E Health Business Models

6,234 views
6,054 views

Published on

Published in: Health & Medicine
0 Comments
27 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,234
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
27
Embeds 0
No embeds

No notes for slide
  • electronicdocument managing system based on the digital signature—involving the use ofsmart cards—network transmission of the coded document, document collectionand filing on optical supports in compliance with the laws and regulations
  • E Health Business Models

    1. 1. Identification of Best Practice eHealth Business Models<br />Methodology<br />Expert Vision on eHealthcare<br />Case Studies<br />Lorenzo Valeri<br />Koen Klokgieters<br />Daan Giesen<br />
    2. 2. Expert Vision – Results of Interviews <br />Interviewed Experts<br />General Results<br />Current eHealth challenges in Europe<br /><ul><li>Decline in available operational budget or re-allocation of funds towards other priorities
    3. 3. Complex national and international legislation
    4. 4. Lack of understanding of needs and interests of healthcare delivery staff and patients</li></ul>Provide stakeholders the real benefits of eHealth<br /><ul><li>Inclusion of affected healthcare professional in the overall development and delivery phase of an eHealth system
    5. 5. Comprehensive analysis of processes affected by eHealth
    6. 6. Involvement of health system independent researchers during eHealth system development</li></ul>Success factors in the health experience:<br /><ul><li>eHealth system development and implementationthroughphases
    7. 7. Increase the valuefor stakeholders with the system
    8. 8. Enable a positivechange to the healthcare service delivery
    9. 9. Usean‘Affiliated Business Model’ forfunding</li></ul>Evaluation<br /><ul><li>Collect ex ante/ex post baseline data to assess financial and operational sustainability
    10. 10. Moving beyond ROI/CBA, so also use soft/qualitative KPI’s
    11. 11. Stakeholder’s Usability</li></ul> Source: Findings from Expert Interviews<br />
    12. 12. To analyse case studies of sustainable eHealth Business Models we developed a four phased approach<br />eHealth Business Model Approach<br />I. Case Study Overview<br />II. Business Model Analysis per case study<br />IV. Comparison of eHealth Case Studies with Expert Insights<br />III. Impact of the Business Model change on the eHealth service <br />Identify the main drivers <br />for eHealth<br /><ul><li>Environment
    13. 13. Main drivers to change the business model
    14. 14. Solution
    15. 15. Key Success Factors</li></ul>Map the situation and <br />solution:<br /><ul><li>Market segment
    16. 16. Geographic position
    17. 17. Value Proposition (Offer)
    18. 18. Value Chain (care chain)</li></ul>eHealth Business <br />Model<br /><ul><li>Changes on the building blocks</li></ul>Effect of Value Proposition<br /><ul><li>Determine perceived value of the new offer</li></ul>Effect of Financial Performance<br /><ul><li>Business case insight</li></ul>Key Performance Indicators on: <br /><ul><li>Resources
    19. 19. Value Proposition
    20. 20. Client/Patient
    21. 21. Financial Performance</li></ul> Source: Capgemini Consulting Analysis<br />
    22. 22. A Business Model can be seen as a simplified representation of a system’s or service’s logic<br />2.1 Business Model Outline<br />Client (patient/user/doctor)<br />Offer<br />Resources<br />Cocreation<br />Relation<br />Key Activities<br />Key Resources<br />Channels<br />Value Proposition<br />Segments<br />Partner Network<br />Cost Structure<br />PROFIT<br />Revenu Streams<br />Financial Performance<br /> Source: Adapted from Alexander Osterwalder, Business Model Innovation<br />
    23. 23. The Business Model tries to indicate what the eHealth system/service offers to its clients, how patients/users/doctors are reached, what type of relationship is build, which resources are needed, and how sustainability is developed<br />2.1 Business Model Outline<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />What key activities do you need to perform and how easily can you do this?<br />What kind of relations does your patient/user/doctor expect and which kind do you maintain?<br />What can partners do to leverage your eHealth system/service (better, at lower cost)?<br />Which of you clients’ (patient/user/doctor) problems do you solve and which needs are satisfied?<br />What are your patients’, users’, doctors’ needs, problems, desires, and ambitions? <br />CHANNELS<br />KEY RESOURCES<br />Through which means do your clients want to be reached to leverage eHealthcare and which means do you utilize?<br />What key resources does your eHealth system/service require?<br />COST STRUCTURE<br />REVENUE STREAMS<br />What is the cost structure of your eHealth system/service and is this in line with the core values of the business model?<br />What value are your clients willing to pay for and what is the preferred payment mechanism?<br /> Source: Adapted from Alexander Osterwalder, Business Model Innovation<br />
