France, Germany, Sweden, UK

Transcription

1 Personal Health Systems/Remote Patient Monitoring and Treatment market: Stakeholders' interviews France, Germany, Sweden, UK David Brunnen, European Connected Health Campus Henri Hietala, Anna Maksimainen, Nordic Healthcare Group Niilo Saranummi, VTT

2 Presentation outline 1. Study design 2. Summaries of the four country studies France, Germany and Sweden Henri Hietala UK David Brunnen 3. Discussion 2

3 Study design VTT was subcontracted by IPTS to build a picture of the PHS/RMT market in the four EU countries (France, Germany, Sweden and UK). The work was done by collecting data via interviews of key stakeholders and experts from the field, complemented with other data from other sources Overall 37 interviews were conducted in the four countries all together (7 in France, 10 in Germany, 7 in Sweden and 13 in the UK) Different stakeholders interests were covered from Policy Makers, Payers, Health Service Providers, Users, Large Scale Procurement to Technology and IT Service Providers Interviews were conducted face-to-face and as telephone interviews Interviews were structured using the same set of questions Interviews were recorded and documented to enable reliable analysis of the collected data 3

4 Interview topics 1/2 Facts on PHS/RMT market: 1) Main perspective of the stakeholder on the market of PHS/Remote monitoring, now and in the near future 2) Type of market data or business information the stakeholder is aware of and/or uses with the aim of supporting activities in the PHS market, and accessibility of such data 3) Type of qualitative data the stakeholder is aware of and/or uses with the aim of supporting activities in the PHS market and accessibility of such data 4) Type of activities, products and/or services deployed in the market on PHS/Remote Patient Monitoring 5) Role of the stakeholder in the healthcare delivery chain with regard to PHS/ Remote Patient Monitoring implementation 6) Established or planned partnerships among actors

5 Interview topics 2/2 Analysis of stakeholders' roles and strategies 7) Key factors for successful PHS implementation according to the stakeholder, including known examples of successful business approaches or business cases 8) Factors (demographics, economics, disease occurrence, technology etc.) influencing the stakeholder's PHS procurement/deployment decisions 9) Stakeholder's strategy in getting its activities running (business as usual, seizing new opportunities, allying with other businesses/public authorities, ) 10) Business models behind the stakeholder's activities and funding models for PHS 11) Drivers (business, political, social) as perceived by the stakeholder as key for the realization of a full-fledged PHS-market 12) Barriers perceived as impeding the realization of a full-fledged PHS-market Stakeholders' views and perceptions 13) Successful innovation models and perceived role of the various actors within these models (medical practitioners, public authorities, industry, patients, ). 14) Kind of activities, initiatives, measures etc. seen as necessary to realise a full-fledged

6 Study team David Brunnen Henri Hietala Anna Maksimainen Niilo Saranummi

7 COUNTRY REPORTS 7

8 France French healthcare system and positioning of RMT: No actual positioning in the healthcare system Management of Chronic Conditions: One of the top priorities in French health policy Still lack of coordination and continuity of care Two major approaches to chronic disease management include: Health network approach: Formalized provider networks at local level Long-term disease (ALD) procedure: Exempts patients with long-term conditions from co-payments if their care adheres to evidence-based guidelines 8

9 France PHS& RMT Market Situation: No true success stories in the French market Projects and pilots do not lead to business Prior estimates of rapid RMT market growth have been toned down However, still strong belief in the potential of RMT Not a matter of will it grow, but when will it grow Fragmented market, but partnering becoming common Shift in thinking has happened from technology to services Value-chains (front and back end of service) PHS & RMT Market s Anticipated Growth: At least 2,5 years (political cycles and next election) Actions to bring the market forward currently insufficient 9

10 France Availability of PHS&RMT Market data: Low levels of data overall Fragmented market, fragmented data Quantitative data hard to find (reliability, robustness) market extrapolations possible, but results are not evidence but opinions Currently main sources of data include the internet, publicly available market research reports and word of mouth Need for academic papers, but solid results take time RCT& review process lag in solid data being available Strong need to collect more information (SIMPHS) Evidence-based facts, contact persons interested in RMT 10

