E Health Business Models

Identification of Best Practice eHealth Business Models
Methodology
Expert Vision on eHealthcare
Case Studies
Lorenzo Valeri
Koen Klokgieters
Daan Giesen

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
Complex national and international legislation
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
Comprehensive analysis of processes affected by eHealth
Involvement of health system independent researchers during eHealth system development
Success factors in the health experience:
eHealth system development and implementationthroughphases
Increase the valuefor stakeholders with the system
Enable a positivechange to the healthcare service delivery
Usean‘Affiliated Business Model’ forfunding
Evaluation
Collect ex ante/ex post baseline data to assess financial and operational sustainability
Moving beyond ROI/CBA, so also use soft/qualitative KPI’s
Stakeholder’s Usability
Source: Findings from Expert Interviews

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
Main drivers to change the business model
Solution
Key Success Factors
Map the situation and
solution:
Market segment
Geographic position
Value Proposition (Offer)
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
Value Proposition
Client/Patient
Financial Performance
Source: Capgemini Consulting Analysis

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

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

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
It operates through 4 districts and with 4300 employees and professional convention with 500 healthcare specialists (GP and pediatricians)
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
Improvement in operational management
Towards electronic patient records
Digitalisation of documents produced by the Diagnostic Services of Laboratories/Radiology departments to be then forwarded to Internal Units/Wards
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
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
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
Provide an additional and convenient channels for the distribution of digital documents beyond the hospital
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
Entire Veneto region
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
Physical storage and archival
Electronic access
3
Patient
Physical pickup of results by citizens
Patient
Hospital

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
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:?

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
Elimination of mistakes due to sending and receiving paper copies
Service
Improved appropriateness of the therapeutic process
Establishing the first building block for the future “Electronic Patient Record” and new innovative services such as Farmescape
Fostering an image of “innovation”
Facts and Figures
Organisational savings of EUR 636.650; in particular:
Savings due to staff reallocation: EUR 480.000
Savings due to less interactions between diagnostic tests hospital wards: EUR 100.000
Savings to due to cut in CAPEX costs (e.g. printing, envelops) EUR 41.650
Savings due to reuse of hospital areas used for physical storing: EUR 15.000
Improvements in interactions with citizens quantified in “social” savings:
Savings associated to less car trips for collecting test results: EUR 808.000
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
Integration with Umbria’s local radiology information system, laboratory information system and hospital information system
Direct link with Italy’s Ministry of Economic and Finance
Environment
Multichannel access for patients to book/cancell/rescheduling of specialised test or visit
Facilitation for rural areas
Efficiency in the collection of payments for test (tickets)
Financial incentives for the involvement of private pharmacies
Business Model
Solution
Client/Server solution via regional Intranet solution managed by Umbria’s in-house IT company Webred
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
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)
Direct involvement of all actors in the development of the system
Financial incentives for private pharmacies to link-up to the system
Centralised IT infrastructure
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

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
Secondary Usage of non-clinical systems
Umbria
Central government-Ministry of Economics and Finance
Measurement of the effectiveness of health awareness campaigns
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

CUP has extended the delivery channels for activities related to citizens’ booking of test or specialised visits
KEY PARTNERS
KEY
ACTIVITIES
VALUE PROPOSITION
RELATION
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: ?

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
Numbers of Transactions via CUP in 2008
Benefits
Easy access for the population
More customer retention for pharmacies/additional revenues
Online control of the situation
Management of waiting lists
Differentiating
On Par
Dominating
Multichannelfor service delivery
Possibleextension to web-enabled services
Overcomingpotentialdifficultiesforrural areas and olderpeople
Possilibility of service extention
Vendor independent
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)
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)
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)
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
Less travel
Local authorities
Better services to citizens
Centralised control
Flexibility in managing waiting lists and general financial cash flow
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)

Tactus organises asynchronous distance interaction between counselor and client through Tactive’sAlcoholdebaas.nl to treat alcoholic addicts
Tactus delivers care and treatment to addicts with alcohol, drugs, medicine, gambling, and eating problems
Especially alcoholic abuse has a stigma: people are ashamed; it is a taboo
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
Research pointed out that preventive actions should indicate better results
The behavioral change side of the treatment needs to be easily accessible
Business Model
Structured asynchronous Internet treatment program (Tactive) with a focus on cognitive behavioral therapy through one-to-one counseling of a professional assistant:
Two-sided treatment (diagnostics & behavioral change)
Informative website
Forum for online contact with fellow-sufferers
Internet-based treatment (on a secured platform)
Aftercare chat module
Three executing organisations: Tactus, Mondriaan, and Symphora Group
Solution
Research that underpins the benefits of the service, and gives opportunities to adjust
Personal counseling relation between professional assistant and alcoholic is key
Price from M&ICT of €650K
No transportation needed, freedom in time and place
Key Success Factors
Business Model
Source: Interview Hans Keizer, Tactive / Tactive Documentation

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
Treatment on distance
Easter region of The Netherlands
The Internet is used to build stronger position in other Dutch areas
Feedback
Deliver a total solution on treatment of addicts
Different treatments are possible (Internet vs. f2f)
Usable in every kind of addiction (alcohol, drugs, medicine, gambling, eating)
Market Segment
Consultation
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
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

Tactus has set up ‘Tactive’ as an eHealth Business Model for the provision of internet-based treatments for addicted people
KEY PARTNERS
KEY
ACTIVITIES
VALUE PROPOSITION
RELATION
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:
Gambling
Drugs
Eating
Medicine
People with addicts
Desired knowledge and experience around addictions
Other target groups:
Anonymous patients
Policyholders
Companies
Self-payers
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
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