    24. 24. Telemedescape is an electronic document managing system based on electronic signature-involving the use of smart card- and the collection, transmission and filing in compliance with all Italian required legislation<br /><ul><li>ULSS 9 Treviso provides healthcare services for 407.000 residents, scattered around 37 municipal authorities
    25. 25. It operates through 4 districts and with 4300 employees and professional convention with 500 healthcare specialists (GP and pediatricians)
    26. 26. ULSS 9 Treviso operates an hospital which comprise two separate structures (Treviso and Oderzo), that provide 70 operational units, 1272 beds and manage 54000 admission of which 13000 in day hospital</li></ul>Environment<br />Main drivers to change <br />Business Model<br /><ul><li>Dematerialisation of all documentations
    27. 27. Improvement in operational management
    28. 28. Towards electronic patient records
    29. 29. Digitalisation of documents produced by the Diagnostic Services of Laboratories/Radiology departments to be then forwarded to Internal Units/Wards
    30. 30. Digitisation of documents produced by the Diagnostic services of the Hospital of Treviso and forwarded to the six Socio-Healthcare districts of ULSS 9 of Treviso and to outpatients
    31. 31. In 2003, digitised documents were trasmissed to Postel (part of Italy Poste for the delivery of documents to individual citizens); Postel would print them and mail them
    32. 32. In 2008 individual citizens can register with Postel and download the digitally signed PDF document directly from the Internet</li></ul>Solution<br />Key Success Factors <br />Business Model<br /><ul><li>Increase the operational efficiency of the ULSSorganisation when it comes to diagnostic services leading to improvements in terms of reputation for quality and innovation
    33. 33. Provide an additional and convenient channels for the distribution of digital documents beyond the hospital
    34. 34. Improve the overall “quality” of the medical data while fostering overall security and privacy</li></li></ul><li>Telemescape has totally changed the way documents with test results are delivered by diagnostic centres to internal wards and to patients/citizens<br />Map the situation – Pre Telemescape<br />Define the solution - Telemescape<br /><ul><li>Clinical Information System</li></ul>Patient<br /><ul><li>ULSS 9 Treviso
    35. 35. Entire Veneto region
    36. 36. Cross regional (Programma Riuso)</li></ul>1<br />Patient<br />Doctor<br />Request/Performance of medical test<br /><ul><li>Electronic document managing system based on the digital signature</li></ul>Market Segment<br /><ul><li>Paper document management</li></ul>Hospital<br />Diagnostic Centre<br />Request/ Performance of medical test<br />Doctor<br />Internal Unit/Wards<br />Telemescape value chain<br />1<br />Electronic delivery<br />2<br />1<br />Hospital IT architecture (including electronic archives<br />2<br />Paper Result Delivery<br />Diagnostic Centre<br />Geographic position<br /><ul><li>ULSS 9 Treviso</li></ul>GP<br />Postel<br />Internet<br />Local health districts<br />Internal Unit/Wards<br />Physical archival<br />3<br />Archives<br />2<br />Value Proposition<br /><ul><li>Complex document management
    37. 37. Physical storage and archival</li></ul>Electronic access<br />3<br />Patient<br />Physical pickup of results by citizens<br />Patient<br />Hospital<br />
    38. 38. Telemescape has changed individual elements of the business models related to the delivery of clinical documents by ULSS 9 diagnostic centres <br /> eHealth Business Model (changes are marked in red)<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />CLIENT RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />Physical delivery of test results / Electronic delivery of test results<br />Physical access to test results in the hospital / Electronic access of test results by doctors and patients (channels)<br />Distant relation<br />Closer to needs of patients <br />Hospital wards<br />Diagnostic Tests<br />Postel/Postecom<br />High quality service<br />Efficiency and effectiveness <br />Electronic access and flexibility for citizens and doctors.<br />Doctors<br />GPs<br />Patients<br />Citizens<br />CHANNELS<br />KEY RESOURCES<br />Diagnostic centres infrastructure<br />Doctors<br />Patients<br />IT knowledge<br />Hospital structures Internet<br />Postel<br />GP’s<br />COST STRUCTURE<br />REVENUE STREAMS<br />Personnel<br />Direct cost (printing, etc.)<br />Education & Training<br />Change management <br />IT system integration<br />Evaluation<br />Indirect saving in direct and indirect costs<br />Potential revenues for electronic access to test results via Postecom (currently free  possibly monthly fee)<br /> Source:?<br />
    39. 39. Qualitative/quantitative benefits<br />Value Proposition<br />The progressive delivery of Telemescape since 2003 has led to signification financial savings, more efficiency in processes management and substantial social effects<br />Effect of the Value Proposition on Benefits<br />Benefits<br />Healthcare professionals<br /><ul><li>Improvements in clinical processes associated to test results: currently, an average of 7000 test results are digitally signed on a daily basis</li></ul>Citizens<br /><ul><li>Easiness in citizens’ access to test results; currently, 1600</li></ul> test results are downloaded (average 600.000 per year)<br />Differentiating<br />On Par<br />Dominating<br />Access<br /><ul><li>Fast access in case of loss of test result
