Digital Health Webinar Highlights Portugal's Progress

Webinar
Tues, June 2nd, 11am IL
https://bit.ly/2BdrUos
Ana Gomes
Fidelidade
Micaela Seeman
Jose de Mello Saude
Adalberto Fernandes
ex-Health Minister
Margarida Bajanca
New Angle
Rui Costa
GE Healthcare
Henrique Martins
SPMS

AGENDA
11:00 - 11:05 Welcome- Levi Shapiro, mHealth Israel
11:05 -11:15 Overview: Margarida Bajanca, CEO, New Angle
11:15 - 11:35 Adalberto Fernandes, ex-Health Minister
11:35 - 11:50 Henrique Martins, ex-President SPMS
11:50 - 12:05 Ana Rita Gomes, Head of Multicare Business, Fidelidade
12:05 - 12:20 Micaela Seeman Monteiro, Jose de Mello Saude, Chief Medical Officer
for Digital Transformation, Jose de Mello Saude
12:20 - 12:35 Rui Costa, General Manager- Portugal, GE Healthcare

14%
12%
11%
9%
7%
10%
9%
9%
8% 7%
0%
5%
10%
15%
2014 2015 2016 2017 2018
Unemployment Rate PT vs UE28 (1)
Portugal UE28
(1) Relatório Banco de Portugal – Boletim Económico 2019; (2) INE – Conta Satélite da Saúde, PORDATA
•
•
•
•
0,8%
1,8% 2,0%
3,5%
2,6%
1,8%
2,3% 2,0% 2,4%
1,9%
0,0%
1,0%
2,0%
3,0%
4,0%
0
50.000
100.000
150.000
200.000
250.000
2014 2015 2016 2017 2018 Pro
(€ Millions)
GDP PT GDP PT Growth GDP UE28 Growth

•
•
•
•
Portugal UE 28
44.8 anos
43.1 anos
0-14
14%
15-64
64%
+ 65
22%
(1) INE – Conta Satélite da Saúde, PORDATA; (2) State of Health in the EU Portugal - Perfil de saúde do país 2019 ; (3) Relatório “Retrato da Saúde 2018” – SNS; (4) : Pordata; DGS, 2016
5 main diseases causing morbidities
1st 2nd 3rd 4th 5th
15-49 years
(Women)
Back pain Migrain Depression Skin diseases Anxiety
15-49 years
(Men)
Back pain Skin diseases Migrain Depression HIV/AIDS

✓
✓
✓
0,9%
3,3%
4,5%
3,6%
5,1%
0,0%
1,0%
2,0%
3,0%
4,0%
5,0%
6,0%
14.000.000
15.000.000
16.000.000
17.000.000
18.000.000
19.000.000
2014 2015 2016 2017 2018
Valor Absoluto Variação Homóloga
Families 27,5% 5,02kM€
Private Subsystems 1,1% 0,20kM€
Health Insurances 4,2% 0,77kM€
Others (Privates) 0,7% 0,16kM€
66,5% Public
NHS 57.2% 10,48kM€
Public Subsystems 4.0% 0,73kM€
Others (Publics) 5.3% 0,98kM€
33,5% Private
•
•
•

42,60%
27,50%
15,40%
0% 10% 20% 30% 40% 50%
Hospitais
Prestadores em ambulatório
Farmácias
•
•
•
119
107
4
H. Públicos H. Privados PPP
52% 46%
2%
24.050
10.903
Camas em H. Públicos Camas em H. Privados
31%69%

40%
60%
2018
Individual Group
Public Healthcare
Subsystems
Private Healthcare
Subsystems
•
(1) ADSE – Civil servants subsystem. Other public subsystems include SAD-PSP, GNR and IASFA-ADM (Police and Militaries); (2) -SAMS – Private banks employees subsystems, managed by several Unions;
(3) Websites and management reports of the entities; (4) APS- Associação Portuguesa de Seguradores - ESTATÍSTICA DO SEGURO DE SAÚDE & INDICADORES DE GESTÃO SAÙDE

Source: Healthcare in Transition - Portugal, 2011

Health System Innovation Trends & Focus
Portugal, the “new silicon valley” of Digital Health:
Henrique Martins, MD PhD
Univ. Prof, Independent Consultant,
Ex President of SPMS and Past co-chair EU
eHealthNetwork
www.henriquemartins.eu
Henrique@henriquemartins.eu

