New Business Models for Connected Health

Transcription

1 New Business Models for Connected Health - An Irish Perspective 7 March 2013 Dr. Regina Connolly Dublin City University Ireland

2 Changing demands changing models Population is aging 000 s, persons over Increase in demand from higher-dependency segment of population The average number of cancer cases is predicted to increase 000 s, predicted no. of cases 25 CAGR +3% Increased requirement for prevention and specialist treatment Increasing prevalence of conditions such as diabetes, obesity, heart disease and asthma puts an increasing burden on the health service Source: CSO, National Cancer Registry

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4 Ideal elements in a Healthcare System 1. Focuses on meeting the population s health needs. 2. Matches services, capacity to meet the population s needs. 3. Coordinates and integrates care across the continuum. 4. Has information systems to link patients, providers and payers across the continuum of care.

5 And more 5. Is able to provide information on cost, quality outcomes, and patient satisfaction to multiple stakenolders. 6. Uses financial incentives and organisational structure to align governance, management, physicians, and other caregivers in support of achieving shared objectives. 7. Is able to improve continuum of care

6 THE CASE FOR CHANGE HSE plan has set out a clear vision for implementing an Integrated health & social model for Ireland. Why are we making these changes? To drive and support safe, quality care for patients and clients. To bring decision making close to where services are delivered. To allow clinicians to shape and assure the services they work in. To get the best health outcomes for the money spent. To plan and organise around what we know people need and what we know works to give the best results. To organise to meet increasingly complex patient and client needs To remove barriers to integrated care. To provide an equitable UHI based model of care

7 What is a Business Model? A business model describes the rationale of how an organization creates, delivers, and captures value Osterwalder Business models comprise 4 fundamental activities:» Delivery client (patient) view» Offering product view» Process supply view» Financial cost & income view

8 Systems must adopt an accountability framework, supported by aligned incentives and a unified perspective on value Accountability Many healthcare systems lack a clear accountability framework Accountability must span key stakeholders Aligned Incentives A sustainable accountability framework is not possible without aligned incentives across the various stakeholders Perceptions of Value Key stakeholders must be willing to reconcile their different perspectives on value in order to align incentives An accountability framework, supported by aligned incentives and reconciled perspectives, is needed in an increasingly global environment

9 Demand Supply A realization that value perspectives differ among stakeholders but must be balanced for a win-win Value-Based Transformation is Necessary to Align Incentives Stakeholder Today Future Consumers Fix me regardless of cost or cause Help keep me well Provide appropriate, cost-effective, high quality care when needed Societies Healthcare is a societal right Healthcare is a societal right but available funds must be well prioritized Payers Minimize unit costs Transparent cost/quality information Able to accept value-based reimbursement Providers Financial incentives to treat and to do more, not to prevent Wellness and prevention High quality, cost-effective acute & chronic care

10 Transformation requires answers to critical questions Category Questions Will enough be available? Funding Will it be prioritized and spent well? Sample Metrics % Public/private spending % of GDP Consumers Government What is the overall health status? What are societal expectations and attitudes? What is the willingness to change behaviors? How many literate health activists are there? Does the government have the leadership, political will, and stability to drive significant change? Do government policies and regulations enable transformation? Healthy life expectancy at birth (HALE) Disability adjusted life years (DALYs) Ability to prioritize and follow through Emphasis on accountability in funding arrangements Healthcare Industry Are key stakeholders willing to change? Incentives reward a longer term view Ability to share data Is the healthcare infrastructure (e.g. facilities and IT) appropriately robust?

11 KEY STEPS TAKEN 1. Universal health insurance ( ) 2. Money follows the patient (2014) 3. 6 Hospital Groups/Trusts 4. Primary Care centres (Target 600 in process) 5. Free GP Care for specific long term illness groups (2013)

12 The Goal Services will be more accessible locally, centred around the patient, rather than centred around an institution Shift towards prevention and better self care rather than a focus on acute care and treatment Right balance between inpatient, day case and community based care More efficient use of resources and more transparent accountability DATA must follow the patient throughout the care pathway Real time access to patient data Equitable UHI based healthcare provisioning (aka the Dutch model) Ensure that key pieces of data can be extracted, exchanged and interpreted in a consistent manner by both humans and interacting systems A requirement for a national patient record An integrated standards based platform to accommodate the patient record

13 The strategy cannot be about marginal adjustment it has to be about system transformation

14 An Organising Principle The largest limiting factor is not lack of money or technology or information or people, but rather the lack of an organizing principle that can link money, people, technology and ideas into a system that delivers a more cost-effective case (ie more value than current arrangements).