    40. 40. Elimination of mistakes due to sending and receiving paper copies</li></ul>Service<br /><ul><li>Improved appropriateness of the therapeutic process
    41. 41. Establishing the first building block for the future “Electronic Patient Record” and new innovative services such as Farmescape
    42. 42. Fostering an image of “innovation”</li></ul>Facts and Figures<br />Organisational savings of EUR 636.650; in particular:<br /><ul><li>Savings due to staff reallocation: EUR 480.000
    43. 43. Savings due to less interactions between diagnostic tests hospital wards: EUR 100.000
    44. 44. Savings to due to cut in CAPEX costs (e.g. printing, envelops) EUR 41.650
    45. 45. Savings due to reuse of hospital areas used for physical storing: EUR 15.000
    46. 46. Improvements in interactions with citizens quantified in “social” savings:
    47. 47. Savings associated to less car trips for collecting test results: EUR 808.000
    48. 48. Savings associated to less trips via public transportation for collecting test results: EUR 15.000</li></li></ul><li>Centro UnicodiPrenotazione (CUP) (Umbria, Italy) is an electronic system through which patients can book/reschedule/cancel and pay for specialist visits/tests requested by GP or following an hospital stay<br />Identify the main drivers for eHealth<br /><ul><li>Booking/cancellation/rescheduling and payment by patient of specialised visit or tests following the request by the GP via contact point at hospitals, health local authorities and private or local authority pharmacies
    49. 49. Integration with Umbria’s local radiology information system, laboratory information system and hospital information system
    50. 50. Direct link with Italy’s Ministry of Economic and Finance</li></ul>Environment<br /><ul><li>Multichannel access for patients to book/cancell/rescheduling of specialised test or visit
    51. 51. Facilitation for rural areas
    52. 52. Efficiency in the collection of payments for test (tickets)
    53. 53. Financial incentives for the involvement of private pharmacies</li></ul>Main drivers to change <br />Business Model<br />Solution<br /><ul><li>Client/Server solution via regional Intranet solution managed by Umbria’s in-house IT company Webred
    54. 54. Actors involved: 2 Regional Hospitals (Perugia/Terni), 4 local health authorities (CittadiCastello, Perugia, Terni, Foligno) and 266 pharmacies (144 in rural areas, 122 in urban areas) and 487 specialist doctor or approved laboratories
    55. 55. Potential users: over ca. 880.000 citizens, of which 140.000 foreigners (650.000 in the Province of Perugia and 230.000 in the Province of Terni)
    56. 56. Direct involvement of all actors in the development of the system
    57. 57. Financial incentives for private pharmacies to link-up to the system
    58. 58. Centralised IT infrastructure
    59. 59. ITIL-aligned approach with IT support call centre (especially for private pharmacies) and for specific operational issues (e.g. suspension of booking by a single laboratory/diagnostic centre due to long waiting lists) </li></ul>Key Success Factors <br />Business Model<br /> Source: Webred Interview and Dr. Francesca Duranti, Owner of Tarpani Pharmacy, Perugia<br />
    60. 60. Through the direct involvement of 266 pharmacies and 15 GPs, Umbria’s regional health authorities have extended points of access for booking specialist visits in the entire region<br />Map the situation<br />Define the solution<br /><ul><li>Clinical Information System
    61. 61. Secondary Usage of non-clinical systems
    62. 62. Umbria
    63. 63. Central government-Ministry of Economics and Finance
    64. 64. Measurement of the effectiveness of health awareness campaigns
    65. 65. Decentralisation of the overall booking of visits and related payment</li></ul>Market Segment<br /><ul><li>Booking</li></ul>Diabetes care value chain (care chain)<br />Geographic position<br /><ul><li>Umbria</li></ul>Value Proposition<br /><ul><li>Centralisation of booking and payments of visit</li></ul> Source: Webred Interview and Dr. Francesca Duranti, Owner of Tarpani Pharmacy, Perugia<br />
    66. 66. CUP has extended the delivery channels for activities related to citizens’ booking of test or specialised visits<br />eHealth Business Model (changes are marked in red)<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />6 locations for booking/payment/reschedule/cancellation of lab.test/specialised visit/ 281locations<br />High quality service<br />Efficiency and effectiveness <br />Multiple access points especially for rural areas<br />Customer retention/additional revenues for pharmacies<br />Management of the results of health awareness campaigns<br />Distant relation<br />Closer to needs of patients <br />Hospital wards<br />Diagnostic Tests<br />144 Rural Pharmacies<br />122 Urban Pharmacies<br />15 GPS<br />Web (TBD)<br />Doctors<br />GPs<br />Patients<br />Pharmacies<br />CHANNELS<br />KEY RESOURCES<br />Hospital structures<br />Local Healthcare authorities<br />Pharmacies <br />GP’s<br />Diagnostic centres<br />Hospital/Local Health Authorities<br />Patients<br />Pharmacies<br />COST STRUCTURE<br />REVENUE STREAMS<br />Personnel<br />Direct cost (printing, etc…)<br />Education & Training for pharmacies<br />IT Call centre <br />IT system integration<br />IT support for pharmacies <br />Pharmacies: <br />2 EURO per booking<br />Better cash flow for pharmacies<br />Increased customer retention <br /> Source: ?<br />