Digital Health in Portugal
the “new silicon valley for digital health”
• Existing “basic building blocks of digital health”
• Culture and dynamic & Need to invest – green field or “renewal” areas
• Enablers for new projects/companies
• Digital Healthcare Systems and Digital Patients
Needed healthcare system paradigm change
Henrique Martins, MD PhD, Univ. Prof, Independent Consultant,
Ex President of SPMS, Portugal’s eHealth Agency, and Past co-chair of the EU eHealth Network; www.henriquemartins.eu email: Henrique@henriquemartins.eu

02/06/2020 3
European Directives - EC Communication
Brussels, 25.4.2018
Communication from the Commission to the European Parliament, The
Council, the European Economic and Social Committee of the regions on
enabling the digital transformation of health and care in the Digital Single
Market; empowering citizens and building a healthier society
The Communication contains a package of legislative & non-legislative proposals
with the aim of supporting Member States action on eHealth to:
1
2
3
Access and Sharing of Eletronic Health Records for citizens
Connected health data to advance research, prevention and personalised
health and care
Digital tools to foster citizen empowerment and person-centred care

02/06/2020 4
Citizen Life Cycle

2016-10-06 5
Portuguese Ministry of Health
Clinical
Guidance
Financial and
ruler
Technical
implementation
Portuguese Ministry of Health – Entities

02/06/2020 6
National Strategy for the Health Information Ecosystem 2020
Strategic Principles and Objectives:
 …principle of transparency and open data, proactive management of the value of
health data, and promotion of a new knowledge-based knowledge economy;
 …principle of centrality in the citizen;
 …principle of data portability (...) adoption of the Mobile Health / mHealth concept;
 Promotion of interoperability (...)
 Adoption of a comprehensive governance model (...)
Council of Ministers Resolution n.º 62/2016
http://enesis.spms.min-saude.pt/

22/11/2018 7
Clinical Terminology Centre
http://spms.min-saude.pt/product/ctc-pt/
COMUNICATION COMUNICATION COMUNICATION
Technical Interoperability

22/11/2018
SPMS - , E.P.E.
www.spms.min-saude.pt
Shared Services for Ministry of Health
8
Clinical Terminology Centre - Services

02/06/2020
SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E.
9
Some Flagship National Projects
Paperless Prescription
eDeath Certification
National Epidemiological
Surveillance System

2016-10-06 10
A single patient record supporting clinical decision making
Aggregate data to make it omni-available in a safe way.

02/06/2020 11
Professional Portal - Clinical Episodes Timeline
The Professional
area has been
visualized by more
than 60.000
professionals,
integrates around
600 databases and
accounts for an
average of 130.000
daily views.

02/06/2020
12
Citizen Portal
Citizen Portal
www.sns.gov.pt/cidadao
> 2.5 M eCitizens (2020)

02/06/2020 13
Citizen Portal - National eID (and mobile ID)

02/06/2020 14
Patient Summary
Minimum set of essential information for health professionals, whenever there is a
need for urgent or scheduled care in a national or foreign health entity;
• Identification of the patient, health unit and family doctor
• Allergies
• Chronic Medication
• Vaccines
• Medical and Nursing Diagnostics
• Medical procedures
• Medical Devices
• Single location of essential information for health professionals
• Scheduled care at a national health entity
• Customer service abroad
• The Citizen can transport his / her minimum essential information for the
provision of health care
• Abroad, the health professional can consult the minimum information for the
provision of health care, with the authorization of the Citizen

02/06/2020 15
MyNHS Apps
MySNS
214 306
Downloads*
MySNS Tempos
57 571
Downloads*
MySNS Carteira
240 279
Downloads*
* Data 26.10.2018

20/01/2017 16
MySNS – Wallet: Your Health Record in your pocket
Treatment Guide
ADSE Card
eVital will
Vaccines
Physical Activity
CARDS
Partial dispensation
Medication alert on mobile calendar
Portability
Security
Tailoring
Integration with smartphones features
ADVANTAGES

