report of the Advisory Panel on Healthcare Innovation ("Report"), entitled, "Unleashing Innovation: Excellent Healthcare for Canada" was released. The Advisory Panel on Healthcare Innovation  ("Advisory Panel"), which is chaired by former University of Toronto President and Dean of Medicine, Dr. David Naylor, received its mandate from the Federal Minister of Health, the Honourable Rona Ambrose, in June 2014. The mandate of the Panel was to[1]:

  • identify the five most promising areas of innovation in Canada and internationally that have the potential to sustainably reduce growth in health spending while leading to improvements in the quality and accessibility of care; [and]
  • recommend the five ways the federal government could support innovation in the areas identified above.

In particular, the Advisory Panel was to draft a report ensuring that the recommendations: fell within the Canada Health Act; properly respected the division of powers for healthcare between the federal and provincial governments; did not result "in increasing spending pressure on provincial and territorial budgets"[2]; and did not "imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in healthcare."[3]

The Advisory Panel reviewed submissions across the country, commissioned research reports, reviewed publications and consulted with citizens, stakeholders and federal, provincial and territorial leaders as well as international experts from the field. In conducting this research, the Advisory Panel made two important discoveries. Firstly, Canada appears to be losing ground in its performance and delivery of healthcare when compared to many of its OECD peers and, secondly, there are many pockets of healthcare innovation across the country, but they are not integrated and therefore have not been identified or scaled up in a meaningful way. As a result of these findings, the Advisory Panel made recommendations for one very large healthcare infrastructure change and identified five broad themes that should be addressed by the Federal government in order to best promote innovation in healthcare.

The following is a brief overview of the key findings.

Federal Healthcare Infrastructure Change

The biggest fundamental change proposed is the recommendation to consolidate the Canadian Foundation for Healthcare Improvement, the Canadian Patient Safety Institute, and (after a period of transition), Canada Health Infoway into "a new vehicle for accelerated change", termed 'the Healthcare Innovation Agency of Canada' ("HIAC").[4] The reason for this recommendation is the conclusion that each of these entities has an element of innovation in its mandate and, therefore, one large agency such as HIAC that operates at arm's length with the government could have a much broader mandate dedicated to "catalyzing change in real-time, evaluating the impact of those changes and accordingly, rejecting, revising and re-evaluating, or scaling-up the resulting innovations."[5]

HIAC would be supported through the newly envisioned Healthcare Innovation Fund ("Fund") and governed by Canadian experts appointed on merit. These experts would be linked to advisory committees composed of a diversity of stakeholders across the country. The Fund's goals would be to: "support high-impact initiatives proposed by governments and stakeholders; breakdown structural barriers to change; and accelerate the spread and scale-up of promising innovations."[6] The Advisory Panel suggests that the proposed target would be $1 billion per year and that this goal could be reached as early as the year, 2020.

Both the HIAC and the Fund, as proposed by the Advisory Panel, would be enablers for the five areas identified as the priorities for innovation. These priorities are labelled as 'themes' and key points are outlined below.

Themes for Innovation

Theme 1 - Patient Engagement and Empowerment

Issue: there is currently a gap between the desire for patient-centred care and the actual experience of patients navigating through the healthcare system.

Specific recommendations include:

  • implementing models of payment and accountability centred on patients' needs instead of the existing focus on healthcare providers and institutions
  • scaling-up of patient programs that currently exist and have had positive results with respect to patient centred-care (include patient and family in the design process)
  • augmenting the promotion of health/healthcare literacy
  • better use of patient portals so that patients can co-own their personal health records

Theme 2 - Health Systems Integration with Workforce Modernization

Issue:  lack of integration to achieve enhanced access, high quality care from multi-specialty teams at lower costs for patients.

Specific recommendations include:

  • better integration of healthcare and social services
  • improvement of integrated healthcare alongside 'bundled payment' models
  • scaling-up of inter-professional care (including reviewing the recommendations from the Canadian Academy of Health Sciences report on Optimizing Scopes of Practice, 2014[7])
  •  re-examining the roles, responsibilities and payment for health professionals when compared to the value generated
  • co-creation of a First Nations Health Quality Council and liaison committee for Inuit representatives

Theme 3 - Technological Transformation via Digital Health and Precision Medicine

Issue: Canada lags in comparison to its peers when it comes to electronic health  (namely: use of digital resources, secure access to patient health records, enabling patients to access their own health records, development of apps, and standardization of data for performance measurement and analytics).

Specific recommendations include:

  • moving Canada Health Infoway into the HIAC (with a transition period for completion of current projects)
  • greater role for the "Canadian Institute for Health Information" ("CIHI") as it relates to transparency, data gathering, supporting integrated delivery models, bundled payments and greater dissemination of information to the general public
  • a national healthcare strategy for precision medicine[8] that brings this concept to front-line care (especially in pharmacogenomics and cancer diagnosis and treatment)
  • better commercialization of made-in Canada concepts and tools

Theme 4 - Better Value from Procurement, Reimbursement and Regulation

Issue: Canada is lagging behind other OECD countries when it comes to healthcare finance, purchasing, and regulation in areas such as prescription drugs, physician services and medical technologies.

Specific recommendations include:

  • improvement in pharmaceutical pricing models
  • ensuring existing federal pharmaceutical drug plans reaffirm their commitment to join the Council of the Federation's pan-Canadian Pharmaceutical Alliance ("pCPA") and that HIAC be the secretariat, in addition to exploring this alliance with private insurance plans
  • implementing a national transparency regime for net prices paid of pharmaceuticals and review of the policies and practices of the Patented Medicines Pricing Review Board

Theme 5 - Industry as an Economic Driver and Innovation Catalyst

Issue: Canada lags when compared to its peers in adopting policies designed to "nurture a domestic healthcare industry and to reshape interactions with multinational companies that provide healthcare goods and services".[9]

Specific recommendations include:

  • creation of a Healthcare Innovation Accelerator Office (within the HIAC) focused on technologies that have potential value for money and benefit for patients
  • spreading and scaling-up of improved procurement processes
  • reviewing recommendations from the Review of Federal Support to R&D (2010)[10]
  • enabling Health Canada to work with stakeholders to support the growth of commercial enterprises in healthcare
  • reducing duplication when it comes to regulatory enhancements for drug and device safety

The Advisory Panel provided recommendations for Health Canada to work in partnership with the new Agency and other stakeholders. In particular, the Report placed a strong emphasis on consensus building across the provinces and territories to resolve legislative ambiguities and ensure consistency throughout the country. One specific example noted for rapid innovation is the need for the provinces and territories to agree on the ways in which they will safely share anonymized data with each other. One other noteworthy recommendation made by the Advisory Panel is to create an income-scaled Refundable Health Tax Credit ("RHTC") to replace the Medical Expense Tax Credit Supplement and "provide tax relief of 25% on eligible out-of-pocket healthcare expenditures up to $3,000 per year."[11]

Overall, the Advisory Panel concluded that innovation should be the driving force for the renewal of our healthcare system. The recommendations set out in the Report call for a "renewed spirit of collaboration and shared political resolve on the part of all jurisdictions"[12] so that by 2025, there will be a meaningful difference in the way healthcare is organized, managed and delivered.