Insight Driven Health Top 10 Healthcare Game Changers Canada s Emerging Health Innovations and Trends Copyright 2011 Accenture All All Rights Reserved. Accenture, its its logo, and High Performance Delivered are trademarks of of Accenture.
The time has come for healthcare transformation in Canada From health reform and skyrocketing costs to consumer expectations and technology advances, healthcare in Canada is undergoing significant transformation. The entire health community from private providers and public health organizations to patients themselves is feeling the impact and looking for new outcomes. What emerging trends and innovations are driving Canada s healthcare transformation from today and into tomorrow? And what organizations are leading the way to change? Accenture works across the global health community helping our healthcare clients achieve high performance by using knowledge in new ways to deliver more effective, efficient and affordable healthcare with Insight Driven Health. Our thought leaders have drawn on this experience along with our work with health organizations in Canada to provide our insights on the Top 10 Healthcare Game Changers to watch. Take a moment to explore our future vision for the nation s healthcare landscape. Discover a range of technology-driven, information-powered trends including organizational and structural reinvention, new options for providers and care delivery and innovative consumer empowerment tools and approaches. While each is unique, together, they will contribute to a new model of Insight Driven Health for Canada. 2
Canada s Top 10 Healthcare Game Changers 1 Healthcare Clouds Taking health records off the mainframe 6 Social Networking Patient-connected online communities 2 Health Analytics Data insight into action 7 Point-of-Care Diagnostics De-centralizing the centralized lab 3 New Payment Models Toward outcomes-based funding 8 Hospital at Home Home is where the care is 4 Tablet Computing The key to health IT adoption 9 Regionalization 2.0 Aggregate then integrate 5 mhealth The rise of the mobile health consumer 10 Exporting Health New pursuit of commercial opportunities 3
1 Healthcare Clouds The Internet and cloud computing will take health records off the mainframe for secure and unprecedented access to health stakeholders anywhere in the world. Taking Health Records off the Mainframe Today. Electronic health records today are most often housed on siloed, institutional databases that do not facilitate easy information access for cross-organizational data sharing and are not available to patients and consumers. Tomorrow. Part of the utility computing trend, healthcare clouds will push the trend away from large monolithic systems to point-of-care systems. Clouds are secure Internet-based platforms used to link, access, store and manage health information. Healthcare clouds will help providers access and store information in more efficient, flexible and secure ways while helping save money driving the push toward physician electronic medical records. For patients and consumers, healthcare clouds will be a platform for personal health records, offering new access, control, visibility and convenience. While clouds are focused on information, services may also be delivered over these emerging health care platforms. Leading the Way. Microsoft HealthVault is an online health information storage tool with services for consumers and providers. 4
2 Health Analytics With more health data at their fingertips, decision makers will rely on analytical capabilities to evolve to the next level of healthcare delivery. Data Insight into Action Today. Current systems typically measure healthcare as a series of transactions rather than a process that may or may not be executed as designed. To reach the next level of quality and innovation in care delivery, practitioners require a comprehensive set of facts around healthcare delivery including compliance with every aspect of the protocol and care outcomes. Tomorrow. Canada s growing network of electronic medical records lays the groundwork for advanced analytics. Together, advanced analytics and new data visualization techniques will help unlock the power of data to drive more informed decision making and, ultimately, higher quality, lower cost care from public health monitoring and prevention to the treatment of chronic illnesses. Access to health information to deliver high quality care New ways of presenting lab data Visualizing future chronic care costs in the future by geography Visualizing and comparing hospital performance Leading the Way. GE is a leader with data visualization projects in its groundbreaking Healthymagination effort. NHS Evidence provides access to a wide range of health information to deliver quality care. 5