15 Our Vision for Connected Health: Partnership for Performance LIFESTYLE ILLNESSES DATA 4 sites of care (Kaiser Perm.) VIRTUAL WEB Data and information Nursed Beds HOSPITAL Primary Care COMMUNITY Selfmanaged HOME Chronic diseases Healthy lifestyles Research STRESS Electronic records Diagnostics/imag ing DIABETES OBESITY DIET NUTRITION ANYTIME ANYWHERE COPD Clinical Libraries PHYSICAL ACTIVITY CVD Pathways Protocols logistics FALLS / FRACTURES COGNITIVE ACTIVITY Prescriptions Selfmanagement COGNITIVE DECLINE SOCIAL CONNECTION Promotion STROKE COMFORT

16 Connect health and care in the home Great Northern Haven ++ Beaumont Hospital (COPD) Mater Hospital (RPM) Hermitage Clinic (RA) Community Groups Primary Care Practices UHC / Health Innovation Hub Acute care Primary care Community care CARA wellness is a cloud-based platform enabling health and care providers to deliver care services into the home

17 The Vision - what Health I.T has to deliver Integrated Information - View, Access and Availability Patient Centric Integrated View Access Anywhere

18 Challenges in realising this Vision

19 Complexity of Data - Source & Volume

20 Some Considerations Success of integrated health systems: - achieving clinical integration. Improving value of the healthcare investment: - achieving clinical integration of care. There is emerging evidence that more integrated systems of care provide higher quality of care.

21 Has Avoiding Healthcare the ICT Pitfalls delivered? RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the USA more than $81 billion annually 7 years later the empirical data on ICT impact on health care efficiency and safety are mixed, and annual health care expenditures in the USA have grown by $800 billion The disappointing performance of health IT attributed to: Slow adoption of health ICT systems The choice of systems that are neither interoperable nor easy to use The failure of health care providers and institutions to reengineer care processes to reap the full benefits of health ICT The original promise of health ICT can be realised: If systems are redesigned to create more-standardised systems that are easier to use, truly interoperable and afford patients more access to and control over their health data. Health care providers and institutions reengineer care and delivery processes to take full advantage of efficiencies offered by health ICT What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology - Rand Report HEALTH AFFAIRS 32, NO. 1 (2013): 63 68

22 Standards are critical Standards are not only technical questions. They determine the technology that will implement the Information Society, and consequently the way in which industry, users, consumers and administrations will benefit from it. - European Commission on Standardization and the Global Information Society Something considered by an authority or by general consent as a basis of comparison; an approved model or requirement that is used for the basis for judgement. Standardisation brings important benefits to business including a solid foundation upon which to develop new technologies and an opportunity to share and enhance existing practices.

23 For these reasons Electronic systems and technologies require a multi-layered infrastructure to enable flexibility and interoperability of the various technology components to provide ehealth services. Necessitates an overarching framework for all ICT systems and technologies to contain and maintain and enable the unique identification of the key information and technology required in all patient care, service delivery, management and operational locations and provides the means to access, communicate and utilise information and technology effectively This can only be achieved through a standards based systems, information, technology and communications services oriented architectures

24 HSE National Integrated Services Framework The purpose of the ISF project is to develop a standards based framework for applications, information, communications and technical architecture in Irish Healthcare. The standards based framework will define the environment in which we design, develop and acquire systems in the future. The framework will ensure that the manner in which we deliver ICT solutions is aligned with the overall National strategy and business objectives. Implemented correctly, the framework will ensure that the required levels of integration between systems are achievable.

25 The Integrated Services Framework A standards based single framework for the public health system A Technical Architecture An Applications Architecture An Information Model and Architecture An Communications / Network Architecture Secondary Benefit A Single Information Systems Framework to provide for integration and sharing of data and information Deliver the ICT Strategy work streams Strategic National Business Initiatives Develop, implement & support local & regional initiatives Develop the EHR Information Framework Develop & improve ICT Infrastructure Foundation for the Electronic Health Record (EHR) and a National Patient/ Client Portal

26 Helping Irish Industry help Global Healthcare

27 A NEW JOURNEY & NEW OUTCOMES

28 Thank you.