Paperless Prescription
National level Drug-to-Drug, Drug-to.Disease
Inteactions
i-Prescription -Intelligent Prescription
automated and automatically generated
prescription
PROMS (Patient Reported Outcomes Mesurements) –
Based dose adjustment
Implementation of the paperless prescription for all the type of medicines /
Target of 100% for paperless Prescription;
Drug-to-Alergy Interaction
Develop digital technology to the access of the treatment guide (mySNS Wallet;
Online Portal, NEW SMSs);
Kick off of the project ePrescription and eDispensation for Cross Border
Services;
Strategic Objectives

Overview – Paperless Prescription
736 676 203
Total of emited
paperless
prescription for
medicine package*
151 924 945
Total of emited
paperless
prescriptions*
10 293 187
Patients with at least
one paperless
prescription*
483 219 761
Total of medicine packages
dispensed with paperless
prescription*
2 942
Pharmacies that have
dispensed paperless
prescription*
98 238 621
Total of paperless
prescriptions in
NHS*
*30/06/2019

LEDTS – Linhas Estratégicas para o Desenvolvimento da
Telessaúde
As LEDTS têm como objetivo criar uma visão estratégica global que aborde os
principais blocos de desafios identificados e manter um alinhamento da estratégia
europeia e nacional no setor da saúde.
20

Mobile Prescription – Overview (over 9000 doctors
have used)
Available since 20th February 2019;
Strong Authentication and digital signature thru
Digital Mobile Key;
Mobility for physicians and patients;
Secure and fast prescription;
Interactive PRESCRIPTION AND DISPENSATION
96 953
Total of emited
paperless
prescription
217 532
Total of medicine
packages

SNS 24 – WEBSITE
Analytics
400 987 users
531 744 acesses*From 18/01/2019 until
30/06/2019
66,2%
Mobile
31,2%
Desktop
2,6%
Tablet

SNS 24 – WEBSITE
Symptom Checker
Initiated with the FLU
algorithm
37 706 page views
18 590 started the flow - Flu
*From 18/01/2019 until
16/05/2019

SNS 24 – WEBSITE
Next steps
New
Contents
New
Symptoms
New themes | Guides | Online services
Development and implementation of new clinical algorithms in the
symptom checker
Total Integrate
Integration of the site with the Contact Center
Implementation of a Chat Bot in the website
AI & Chat Bot

6/6/2019
25
CONSULTA
PÚBLICA

Digital Healthcare Systems
and Digital Patients
• Vision...
• Preventive, paperless, empowering, personalised, and accountable.
Digital healthcare strengths lay not in technology but rather that
digital technology will be present in processes, professionals and
people, in ways such that everyone can be a healthcare creator.
He/she can be a prevention specialist; care for him/herself and family
with the best scientific support; access digital therapeutics by default.
Moving to any form of needed physical care, drug therapy, surgery,
hospital admission, or ventilation support, etc, as last resource

• Basis of DHS...
• •First, healthcare transformation – of processes, professionals and patients,
alternatively, of the care philosophy, interprofessional collaboration and of
health-aware citizens.
• •Second, significant investment in rethinking any need for physical interaction –
even before COVID-19 crisis we should protect frail citizens from nosocomial
infections, unnecessary travel, cost and suffering – Tele-health is the new health.
• •Third, security of data, privacy and interoperability – The basis of trust,
necessary for the new social contract required for using advanced population-
based digital tools or for Robotic professionals to step-in where humans are at
risk, not enough, or where human-robot hybrids outperform both.
• •Fourth, motivation – Rethinking healthcare systems worldwide was already
needed. 2020 gave us extra motivation, especially if we now better understand
why a digital-based healthcare system is desperately needed.

• Digital Patient
• Digital patient is a double sided concept.
• On one hand digital patients are those who will progressively be connected, sometimes
for life (see examples of brain electrodes implants) to digital technologies, or wear them
so close to heart and skin that they feel ultimately connected. Digital patients are us, as
we increasingly measure our health, wellness, and now with track apps, the health of
others around our physical proximity spaces. Bluetooth zone around our phone is likely
to become our new digital skin.
• Digital patients are also humans suffering from, what I call as a physician Internist, a new
category of systemic diseases - Digital Sickness. Under which, one can find, for example,
digital obesity, digital dependency syndromes like restlessness, anxiety and irritation
from lack of immediate access to wifi/internet resources. Our sadness and depressive
symptomatology for lack of likes and comments in social media.

