World Health Summit: Berlin 2014
Medical Technology and Digital Health Using Digital Health to enable Integrated Care: Overcoming Barriers and Challenges Jacqueline Mallender, Partner, Optimity Matrix
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Introductions Jacqueline Mallender • International health and welfare economist • Partner: Optimity Matrix • Convenor: Campbell Cochrane Economics Methods Groups
Contributors • Ken Barrette: Partner, Optimity Advisors • Courtney Shaw: Researcher, Optimity Matrix • David Welbourn: Associate Professor Health Management Cass Business School
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Why do we need Integrated Care? Complex services are provided by a diverse array of super skilled professionals, across many different organisations, in a knowledge hungry, innovation driven environment.
Comprehensive needs assessment Lower Cost
Effective Care Pathways
Improved Outcomes
Connected Care Transitions
This results in: Disconnected care Broken care pathways Expensive care pathways Poor Health Outcomes Inequalities Unmet need Failure to recognise what matters to service users inform | transform | outperform
Improved Quality Experience Consumer Driven Connected Care Across Organisations & Professionals Proprietary & Confidential
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Systems for delivering Integrated Care are evolving internationally: One such model is Accountable Care: An accountable care system is: “one in which a group of providers are held jointly accountable for achieving a set of outcomes for a prospectively defined population over a period of time and for an agreed cost.” McClellan et al * These systems need relevant, timely and comprehensive information available to the health and social care professional at the point of care. * McClellan, M., Kent, J., Beales, S.J., Cohen, S.I.A., Macdonnel, M., Thoumi, A., Abdulmalik, M., Darzi, A. (2014a)
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Some Examples: • Geisinger Health System, USA • Ribera Salud, Spain • Gesundes Kinzigtal (Germany) • ThedaCare, USA • Ontario, Canada • Cigna, USA
Accountable Care Around the World: A Framework to Guide Health Affairs, 33. n9. (2014): 1507-1515 Reform Strategies
International Evidence of Contracting Models for Integrated Care
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The industry is moving towards an end-to-end consumer experience through health behavior change programs and incentives based on:
• Member segmentation (i.e. healthy and engaged) • Increased focus on business analytics and measures • Integrated health and wellness member digital experience
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ACO “Readiness” Tools & Informatics Evaluation findings and professional consensus… requirement for ACOs to have informatics informatics and more informatics… Example tools include:
• American Institute for Research – Bundled Payment for Care Improvement: Readiness self assessment • American Medical Group Association –ACO readiness assessment • University of California Berkeley – Safety Net ACO readiness assessment tool • Health Dimensions Group – Health care reform readiness assessment • Research Triangle Institute – ACO accelerated development session – pre-meeting registration and planning tool • National Committee for Quality Assurance – ACO accreditation programme (incorporating the standards review of structures and processes and the relevant performance measures from HEDIS – the widely recognised Health Effectiveness and Data Information Set) inform | transform | outperform
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Basic Informatics Requirements • Electronic Medical Records • IT Infrastructure (Desktops, Servers, Networking, Remote Access, Standards) • Practice Management Systems • Registries (Disease) • Base Reporting (Meaningful Use, PROM/PREM Whole System, Cost) • Patient portal (digital member experience) Integrated Care is really difficult to achieve without having these basic capabilities in place across provider networks inform | transform | outperform
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Added Value Informatics Requirements • Decision Support Tools (i.e., utilization management/appropriateness) • Care Management (Intra-system: auto-trigger messaging, case management, disease management/service lines) • Robust Data and Informatics (aligned incentives, aggregate patient claims encounter, predictive modeling) • Patient Health and Wellness Tools/Personal Health Record • Electronic Ordering (ePrescribing, eLabs) • Health Benefit Coordination/Administration (i.e., health insurance) inform | transform | outperform
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Differentiating Informatics Requirements • Care Management (Inter-system: network management, care transitions) • Point of Care smart technology devices • Advanced Data and Informatics Mining (integrated reporting/alerts/actions, actuary & underwriting) • Remote Consultations/Biometrics Screenings/Remote Portable Patient Smart Devices • Health Benefit Coordination/Administration (i.e., health insurance) • Social and member environment analytics inform | transform | outperform
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Best Practice Requires Data Information
Data Repository (real or virtual)
Multiple points of data capture
Diverse array of legacy operating systems across departments, divisions, sites and organisations inform | transform | outperform
• • • • • •
Semantic harmonisation Comprehensive coverage Up-to-date Accurate Secure storage Robust governance
Integrated Electronic Record
• Decision relevant • Roles-based access • Harmonised with operational practice
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We Have A Long Way To Go!
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Main Challenges for Information Exchange 1. Diversity of core systems: – Technical inter-operability – Semantic inter-operability
2. Technological Innovation – Technology innovation moves fast than procurement systems – Best of breed vs single vendor solutions
3. Money & ROI – – – –
Base systems cost money Interoperability costs money Health information costs money The industry is littered with expensive mistakes
4. Data Security and Ethics – –
Informed patient consent to share information Governance on security, storage and access
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All of these challenges can be overcome with the cooperation and commitment of policy makers and payers Proprietary & Confidential
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How Policy Makers Can Provide Solutions • Please don’t: prescribe IT standards, semantic dictionaries, technology solutions or procure vendors! • Please do: – Provide a clear regulatory framework to support data governance, data security, ethical standards and consent requirements for information sharing – Foster innovation by supporting knowledge sharing, rapid cycle evaluation, and identification of good practice – Provide a “co-opetition” regulatory framework to enable networks of providers to form longterm partnerships, collaborate and innovate with technology providers – Provide appropriate financial incentives to enable local networks to overcome investment barriers – Support an agile and competitive international technology industry to drive innovation through competition and investment
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Thanks! For questions or comments please contact: Jacque Mallender Partner, Optimity Matrix
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Optimity Matrix Kemp House, 152-160 City Road London EC1V 2NP
[email protected] +44 (0)20 7553 4800
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