    67. 67. Qualitative/quantitative benefits<br />Value Proposition<br />The redesigned value proposition increases value for hospitals and its stakeholders in terms of quality/quantity of care and related revenues for CUP Umbria<br />Effect of the Value Proposition on Benefits<br />Numbers of Transactions via CUP in 2008<br />Benefits<br /><ul><li>Easy access for the population
    68. 68. More customer retention for pharmacies/additional revenues
    69. 69. Online control of the situation
    70. 70. Management of waiting lists</li></ul>Differentiating<br />On Par<br />Dominating<br /><ul><li>Multichannelfor service delivery
    71. 71. Possibleextension to web-enabled services
    72. 72. Overcomingpotentialdifficultiesforrural areas and olderpeople
    73. 73. Possilibility of service extention
    74. 74. Vendor independent
    75. 75. Exploitation of the role of pharmacies as point of contact forhealthcaredelivery</li></ul>Facts and figures<br />Pharmacies:<br /><ul><li>Free service for patients (in other regions, for example, Lazio, patients have to pay for CUP-enabled booking)
    76. 76. 20% average sales increase per individual pharmacy even in light of stable number of booking (about average 250 per month leading to average of EUR 7500 yearly per pharmacy)
    77. 77. Incentives to pharmacies by Health local authorities in terms of transactions (EUR 2 per CUP-enabled individual transactions) and the necessary hardware/software (inclusive assistance)
    78. 78. Better cash management since payments are made through compensation (including fee paid by citizens for tests)</li></ul>Citizens: <br /><ul><li>Multiple location to access CUP even in rural areas
    79. 79. Less travel</li></ul>Local authorities<br /><ul><li>Better services to citizens
    80. 80. Centralised control
    81. 81. Flexibility in managing waiting lists and general financial cash flow
    82. 82. Towards a regional patient healthcare record infrastructure with the involvement of all stakeholders</li></li></ul><li>Example of CUP daily performance<br />Number of reservations<br />Cancellations<br />Payments<br />Immediate Payments<br />Delayed payments<br />Manual payments<br />Reinbursement<br />CUP Access points<br />Local authorities<br />Request for tests in day hospital<br />Request for tests in day hospital (paid)<br />Request for tests in day hospital (cancelled)<br />Request for tests in day hospital (free)<br />
    83. 83. Tactus organises asynchronous distance interaction between counselor and client through Tactive’sAlcoholdebaas.nl to treat alcoholic addicts<br />Identify the main drivers for eHealth<br /><ul><li>Tactus delivers care and treatment to addicts with alcohol, drugs, medicine, gambling, and eating problems
    84. 84. Especially alcoholic abuse has a stigma: people are ashamed; it is a taboo
    85. 85. Tactus performs 5,500 units of care per year and the 2007 result was €1,605,000 (budget of €57 mio)</li></ul>Environment<br /><ul><li>10% of all Alcoholics ever got help
    86. 86. Research pointed out that preventive actions should indicate better results
    87. 87. The behavioral change side of the treatment needs to be easily accessible</li></ul>Main drivers to change <br />Business Model<br /><ul><li>Structured asynchronous Internet treatment program (Tactive) with a focus on cognitive behavioral therapy through one-to-one counseling of a professional assistant:
    88. 88. Two-sided treatment (diagnostics & behavioral change)
    89. 89. Informative website
    90. 90. Forum for online contact with fellow-sufferers
    91. 91. Internet-based treatment (on a secured platform)
    92. 92. Aftercare chat module
    93. 93. Three executing organisations: Tactus, Mondriaan, and Symphora Group</li></ul>Solution<br /><ul><li>Research that underpins the benefits of the service, and gives opportunities to adjust
    94. 94. Personal counseling relation between professional assistant and alcoholic is key
    95. 95. Price from M&ICT of €650K
    96. 96. No transportation needed, freedom in time and place</li></ul>Key Success Factors <br />Business Model<br /> Source: Interview Hans Keizer, Tactive / Tactive Documentation<br />
    97. 97. Tactus has given its treatments an extra dimension: Tactive, that built an Internet application with TheFactor.e, made it possible to treat alcoholics online<br />Map the situation<br />Define the solution<br /><ul><li>Telemedicine – tele-consultation
    98. 98. Treatment on distance
    99. 99. Easter region of The Netherlands
    100. 100. The Internet is used to build stronger position in other Dutch areas</li></ul>Feedback<br /><ul><li>Deliver a total solution on treatment of addicts