Digital Health in Portugal
the “new silicon valley for digital health”
CONCLUSIONS:
- PORTUGAL has built important “basic building blocks of digital health”
- There is a Culture and dynamic & Need to invest
- Enablers for new projects/companies
• National tele-health plan, financing models, Broad-band and digital savvy patients,
100% mobile Prescription, full interoperable national HER
NEW WAYS of thinking Digital Health in Portugal and Worldwide
• Digital Healthcare Systems and Digital Patients
Needed (“post-COVID”) healthcare system paradigm change

Thank you!
Any Questions
now
or via
Henrique@henriquemartins.eu

1
T-GMK-04 (5)
HEALTH INSURANCE OVERVEW
Rita Gomes, Business Development Director
Webinar mHealth Israel
2nd June 2020
T-GMK-04 (5)

2
37.2% market share covering over 1
Million customers
Distinctions
Innovation
#1 HEALTH INSURANCE IN PORTUGAL
+20 years of experience
2016: Oncology insurance cover
2009: Focus on prevention with free check ups
Telemedicine in partnership with Teladoc

3
T-GMK-04 (5)
OVERVIEW
Health
Insurance
Market
01

4
T-GMK-04 (5)
HEALTH FUNDING AND INSURANCE MARKET
H e a l t h i n s u r a n c e m a r k e t h a s b e e n g r o w i n g
s u s t a i n a b l y a t 8 % a n d a c c o u n t s ~ 8 8 0 M €
Portuguese health insurance premiums (M€)
589
694
2014 201920172015
751
2016 2018
877
633
809
+8%
18,345 M€
9,1% GDP
63%
6%
27%
State
Sub-systems
4%
Private Insurance
Out-of-pocket
Portuguese healthcare funding (M€; 2018)
Source: INE 2018; APS (Portuguese Insurers Association) and ASF (Portuguese Insurance Supervisory)

5
T-GMK-04 (5)
H e a l t h i n s u r a n c e g r o w t h h a s b e e n f u e l l e d b y t h e
i n c r e a s e d a v a i l a b i l i t y o f p r i v a t e h e a l t h c a r e o f f e r
GROWTH DRIVERS AND VALUE PROPOSITION
Reinforcement and
improvement of private
healthcare offer
Reinforcement of insurance
as complementary of public
healthcare investment
Reinforcement of
health insurance as
an employee benefit
HEALTH INSURANCE VALUE PROPOSITION
Reduced times
for consultations
and treatments
Quality of
service with
value-added
services
Freedom of
choice among
wide providers
network
Ease of access
to private
healthcare
providers
MAIN GROWTH DRIVERS

6
T-GMK-04 (5)
M a r k e t i s c o n c e n t r a t e d w i t h t o p 3 a c c o u n t i n g f o r
> 7 5 % , l e a d b y M u l t i c a r e a P o r t u g u e s e p l a y e r
TOP HEALTH INSURANCE COMPANIES
Source: APS; Dec. 2019
Multicare
(Fidelidade)
37,2%
Médis
(Ageas)
28,9%
Generali (including
Seguradoras Unidas)
12,0%
Allianz
7,7%
Victoria
3,7%
Outros
13,5%
Market Share
(Premiums %; 2019)

7
T-GMK-04 (5)
DIGITAL
HEALTH
Mega trends
and insurers’
response
02

8
T-GMK-04 (5)
MEGA TRENDS SHAPING HEALTH INSURANCE
T h r e e m e g a t r e n d s a r e s h a p i n g t h e i n d u s t r y a n d
f o s t e r i n g t h e o p p o r t u n i t y f o r d i g i t a l h e a l t h
Health costs are
steadily increasing
Behaviours
are changing
Personalised medicine
& AI can disrupt health
insurance model
• Ageing
• Physical activitity & overweight
• Impact of chronic diseases
• Costly new treatments
• More demanding and empowered
• Tech savvy and use sharing economy
• Lack of time
• Require transparency
• Healthcare is ever more complex,
expensive and personalized
• AI is expected to be the next
industrial revolution
Trends
Newhealth
insuranceage
Enabling technologies can make health / aging more sustainable
“Plug & Play”
Customer
centric