11 France RMT Market Drivers: The usual suspects : Ageing population, chronic diseases, lack and uneven distribution of physicians Both bottom-up and top-down diffusion needed to drive change. (Various stakeholders = drivers) Strong call for government policy on RMT to create rules for the RMT game Patients as drivers (out of pocket payments) Physician drivers: Gatekeepers for RMT breakthrough Education and incentives New agency CNR as a driver: Little data available Role in for example consolidating the RMT market, collecting data, running pilots, creating a vision 11

12 France RMT Market Barriers: Current healthcare system: No room for disruptive innovations Need for system level change and rules before major breakthroughs will occur. Other barriers often consequences of the system Legal and privacy issues, implementing issues Need for new medical professions (monitoring) Lack of education and clear goals of where to take and how to implement RMT (physician s view & patients (view) Data collection: 1) Health benefits 2) Economic benefits 3) Sales points & implementation Insufficient proof of concepts (business models will follow) Cultural barriers (loss of power) & missing incentives 12

13 France RMT in a social care context: Organizational boundaries in provision of care and unclear roles and responsibilities hinder potential RMT growth in home care Patient Empowerment taking steps forward but Actual tools to empower patients still missing 13

14 Germany German healthcare system and positioning of RMT: Despite continuous reform RMT issues have not been addressed on a political level No actual positioning in the healthcare system Management of Chronic Conditions: No overarching national chronic disease strategies Reforms have tried to build incentives for integrated care Prior critic towards care of the chronically ill led to the implementation of disease management programs in DMPs Future open after recent elections DMP and RMT: Unrealized potential? 14

15 Germany PHS & RMT Market Situation and Anticipated Growth: Currently market at a formative stage (at best) Market mostly made up of regional and local pilot studies Turning pilot studies into business extremely problematic Partnering becoming more common, but still strong need for market consolidation. No solid business models have emerged. Fuzziness of RMT&PHS makes it difficult to scope the market PHS & RMT Market s Anticipated Growth: Most estimates from 2 to 3 years until market matures More skeptical views: +10 years (systems change slowly) 15

16 Germany Availability of PHS&RMT Market data: Scattered & Scarce: Current sources academic papers, own research, case studies, meetings & market reports Low levels of quantitative data with questionable reliability Evidence-based proof of concepts and RMT success stories would be of great interest Turning data into action should be focus of SIMPHS, not informing Factors influencing the Market Drivers and Barriers: Currently barriers heavily outweigh the drivers Healthcare system is still doing good enough: PHS&RMT does not need to happen today 16

17 Germany RMT Market Drivers: Demographic & lifestyle changes: ageing population and the increase of chronic conditions Lack of physicians in rural areas Physician & Political support (especially The Ministry of Research and Education) Evidence-based proof of concepts Continua Alliance & Market consolidation (critical mass and interoperability) RMT Market Barriers: Main barrier: Healthcare system not tailored for RMT Need to change current system not urgent enough to push the RMT market forward on a system level 17

18 Germany Market barriers: No long term strategy and time-cycle related barriers Budgetary cycles & political cycles (market on hold ) Lack of reimbursement possibilities partially due to a fuzzy innovation process Role of the Federal Joint Committee (G-BA) in RMT open Is RMT an innovation or not? Fragmented market need for consolidation and critical mass Unclear roles and no aligned incentives between stakeholders Currently no leadership Cultural problems Lack of evidence-based data and its efficient use Implementation problems due to organizational boundaries 18

19 Germany RMT in a social care context: Great potential in independent ageing, connected living and ambient assisted living, but organizational boundaries hinder growth The holy grail from industry perspective Patient Empowerment still a vision in Germany Political will, but actions are scarce 19

20 Sweden Swedish healthcare system and positioning of RMT: Increasing awareness of RMT on a political level However, no specific RMT strategy has emerged No clear positioning in the healthcare system Management of Chronic Conditions: Integrated care has received attention through Chains of care Building links between primary care, hospital care and community care Organizational boundaries still problematic in practice Care guidelines due not translate into actions 20

21 Sweden PHS & RMT Market Situation and Anticipated Growth: No actual RMT market to date Successful business cases very rare RMT activity mostly project-based pilots Increasing partnering happening with a variety of stakeholders but market currently very fragmented PHS & RMT Market s Anticipated Growth: Most estimates from 2 to 5 years until market matures Current market not seen as attractive, but most stakeholders believe in its future potential Many SMEs have gone bankrupt lately 21