    101. 101. Different treatments are possible (Internet vs. f2f)
    102. 102. Usable in every kind of addiction (alcohol, drugs, medicine, gambling, eating)</li></ul>Market Segment<br /><ul><li>Consultation
    103. 103. Providing a solution to alcoholics</li></ul>Forum<br />Informative website<br />Aftercare chat module<br />Internet-based treatment<br />Addict treatment value chain (care chain)<br />Local, regional, <br />national<br />government<br />Quality & Control; Subsidy<br />Treatment<br />Tactive <br />(Alchoholdebaas.nl)<br />Geographic position<br /><ul><li>Easter region of The Netherlands</li></ul>Provide treatment & care to clients<br />Tactus<br />Professional<br />Assistants<br />Knowledge<br />Local, regional, <br />national<br />government<br />Healthcare<br />Insurer<br />Tactus<br />Healthcare<br />Insurer<br />Value Proposition<br /><ul><li>Provide care and treatment to alcohol addicts</li></ul>Orders & Leads; Money<br />Professional<br />Assistants<br /> Source: Interview Hans Keizer, Tactive / Tactive Documentation<br />
    104. 104. Tactus has set up ‘Tactive’ as an eHealth Business Model for the provision of internet-based treatments for addicted people<br />eHealth Business Model (changes are marked in red)<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />Need-oriented relationship<br />Personal & Anonymous<br />Patient has the control over his/her own treatment<br />Give care & treatment<br />Supervise assistants<br />Provide addict care<br />Develop internet-based platform<br />Local, regional and national government<br />Tactus<br />TheFactor.e<br />Health insurer<br />Mondriaan<br />Symphora Group<br />Tactive online treatments<br />E.g. Alcoholdebaas.nl<br />Provide information, fellow-sufferer contact, treatment and aftercare assistance<br />Roll-out to other areas:<br /><ul><li>Gambling
    105. 105. Drugs
    106. 106. Eating
    107. 107. Medicine</li></ul>People with addicts<br />Desired knowledge and experience around addictions<br />Other target groups:<br /><ul><li>Anonymous patients
    108. 108. Policyholders
    109. 109. Companies
    110. 110. Self-payers</li></ul>Roll-out to other countries<br />CHANNELS<br />KEY RESOURCES<br />680 Prof. assistants<br />20-25 Prof. assistants<br />Knowledge on diagnostics & behavioral change<br />IT knowledge<br />Front-end IT system <br />Professional assistants<br />Health insurer<br />COST STRUCTURE<br />REVENUE STREAMS<br />Personnel – Professional assistants<br />Education & Training<br />Coaching on digital treatment<br />IT application: development and maintenance<br />Client fee: fixed fee + fee per hour for delivered treatment/care<br />Franchise fee<br />Resell of application to other countries<br /> Source: Interview Hans Keizer, Tactive / Tactive Documentation<br />
    111. 111. Qualitative/quantitative benefits<br />Value Proposition<br />The redesigned value proposition increases value for addicts in terms of quality/quantity of care and related revenues for Tactive and its stakeholders<br />Effect of the Value Proposition on Benefits<br />Benefits<br />In general<br /><ul><li>Compensation through health insurers
    112. 112. Reimbursements for addicts
    113. 113. Less failures in files of clients since these are online accessible to all
    114. 114. Increased effectiveness on method – patient empowerment</li></ul>Based on group of 903 clients<br /><ul><li>Less costs for consultation rooms
    115. 115. Less administrative costs in treatment care process – large part of diagnostic list is filled-in through the internet</li></ul>Differentiating<br />On Par<br />Dominating<br />Access<br /><ul><li>Anonymity as the key to success
    116. 116. Easy to access
    117. 117. Increased positivism on Internet treatment (overall 96% satisfied)
    118. 118. 5000 unique visitors per month – 700 forum members</li></ul>Product<br /><ul><li>36% has finished treatment
    119. 119. 61.2% starts with part II
    120. 120. Differentiation on different ways of care and treatment to addicts
    121. 121. After internet treatment, there is always a possibility to return to f2f treatment</li></ul>Facts and Figures<br />In general<br /><ul><li>Direct financial damage to the Dutch society is €2,58 bio
    122. 122. Service is scaled up to 2 other EU Member States</li></ul>Based on group of 903 clients<br /><ul><li>Less additional costs for ‘no shows’: -30%
    123. 123. Decrease in alcohol abuse (36.7 glasses  11.4 glasses)
    124. 124. Significant decrease in 10 of 12 alcohol-related symptoms</li></ul>Tactive<br /><ul><li>Investment of € 3-3.5 mio
    125. 125. Up scaling costs: €650K
    126. 126. Revenue per patient: €2,000,-
    127. 127. Profit per patient: €200,-</li></ul> Source: Interview Hans Keizer, Tactive / Tactive Documentation<br />
    128. 128. The DepartmentforPaediatricEndocrinology at UCLHwanted to createopportunities to control diabetes avoidingrenaldialysisor transplant needs<br />Identify the main drivers for eHealth<br /><ul><li>The Department for Paediatric Endocrinology at the University College London Hospital (UCLH) serves a target population of 2500 children and young people who need better access to information about their diabetes condition</li></ul>Environment<br /><ul><li>UK Government’sEveryChildMattersinitiative:giveyoungpeople the support theyneed