9
T-GMK-04 (5)
HOLISTIC APPROACH TO RISK MANAGEMENT
T h i s c o n t e x t r e q u i r e s i n s u r e r s t o c h a n g e f r o m
c l a i m s p a y e r t o h e a l t h p a r t n e r a n d p r e v e n t e r
Source: Adapted from World Insurance Report 2019 from Cap Gemini
EVALUATOR:
From risk taker to
risk assessment
PREVENTER:
Proactively take a role to
reduce risk exposure
PARTNER: Compelling
value-added services to
stay healthy or improve
health status

10
T-GMK-04 (5)
DIGITAL INITIATIVES TOWARDS A NEW POSITIONING
M u l t i c a r e e m p h a s i s o n p r e v e n t i o n h a s b e e n
l o n g s t a n d i n g a n d g r o w i n g
PREVENTER - Prevention and primary care
TELEMEDICINEBEHAVIOR MODIFICATIONWELLNESS (BODY+MIND)
• Check-ups with no
additional costs
• Remote lifestyle coach +
programs
• Remote mental wellbeing
services
• Online Medicine
– 1st to market, prizes, no cost
– GPs, specialties and wellness services
– Symptom checker
– Drugs delivery (2h)
• Rewards program to
promote healthy lifestyles
(wearables and app)

11
T-GMK-04 (5)
DIGITAL INITIATIVES TOWARDS A NEW POSITIONING
S e v e r a l i n i t i a t i v e s a r e u n d e r g o i n g t o b e c o m e a
t r u s t e d p a r t n e r a n d b e t t e r e v a l u a t e / m a n a g e r i s k
PARTNER - Condition
management
• Remote monitoring of chronic
patients
• Services for oncology patients
• Elderly safety
• Second medical opinion
SERVICES TO PATIENTS UNDERWRITING
• Tele-underwriting
• Simplified underwriting for
younger clients
Value
Outcomes that
matter to patients
Costs per
patient
PAYMENT
• Value based healthcare
(payment by outcomes):
diabetes, COPD, baby
deliveries, back pain
EVALUATOR – risk assessment and payment

12
T-GMK-04 (5)
FIDELIDADE GROUP START-UP ACCELERATOR
A n u n i q u e o p p o r t u n i t y f o r s t a r t u p s t o t e s t t h e i r
s o l u t i o n s a n d c o m p e t e f o r a r o a d s h o w t o C h i n a
PARTNERS PILOT PROGRAM PRIZES & PERKS
www.protechting.pt
FOCUS AREAS
• HealthTech
• InsurTech
• FinTech
• 9 month to
integrate solution
in a real business
environment
powered by:
• Roadshow to China
• 10.000€
• Bootcamp

13
T-GMK-04 (5)
COVID-19 IMPACT
T h i s p a n d e m i c a c c e l e r a t e d t h e l a u n c h o f n e w
d i g i t a l s e r v i c e s a n d e m p h a s i z e d i t s r o l e
Impact on DIGITAL HEALTH
• Telemedicine & Symptom checkers
• Mental health
• At-home diagnostics & treatment
• Long-term consumer behaviour changes
REMAIN FOCUS ON OUR STRATEGY
AND BE READY FOR CHANGE
Impact on INSURANCE BUSINESS
• Higher claims costs
• Higher competitive pressure
• Premiums uncertainty
HIGH LEVEL OF UNCERTAINTY
?


?

14
To be a leader is not only about having market
share, is about paving the way to succeed…
… this is

Challenges and opportunities for
digital health – private sector
Micaela Seemann Monteiro, MD
Chief Medical Officer for Digital Transformation

AGENDA
2
Portuguese Private Healthcare Sector 01
José de Mello Saúde / 02
& Digital Health 03
Digital Health Market - Barriers 04
Digital Health Market - Opportunities 05
Digital Health Market - Take Aways 06

3
20,4 M
Público: 12,2 M
Privado: 8,2 M
18 345 M€
Público: 12 193 M€
Privado: 6 152 M€
230
Público: 111
Privado: 119
Number of Beds1
35 429
Público: 21 095
Privado: 14 334
Number of Hospitals1
Outpatient Consultations1 Current expenditure on
health care1
Dados de 2018 | Fonte: PORDATA, INE e Relatório do SNS 2018 | (1) Apenas contabilizadas as consultas hospitalares
PORTUGUESE HEALTHCARE SECTOR
ACCELERATED GROWTH OF THE PRIVATE MARKET