3 New Payment Models Future payment models will be tied to quality and outcomes in a pay-forperformance model that will ultimately replace output-based funding. Toward Outcomes-Based Funding Hospital Funding in Canada Today. Fee-for-service is the principal method of remuneration for more than 70 percent of physicians in Canada. 1, 2 Only a minority are paid by salary, capitation or alternative payment plans. Hospital funding is based mainly on global budgeting. None of these methods are linked to service quality or outcomes. Tomorrow. The convergence of health reform, new data availability and access, and the push to lower healthcare costs will drive the shift toward outcomes-based funding in Canada and globally. New funding models will be linked to meeting specific targets, adjustments for patient case mix and other measures related to achieving quality outcomes. Leading the Way. In Canada, there are new payment model pilot projects underway. There are also initiatives focused on intermediate steps such as patient-based payments. While there are no clear leaders globally, Sweden, Geisinger Health System and Blue Cross Blue Shield of Massachusetts have value-based purchasing mechanisms in place. 100% 80% 60% 40% 20% 0% Current Variable case complexity adjustment Fixed block funding Future? Variable outcomelinked funding* Per-patient funding Case complexity adjustment Fixed block funding 1) CIHI National Physician Database 2008-2009; 2) Canadian Medical Associationhttp://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Statistics/39-Chart-DistRemun.pdf) 6
4 Tablet Computing Easy-to-use and portable, tablet computers will play a critical role in unlocking clinical adoption of technology like physician electronic medical records. The Key to Health IT Adoption Today. Tablet computers have been well received by the public. The healthcare community has shown interest in using tablet computing to transform healthcare. Tablet computers offer the advantage of ease of use, portability and long battery life and allow users to have visual conversations with patients for an engaging user experience. Tomorrow. More than 60 percent 1,2 of physicians have expressed interest in using the ipad for healthcare purposes. The combination of consumer and provider interest could drive a preference for tablet computers over traditional computers. Tablets could become an educational tool at the point of care and a catalyst for increasing physician adoption of health care IT. Leading the Way. Stanford Medical School announced it will provide all incoming students with an Apple ipad as part of a trial to improve and transform medical education. 3 Kaiser Permanente, among other organizations, announced plans to test the ipad for clinical use by physicians and nurses. 1) Business Wire. http://www.businesswire.com/news/home/20100204006741/en/physicians-purchase-ipad-60-percent-intrigued-device 2) Morningstar;http://news.morningstar.com/all/business-wire/20110302005507/ipads-are-the-tablet-of-choice-among-us-physicians.aspx 3) Stanford : http://med.stanford.edu/ism/2010/august/ipad.html 7
5 mhealth Health apps for mobile devices will empower healthcare consumers, change their behaviors and drive new clinical management and physician-patient interactions. The Rise of the Mobile Health Consumer Today. Mobile technology and mobile apps have become a part of everyday life for many people. Interest in health apps is exploding with new applications released weekly (100+ percent growth rate and 78 percent increase in total apps in six months. 1 ) Bant, developed in Canada, is one of the new class of apps simplifying diabetes management. Users can record their glucose readings, links to popular health accounts and share information. Tomorrow. More than 9 percent 2 of Americans reported having at least one health app on their smartphone in 2010. The popularity and consumer appetite for mobile health apps will continue to rise worldwide. These apps will become more sophisticated, empowering consumers to change their behaviours by making it easy to monitor health information. Mobile apps will become another channel for providers to interact in real time with patients. Leading the Way. There are no clear leaders in the consumer mobile app space, but Epocrates has been developing clinical applications for several years. 1) MobiHealthNews: http://mobihealthnews.com/9396/number-of-smartphone-health-apps-up-78-percent/ 2) Pew Internet & American Life Project, Mobile Health 2010: http://www.pewinternet.org/reports/2010/mobile-health-2010.aspx 8
6 Social Networking Social media/networking tools will make it easy for patients to connect and share information, empowering them to take greater control of their health. Patient-Connected Online Communities Today. Patients are using the Internet and social networking tools to connect with one another and to share information about their health and healthcare experiences. Tomorrow. Moving beyond initial trends of connecting and information sharing, the next wave of opportunity will be around patients managing and curating healthcare information via social networking sites. Consumers will be able to access trusted sources and reliable information that reflects patient needs. Social data on healthcare (perception of care, treatment regime, experience, etc.) will be a key part of this content. Leading the Way. PatientsLikeMe.com is one of several leading Web sites that has created an online community for patients with similar diagnoses to help improve their quality of life. Members can chart symptoms with tools that collect outcomes-based patient data and share experiences and resources with other patients and partner healthcare stakeholders. 9