    129. 129. 85% of children and youngpeople in UK with Type 1 diabetes do not have itundercontrol
    130. 130. It is vitalthattheyunderstandhowmuch to take in order to regulate the level of blood glucose levelsso as to have a normalhealthylife</li></ul>Main drivers to change <br />Business Model<br /><ul><li>Cooperation between the NHS, GOSH, UCLH and Capgemini designed and implemented an e-Health technology in diabetes involving children and their parents
    131. 131. Upload blood glucose results directly to a system
    132. 132. Specialist modems in the home. These plug into blood sugar meters and automatically upload results
    133. 133. Results are available to clinicians, and to a specialized team of nurses</li></ul>Solution<br /><ul><li>System gives access to data, which can be analysed. Clinicians can proactively intervene, or simply call patients to give advice or guidance
    134. 134. Creates better care, and ultimately lowering average blood glucose resulting in less complications and fewer costs</li></ul>Key Success Factors <br />Business Model<br /> Source: Interview Prof. Hindmarsh – GOSH, UCLH & Capgemini documentation<br />
    135. 135. Through the system, UCLH provided better care, increased empowerment of patients/clinicians, and improved data access and quality on blood glucose<br />Map the situation<br />Define the solution<br /><ul><li>Homecare remote monitoring system
    136. 136. Adding value in the handling of diabetes
    137. 137. North London Paediatric Diabetes Service
    138. 138. London area; all UCLH hospitals & PCT’s cooperate
    139. 139. Deliver a total solution for young diabetes patients in order to monitor and act on their disease</li></ul>Market Segment<br /><ul><li>Hospitals
    140. 140. Providing a solution in diabetes</li></ul>NHS<br />Monitoring function<br />Quality & Control; Subsidy<br />Feedback<br />Monitoring function<br />Need-oriented<br />diabetes assistance<br />Diabetes care value chain (care chain)<br />Support in diabetes Type I; Young patients<br />Clinicians UCLH<br />Diabetes <br />nurses<br />GOSH<br />Knowledge<br />Knowledge<br />Homecare<br />Monitoring <br />system<br />Geographic position<br /><ul><li>Great Ormond Street Hospital (GOSH), part of UCLH</li></ul>Diabetes care knowledge<br />Clinicians<br />Diabetes<br />nurses<br />Quality & Control; Subsidy<br />Need-oriented diabetes assistance<br />IT Knowledge<br />Capgemini<br />NHS<br />iMetrikus<br />Value Proposition<br /><ul><li>Provide care to young diabetes patients</li></ul>Provide diabetes<br />care to clients<br />System/Service Knowledge<br />Feedback<br /> Source: Interview Prof. Hindmarsh – GOSH, UCLH & Capgemini documentation<br />
    141. 141. The eHealth service’s Business Model moves towards monitoring and preventing complications at young diabetes patients / children<br />eHealth Business Model (changes are marked in red)<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />Need-oriented relationship<br />Monitoring relation; more care in hands of the patient<br />Acquire knowledge & experience on diabetes<br />Consult diabetes patients<br />Provide diabetes care<br />Monitor diabetes patients<br />NHS (National Healthcare Service – publicly funded)<br />Capgemini<br />iMetrikus<br />GOSH<br />Diabetes care<br />Need for assistance during Type 1 Diabetes disease<br />Remote management model of care allowing patients to care more for themselves<br />Young patients / children with Type 1 Diabetes<br />Model of care beyond Diabetes<br />Desire knowledge and experience around diabetes<br />Will need enough information regarding the diabetes disease<br />CHANNELS<br />KEY RESOURCES<br />Staff<br />Knowledge on diabetes Type 1<br />Monitoring systems<br />Specialized modems<br />Diabetes nurses as channel to provide care<br />Data sharing through IT<br />COST STRUCTURE<br />REVENUE STREAMS<br />Personnel<br />Education & Training<br />Service Setup<br />Hardware purchase<br />Maintaining process / service<br />Consultation fee (nr. of consults per patient at a clinician)<br />Fee per hour for delivered diabetes care<br />Connection with medicine provider (fee)<br />License system (beyond diabetes)<br /> Source: Interview Prof. Hindmarsh – GOSH, UCLH & Capgemini documentation<br />
    142. 142. Qualitative/quantitative benefits<br />Value Proposition<br />The redesigned value proposition increases value for diabetica in terms of quality/quantity of care and related revenues for UCLH and its stakeholders<br />Effect of the Value Proposition on Benefits<br />Benefits<br />In general<br /><ul><li>Increased pro-active interventions
    143. 143. Increased personal treatment protocols
    144. 144. Less time needed to consult patients (nurses & clinicians)
    145. 145. Less acute escalations and complications at patients, and therefore less costs on their care</li></ul>Based on group of 2,500 young diabetic<br /><ul><li>Patients are more able to care for themselves, need less hospitalization and have better long-term health outcomes. That saves money, saves limbs, and saves lives
