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E Health Business Models

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  • 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

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