Millions 7 Point-of-Care Diagnostics Point-of-care and lab on a chip testing technologies will transform diagnostic services and de-centralize the lab. De-centralizing the Centralized Lab Today. The at-home pregnancy test was one of the first mass market point-of-care tests (PoCTs). The test gave women new control over their health information. Today, newer and more accurate tests for other diagnoses and monitoring of chronic conditions are available, bringing new convenience, control and ease-of-use to consumers. Recent advances toward lab on a chip allow for thousands of tests to be run on just a few drops of blood. Tomorrow. PoCTs will continue to simultaneously drive consumer empowerment and improve care with the ability to provide reliable and instantaneous results without the need for a large centralized lab. This transformation can also play a role in lowering healthcare costs. $400 $350 $300 $250 $200 $150 Leading the Way. There is no clear leader in this area $100 today, but pharmaceutical companies are already making $50 significant investments in new PoCTs. $0 Total PoCT Spending in Canada, 2003-2013 2003 2005 2007 2009 2011 2013 2015 2017 2019 POCT spending in Canada estimated based on 1) Point of Care Diagnostic Testing Sector Trends http://trimarkpublications.ecnext.com/coms2/summary_0230-4082_itm?referid=3470&gclid=clkh-ijwkzscfsahdqodgfezpg and 2) Point of Care testing established world-wide: Tran NK, Kost GJ. Worldwide point-of-care testing: compendiums of POCT for mobile, emergency, critical, and primary care and of infectious diseases tests. Point of Care: The Journal of Near-Patient Testing & Technology 2006;5:84-92. using official US/Canada exchange rates and OECD health expenditure reports 10
8 Hospital at Home Advances in remote-monitoring technologies will transform healthcare delivery, driving the rise of at-home care options for eligible patients. Home is Where the Care is Today. Looking to control healthcare costs and provide quality, effective care, there is a push to deliver more services within the home for patients whose diagnoses meet certain eligibility requirements. Advances in technology allow for remote monitoring and delivery of services without the need to stay in an acute care facility. Tomorrow. Technology advances will continue to enable more hospital at home options for diagnostics, the care of chronic conditions and post-surgical recovery. This trend is key in lowering hospital admissions and costs, eliminating hospital-acquired infections and supporting the patient s comfort and the physical and mental well being so essential to recovery. Leading the Way. Kaiser Permanente is emphasizing the home hospital as a method of providing flexible, patientcentered and cost-effective care. Ontario Telemedicine Network is one of the world s largest telemedicine networks. 11
9 Regionalization 2.0 The push to deliver better, more cost-effective healthcare will lead to the emergence of super regions in order to truly integrate care and services. Aggregate then Integrate Today. The clear need to lower healthcare costs in the wake of an unprecedented global health reform mandates has sparked moves toward the regionalization of healthcare. The overall aim is to achieve true integration. Already, regional integrated care networks are emerging to drive new efficiencies and economies of scale. Tomorrow. The emergence of these larger regional systems along a centralized governance model and stable funding will continue to enable better integration. Key benefits will include the consolidation of systems, standardization of care protocols and the development of shared service models or managed services contracts. Leading the Way. In Canada, Alberta Health Services is an example of this trend. And in the United States, Geisinger Health System is a regional integrated network. 12
Billions 10 Exporting Health To pay for rising healthcare costs, public health organizations will become more entrepreneurial and pursue and export commercialization opportunities. New Pursuit of Commercial Opportunities Today. Healthcare organizations outside of Canada are entering new markets foreign markets in particular in an attempt to generate new revenue. Opportunities include partnerships, licensing deals, expansion into new markets and commercialization of IP. Tomorrow. While the need to generate new revenue will continue to drive this trend, other factors such as the need to develop new skills, maximize existing resources and build a healthcare brand will come into play. Leading the Way. The Swedish government has announced plans to export its model of healthcare and will partner with private sector firms to pursue opportunities aggressively. The University Health Network and the Cleveland Clinic are both exploring private, for-profit initiatives to generate new revenue sources. Health Expenditures in Canada, 1975-20101 $200 $180 $160 $140 $120 $100 $80 $60 $40 $20 $0 1975 1985 1995 2005 Private Spending Public Spending 1 Figures for 1975 through 2005 taken from National Health Expenditure Trends 1975-2005 (NHET), published by the Canadian Institute for Health Information (CIHI). 13
What Do You Think? Today. Which trends do you see influencing your organization today? Tomorrow. Which trends do you think will have the most impact on your organization in the next two years? Business. What trends do you think best align with your short and long term business objectives? Environment. What other healthcare trends are you tracking today? Challenges. Do you have any concerns about how these trends will impact your organization and its stakeholders? 14
For more information To learn more about these healthcare game changers and how they might impact your organization, please contact: Sanjay Cherian Health Industry Lead, Canada Sanjay.Cherian@accenture.com 416-641-3718 http://www.accenture.com/insightdrivenhealth 15