    146. 146. Less stress at patients / parents</li></ul>Differentiating<br />On Par<br />Dominating<br />Service<br /><ul><li>Increasequality of data
    147. 147. Improvedimmediacy & openness
    148. 148. Betteraccess to information</li></ul>Experience<br /><ul><li>Increased moments of patient contact but with less effort
    149. 149. Data is more granular (less measures on HbA1c - GlycatedHaemoglobin)
    150. 150. -1% in HbA1c leads to -30% complications
    151. 151. Transparency in diabetes process of young patients / children</li></ul>Facts and figures<br />Based on group of 2,500 young diabetic<br /><ul><li>Less costs for PCT’s (Primary Care Trust): £1.75 mio per year</li></ul>Based on all young diabetic in UK (200,000)<br /><ul><li>£20 mio in total savings</li></ul>Based on all diabetics in UK (1,000,000)<br /><ul><li>Potential cost reduction in complication costs: £2.2 bio - £2,200 per patient</li></ul> Source: Interview Prof. Hindmarsh – GOSH, UCLH & Capgemini documentation<br />
    152. 152. Naviva organizes maternity care by an Integrated Healthcare Information Network to increase the amount of healthcare to pregnant women<br />Identify the main drivers for eHealth<br /><ul><li>Naviva delivers high-quality maternity care
    153. 153. Naviva performs 10,000 units of care per year and has a market share of 70%
    154. 154. Naviva is praised by its quality of care, their regional presence, and their partnerships</li></ul>Environment<br /><ul><li>Due to free market system implementation in the Dutch healthcare, competition increased
    155. 155. Clients demand a better informed service and more transparency in the process
    156. 156. Naviva will loose market share when it is not extending its services to clients</li></ul>Main drivers to change <br />Business Model<br />Naviva developed and uses an integrated healthcare information network together with De Waarden to support pregnant women during their maternity time by:<br /><ul><li>Web portal for clients
    157. 157. Connection with ISK (national organization for maternity care)
    158. 158. Datasharing through ICT between Naviva, obstetricians, and maternity assistants
    159. 159. In the near future integrate with other network partners such as healthcare insurers</li></ul>Solution<br />Naviva’s new business model focuses on facilitating a user network on:<br /><ul><li>Different configuration of value to its patients
    160. 160. Better utilization of its partner network
    161. 161. Intensified contact with its patients, which changed the relation</li></ul>Key Success Factors <br />Business Model<br /> Source: Interview Anneke Dantuma - Naviva, documentation, Report Brand Doctors<br />
    162. 162. Through the network build, Naviva’s position strengthened and has possibility to connect and steer maternity care through its partners<br />Map the situation<br />Define the solution<br /><ul><li>Secondary usage of non-clinical system
    163. 163. Integrated regional healthcare information network
    164. 164. Easter region of The Netherlands
    165. 165. Move to use the network to build stronger position in other Dutch areas</li></ul>Feedback<br /><ul><li>Deliver a total network solution for high-quality maternity care</li></ul>Market Segment<br /><ul><li>Expected market growth.
    166. 166. Adding value in the process business of maternity care</li></ul>Youth health<br />care <br />Organization<br />Provide maternity <br />care to clients<br />Quality & Control; Subsidy<br />Feedback<br />Support during birth; Methods & Techniques<br />Need-oriented<br />maternity assistance<br />Maternity care value chain (care chain)<br />Support during birth; Methods & Techniques<br />Obstetrician<br />Obstetrician<br />Maternity <br />Assistants<br />Maternity care<br />Maternity care<br />Knowledge<br />Knowledge<br />Naviva<br />(Health <br />Network)<br />Geographic position<br /><ul><li>Easter region of The Netherlands</li></ul>Provide maternity <br />care to clients<br />Naviva<br />Maternity <br />Assistants<br />Need-oriented maternity assistance<br />Quality & Control; Subsidy<br />Orders & Leads; Money<br />Youth health<br />care <br />organization<br />Healthcare<br />Insurer<br />Healthcare<br />Insurer<br />Value Proposition<br /><ul><li>Provide high-quality maternity care</li></ul>Orders & Leads; Money<br /> Source: Interview Anneke Dantuma - Naviva, documentation, Report Brand Doctors<br />