Ageing Population Under capacity of the Public System
Health Insurance Market Consolidation
Elderly Dependence Index Patients on wating list for Surgery (thousands)
% of the population that benefits from health insurance Weight of the top 4 Private Players1 (%)
Key Growth Drivers of the Private Healthcare Market in Portugal
1) Provision of Services of the top 4 Players / Hospital Private Health Expenditure and Ambulatory
Source: INE; PORDATA; Annual reports
HEALTHCARE MARKET IS EXPECTED TO CONTINUE TO GROW SUPPORTED BY ITS
DRIVERS AND INELASTIC DEMAND

WITH JMS MAINTAINING ITS LEADERSHIP POSITION
REVENUES INCREASED MORE THAN 12% IN THE PRIVATE SECTOR IN 2019
5
Private Sector Historical Revenues (m€)
Note: Only considers revenue from the private business (2018 accounts for other market players not available yet)
Source: Annual reports – excludes PPPs
CAGR 2013-18
+9%
+8%
+11
%
+17
%
Top-4 players +10%
2018-19
+12
%
+9%
-
-
-

PPP
PPP
JOSÉ DE MELLO SAÚDE – 2019 IN NUMBERS
www.josedemellosaude.ptI&D +I
2,4 M €

App Users
> 500 k
Appointments
booked by App
Call Center
calls
> 500 k > 3.4 M
Best Digital
Engagement
Best Digital
Transformation
DIGITAL IS INCREASINGLY A STRATEGIC INSTRUMENT FOR OUR COSTUMER EXPERIENCE
MyCUF APP REMAINS A KEY TOOL TO ENHANCE QUALITY SERVICE
7
Note: Statistics refer to 2018 total activity.
Source: JMS internal.
X X
+ 30%
per
annum
50%
remotely
(CC & App)

Corona Crisis – Highlights need for digital transformation
- 80%
Production
• Outpatients appointments
• Surgeries
• Exams
• Urgent care

TELECONSULTATION IMPLEMENTATION TIMELINE
16th March 23rd May
Decision to implement
teleconsultation
1st teleconsultation (test) GP, Internal Medicine &
Pediatrics start first and
follow-up consultations;
all other specialties start
follow-ups
All specialties that agree
to first consultations start
first consultations
• 20 896 TCs
• Up to 900/ day
• > 1.200 doctors
• > 30 specialties
18th March 23rd March 30th March

Patient’s Portal & App
2014.
1st Chief Medical Officer for Digital Transformation
2020.
“Grow Health “ Start-up program
2017.
Teleconsultations
2020
Road to Digital Health

Hybrid Patient Journey
Prevention Ambulatory Care Exams / Surgery Inpatient Care Monitoring
DIGITAL TOUCHPOINTS HUMAN TOUCHPOINTS
REMOTE
home,work,holiday
ON-SITE
cufunit
©Micaela Monteiro

Barriers
FINANCING
Pay for service model still dominates. Long term health results ,
VBH or population health approaches are not yet financially
rewarded by insurance companies .
WEAK SENSE OF URGENCY
Market and revenues have been growing with traditional
approach. COVID 19 pandemic may have changed perception
recently. It is too early to know whether this perception will
endure.
HESITATION IN TAKING RISK
Recent economic crisis and current corona crisis increase
financial uncertainty.

Main areas of opportunity
Assisted Living/ Telemonitoring / IoT
Ageing and the growth of chronic diseases create a need for
solutions to better manage disease and disability from home
and to prevent institutionalization.
AI to increase clinical efficiency
Automation, " augmented information" and clinical decision
support leveraged by AI promise gains in efficiency , quality and
safety.
POC / sampling at home
Shifting on-site care to remote care is a strong global tendency.
The possibility of taking blood samples performing point-of-
care test yourself at home is still limited.

PORTUGUESE MARKET IS TECHSAVY & START-UP FRIENDLY
QICK WINS AND CAPABILITY OF MONETIZATION APPRECIATED
INTEROPERABILITY & SCALABILITY
“Take-Aways”

‫תודה‬!
Find me here micaela.monteiro@jmellosaude.pt

Digital Health Webinar Highlights Portugal's Progress

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