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
Benefits
In general
Compensation through health insurers
Reimbursements for addicts
Less failures in files of clients since these are online accessible to all
Increased effectiveness on method – patient empowerment
Based on group of 903 clients
Less costs for consultation rooms
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
Easy to access
Increased positivism on Internet treatment (overall 96% satisfied)
5000 unique visitors per month – 700 forum members
Product
36% has finished treatment
61.2% starts with part II
Differentiation on different ways of care and treatment to addicts
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
Service is scaled up to 2 other EU Member States
Based on group of 903 clients
Less additional costs for ‘no shows’: -30%
Decrease in alcohol abuse (36.7 glasses  11.4 glasses)
Significant decrease in 10 of 12 alcohol-related symptoms
Tactive
Investment of € 3-3.5 mio
Up scaling costs: €650K
Revenue per patient: €2,000,-
Profit per patient: €200,-

The DepartmentforPaediatricEndocrinology at UCLHwanted to createopportunities to control diabetes avoidingrenaldialysisor transplant needs
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
85% of children and youngpeople in UK with Type 1 diabetes do not have itundercontrol
It is vitalthattheyunderstandhowmuch to take in order to regulate the level of blood glucose levelsso as to have a normalhealthylife
Business Model
Cooperation between the NHS, GOSH, UCLH and Capgemini designed and implemented an e-Health technology in diabetes involving children and their parents
Upload blood glucose results directly to a system
Specialist modems in the home. These plug into blood sugar meters and automatically upload results
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
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

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
Adding value in the handling of diabetes
North London Paediatric Diabetes Service
London area; all UCLH hospitals & PCT’s cooperate
Deliver a total solution for young diabetes patients in order to monitor and act on their disease
Market Segment
Hospitals
Providing a solution in diabetes
NHS
Monitoring function
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
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

The eHealth service’s Business Model moves towards monitoring and preventing complications at young diabetes patients / children
KEY PARTNERS
KEY
ACTIVITIES
VALUE PROPOSITION
RELATION
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
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)

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
Benefits
In general
Increased pro-active interventions
Increased personal treatment protocols
Less time needed to consult patients (nurses & clinicians)
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
Less stress at patients / parents
Differentiating
On Par
Dominating
Service
Increasequality of data
Improvedimmediacy & openness
Betteraccess to information
Experience
Increased moments of patient contact but with less effort
Data is more granular (less measures on HbA1c - GlycatedHaemoglobin)
-1% in HbA1c leads to -30% complications
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

Naviva organizes maternity care by an Integrated Healthcare Information Network to increase the amount of healthcare to pregnant women
Naviva delivers high-quality maternity care
Naviva performs 10,000 units of care per year and has a market share of 70%
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
Clients demand a better informed service and more transparency in the process
Naviva will loose market share when it is not extending its services to clients
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
Connection with ISK (national organization for maternity care)
Datasharing through ICT between Naviva, obstetricians, and maternity assistants
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
Better utilization of its partner network
Intensified contact with its patients, which changed the relation
Key Success Factors
Business Model
Source: Interview Anneke Dantuma - Naviva, documentation, Report Brand Doctors

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
Integrated regional healthcare information network
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.
Adding value in the process business of maternity care
Youth health
care
Organization
Provide maternity
care to clients
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
Provide maternity
care to clients
Naviva
Maternity
Assistants
Need-oriented maternity assistance
Youth health
care
organization
Healthcare
Insurer
Healthcare
Insurer
Value Proposition
Provide high-quality maternity care

Naviva’s eHealth Business Model moves towards providing an integrated healthcare network in order to assist pre- and post-phases of maternity
KEY PARTNERS
KEY
ACTIVITIES
VALUE PROPOSITION
RELATION
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
IT system and knowledge
Fixed fee
Fee per hour for delivered maternity care
Revenues on network support

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
Benefits
In general
Less administrative costs in maternity care process for all value chain stakeholders due to integrated process through IT network
-25%
Based on group of 2,500 clients
Less costs for maternity assistants
-10%
Less costs for training and education because this can be done web-based
-25%
Differentiating
On Par
Dominating
Experience
Increasedmoments of counseling & confidence
Increased self-regulation ability of patients
Betteraccess to information
Service
High-quality product (maternity)
98% of clients is satisfied with the service
Transparency in maternity care value chain
Facts and figures
In general
Savings not related to client contact (administration, etc.) for total value chain (stakeholders)
20%
Naviva
Increased market share for Naviva in first up scaling period
25%

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
Complex national and international legislation
Lack of understanding of needs and interests of healthcare delivery staff and patients
Inclusion of affected healthcare professional in the overall development and delivery phase of an eHealth system
Comprehensive analysis of processes affected by eHealth
Involvement of health system independent researchers during eHealth system development
eHealth system development and implementationthroughphases
Increase the valuefor stakeholders with the system
Enable a positivechange to the healthcare service delivery
Usean‘Affiliated Business Model’ forfunding
Evaluation
Collect ex ante/ex post baseline data to assess financial and operational sustainability
Moving beyond ROI/CBA, so also use soft/qualitative KPI’s
Stakeholder’s Usability
Case studies have indicated:
Research as an important factor in development
Evidence–based success factors in several services
Used several phases to implement system
Cases score very high on security, privacy, and safety issues
Different stakeholders involved throughout the process
Customized treatment
Examination of operational processes
Nothing known on involvement of health system research
All cases achieved cost-effectiveness
All cases increased value for stakeholders (soft KPI’s)
All cased added value to the healthcare arena
New and innovative business models for funding
Evaluation
Return On Investment / Cost effectiveness
Usability (patient/user perspective)
Soft KPI’s – treatment satisfaction
Source: Capgemini Consulting Analysis

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

E Health Business Models

by Daan Giesen

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