22 Sweden Availability of PHS&RMT Market data: Lack of both qualitative and quantitative data Current projects do not collect sufficient data Strong need for more systematic means of data collection Main sources of data include case studies, published academic studies, national and international meetings and market research reports Strong wish for data concerning health and economic benefits of RMT Also strong need for promotion of social networking: new forums to discuss RMT market development 22

23 Sweden RMT Market Drivers: Demographic changes: An ageing population, chronic illnesses Problems serving rural areas A shift in current healthcare paradigm: To patient-centered care systems would drive change Strong position of ICT in healthcare in Sweden: Acceptance and infrastructure RMT Market Barriers: Lack of clear definitions concerning RMT Political will has increased, but actions still lacking Coordination among key stakeholders insufficient due to unclear roles and responsibilities (centralization vs. decentralization). Also need for incentives. 23

24 Sweden RMT Market Barriers: Lack of funding and resources to get past pilot phase Public sector unwilling to buy, private investors do not see ROI in short term Need for more solid data proving benefits of RMT Changing old habits and attitudes of healthcare professionals difficult strong need for education RMT in a social care context: Strong potential for RMT in home care, but need for further coordination and cooperation between social and healthcare Patient Empowerment Acknowledged need and will for it, but has not happened yet 24

25 UK Position of RMT / PHS in the national healthcare systems Management of chronic conditions (long term conditions) Integration of Healthcare and Social Care A focus on Healthcare Informatics 25

26 List of identified RMT projects England Whole System Demonstrators Wales Chronic Care Management projects Scotland 17 projects including Lothian pilot Northern Ireland major procurement with LTC focus 26

27 PHS & RMT Market Situation and Anticipated Growth Population 61.4m LTC s 17.8m (29%) LTC s addressable by RMT = < 8.9m Currently served by RMT solutions < 0.05% (of addressable LTC market) Population 61.4m Social Care Solutions Currently served by basic Telecare 1.5m 2.5m Currently served by advanced Telecare <200k (<10% of current market) Availability of Market data: QOF Quality of health Outcomes Framework register 27

28 Factors influencing the Market Drivers and Barriers Market Drivers WSD & CCM Learning Continuum awareness IT mainstreaming Green NHS + Economic pressures Systems culture Customer expectations Knowledge transfer growth Market Barriers Scale and timing issues Confidence Investment rationale (clinical and economic) Communication/awareness Post-pilot transition Industry relationships Procurement challenges Managed services evolution 28

29 RMT in Social Care Context The Connected Health continuum Evolution of technical and clinical triage processes Proactive Connected Health choices Reactive Patients as passive objects Individuals as Individuals as co-producers of co-producers of Health & Care Health & Care Health & Care Professionals Dependency Citizen- Patient 29

30 Patient Empowerment a Vision or Reality? Development of the Summary Care record 30

31 DISCUSSION 31

32 Preface to the Discussion National Health Systems vs. RMT & PHS Actually not interesting as this is too high level Also all is available at WHO Observatory and OECD Instead policies for disease management programs are of interest Lack of vision on ICT in Health Vision of the future HC Patients as co-producers Disruptive innovations (Christensen & Porter) Manifesto for Connected Health ( Governance, engagement, procurement, implementation 32

33 Discussion topics Healthcare policy level There is also no feeling of urgency to deploy RMT in healthcare. There are other more important challenges that get the attention of politicians and policy makers. How to create awareness & urgency? Incentives The major barrier holding RMT / PHS back is the current healthcare incentive framework that does not reward services that keep patients away from doctors offices or hospitals. How to create a system that rewards Chronic Care performance? 33

34 Discussion Acceptance of RMT Will clinicians accept vital signs measurements done by patients? Will patients accept and be able to use RMT? Business models Several of the interviewees proposed that what is needed in deployment is a patient doctor relationship supported by an IT-service provider that runs the service 24/7 and a clinical service provider that is available 24/7 In-house or as an intermediary (a triage centre ) between the patient and the healthcare system. Selling the technology directly to healthcare organizations will not lead to efficient use of the investment. 34

35 VTT creates business from technology 35