    167. 167. Naviva’s eHealth Business Model moves towards providing an integrated healthcare network in order to assist pre- and post-phases of maternity<br />eHealth Business Model (changes are marked in red)<br />KEY PARTNERS<br />KEY <br />ACTIVITIES<br />VALUE PROPOSITION<br />RELATION<br />PATIENT / USER / DOCTOR SEGMENTS<br />Need-oriented relationship; they choose for Naviva because of their high-quality care<br />Value chain partners as linking pins<br />Give education/training<br />Supervise trainees<br />Provide maternity care<br />Develop health information network<br />Obstetricians<br />De Waarden-Maternity<br />Hospitals<br />Youth healthcare<br />High-quality maternity care.<br />Need for assistance during the end of pregnancy and birth-period<br />Pre-consult women<br />Allow information sharing during whole pregnancy time<br />Pregnant women that need maternity care after birth<br />Desire knowledge and experience around maternity<br />Will need enough information regarding the first weeks of a child<br />CHANNELS<br />KEY RESOURCES<br />650 Maternity assistants<br />Knowledge on maternity time<br />IT knowledge<br />Naviva has direct link to all stakeholders involved; they provide the channel (Information System)<br />COST STRUCTURE<br />REVENUE STREAMS<br />Personnel<br />Education & Training<br />IT system and knowledge<br />Fixed fee<br />Fee per hour for delivered maternity care<br />Revenues on network support<br /> Source: Interview Anneke Dantuma - Naviva, documentation, Report Brand Doctors<br />
    168. 168. Qualitative/quantitative benefits<br />Value Proposition<br />The redesigned value proposition increases value for pregnant women in terms of quality/quantity of care and related revenues for Naviva and its stakeholders<br />Effect of the Value Proposition on Benefits<br />Benefits<br />In general<br /><ul><li>Less administrative costs in maternity care process for all value chain stakeholders due to integrated process through IT network
    169. 169. -25%</li></ul>Based on group of 2,500 clients<br /><ul><li>Less costs for maternity assistants
    170. 170. -10%
    171. 171. Less costs for training and education because this can be done web-based
    172. 172. -25%</li></ul>Differentiating<br />On Par<br />Dominating<br />Experience<br /><ul><li>Increasedmoments of counseling & confidence
    173. 173. Increased self-regulation ability of patients
    174. 174. Betteraccess to information</li></ul>Service<br /><ul><li>High-quality product (maternity)
    175. 175. 98% of clients is satisfied with the service
    176. 176. Transparency in maternity care value chain</li></ul>Facts and figures<br />In general<br /><ul><li>Savings not related to client contact (administration, etc.) for total value chain (stakeholders)
    177. 177. 20%</li></ul>Naviva<br /><ul><li>Increased market share for Naviva in first up scaling period
    178. 178. 25%</li></ul> Source: Interview Anneke Dantuma - Naviva, documentation, Report Brand Doctors<br />
    179. 179. Relation between results from expert interviews and analysis on case studies<br />Expert Insights<br />Case Study Analysis<br />Current eHealth challenges in Europe<br /><ul><li>Decline in available operational budget or re-allocation of funds towards other priorities
    180. 180. Complex national and international legislation
    181. 181. Lack of understanding of needs and interests of healthcare delivery staff and patients</li></ul>Provide stakeholders the real benefits of eHealth<br /><ul><li>Inclusion of affected healthcare professional in the overall development and delivery phase of an eHealth system
    182. 182. Comprehensive analysis of processes affected by eHealth
    183. 183. Involvement of health system independent researchers during eHealth system development</li></ul>Success factors in the health experience:<br /><ul><li>eHealth system development and implementationthroughphases
    184. 184. Increase the valuefor stakeholders with the system
    185. 185. Enable a positivechange to the healthcare service delivery
    186. 186. Usean‘Affiliated Business Model’ forfunding</li></ul>Evaluation<br /><ul><li>Collect ex ante/ex post baseline data to assess financial and operational sustainability
    187. 187. Moving beyond ROI/CBA, so also use soft/qualitative KPI’s
    188. 188. Stakeholder’s Usability</li></ul>Case studies have indicated:<br /><ul><li>Research as an important factor in development
    189. 189. Evidence–based success factors in several services
    190. 190. Used several phases to implement system
    191. 191. Cases score very high on security, privacy, and safety issues</li></ul>Provide stakeholders the real benefits of eHealth<br /><ul><li>Different stakeholders involved throughout the process
    192. 192. Customized treatment
    193. 193. Examination of operational processes
    194. 194. Nothing known on involvement of health system research</li></ul>Success factors in the health experience:<br /><ul><li>All cases achieved cost-effectiveness
    195. 195. All cases increased value for stakeholders (soft KPI’s)
    196. 196. All cased added value to the healthcare arena
    197. 197. New and innovative business models for funding</li></ul>Evaluation<br /><ul><li>Return On Investment / Cost effectiveness
    198. 198. Usability (patient/user perspective)
    199. 199. Soft KPI’s – treatment satisfaction</li></ul> Source: Capgemini Consulting Analysis<br />
    200. 200. LORENZO VALERI<br />Research Leader <br />RAND Europe<br />lvaleri@rand.org<br />DAAN GIESEN<br />Business Innovation Consultant<br />Capgemini Consulting<br />daan.giesen@capgemini.com<br />KOEN KLOKGIETERS<br />Vice President Business Innovation<br />Capgemini Consulting<br />koen.klokgieters@capgemini.com<br />

    ×