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Making Care Mobile:
Shifting Perspectives on theVirtualization of Health Care
ATA Fall ForumLuncheon KeynoteSept 10, 2013
@willfalk
slides available on Twitter
PwC
Who I am
Will Falk
Managing Partner – Healthcare, PwC Canada
Executive Fellow, Mowat Centre for Policy Innovation
Adjunct Professor, Rotman School of Management
Twitter: @willfalk
2
PwC
Making Care Mobile: Shifting Perspectives on the Virtualizationof Health Care
• Report explores Canadians’ attitudes towards pertinentissues in the health care industry
• Provides analysis of what citizens expect decision makers tokeep in mind when thinking of the future of health care inCanada
Goal of the report
• What improvements are citizens looking for in health care?
• What channels are citizens using to access health care andinformation now, and in the future?
• What innovations are citizens ready to use that can makehealth care delivery more efficient?
• What are the future possibilities in health care delivery?
Key Questions
www.pwc.com/ca/virtualcare
3
PwC
Making Care MobileShifting perspectives on the virtualization of health care
More than 2,400 Canadians participated in our research to address thecentral question, “What does the future of health care delivery look like?”
4
PwC
Virtual assessments via apps are good options inthe right situation…
52%of patientsindicate thatfaster access tocare is theprimaryappeal ofvirtualassessment
1%
8%
15%
20%
21%
36%
No answer
Not sure
None of the above
You use an app for an initial assessment
You send it to your doctor using an app
Doctor takes the photo and communicates withdermatologist
77% of Canadians were comfortable with virtual mole assessment appscenario – although, at this time, most prefer doctor-controlled option.
5
PwC
Canadians told us they are ready for virtualmonitoring for chronic conditions…
79%of Canadiansindicate thatthey arecomfortablewith virtualmonitoring forchronicconditions
Most Canadians indicated they would be comfortablehaving a chronic condition monitored virtually...
36%
43%
10%
5%
4%
2%
Yes, definitely
Probably
Not likely
Definitely not
Not sure
No answer
... and 62% of caregivers indicated that virtual healthcare would help them to provide care for someoneelse (e.g. parent/ child)
6
PwC
… and virtual visits for post-surgical follow-up.
54%of Canadiansindicate thatvirtual visits,homemonitoring,and virtualwards are goodcare deliveryoptions
24%
43%
17%
11%
5%
0
Yes, definitely
Probably
Not likely
Definitely not
Not sure
No answer
The majority of Canadians indicated they would becomfortable having post-surgical follow-up visitdone by video conference.
7
PwC
Q: Are mHealth and vHealth different?
Consumer mHealth is exploding in part as a result
8
PwC
Telemedicine and mobility are coming togetherfacilitating delivery of virtual care anywhere
Telemedicine mHealth Virtual Care
9
PwC 10
many small pilots 25%
By 2020, more than 25% of care will be deliveredvirtually (with provider and patient in separate places).
- Dr. Ed Brown, 2012
PwC
Virtual Health Care: We have been throughsimilar shifts before…
InpatientCare
OutpatientCare
VirtualCare
1992…More people leave
hospital after procedurethan remain overnight
202X?…More virtual visits than
physical visits
Each transition involved people, process, and technology changes.Major shifts in how we organize our care delivery services and assets
11
PwC
Virtualization improves health system access,quality, productivity, and sustainability…
Access Quality Productivity Sustainability
• Deliver care overlong distances
• Reduced traveland wait times
• Re-distributionof HHR – accessto scarcespecialties
• Better waitingrooms
• Auditability ofdecisions
• Use ofmanufacturing,QI, and QAtechniques
• Lower infectionrates/ Infectioncontrol
• Automatedscheduling
• Elimination of“politeness time”
• Asynchronousconsultations
• Ability toaggregatevolumes
• Avoidance ofgreenhouse gases
• Ability tosubstitute lowercost care providers
• Auction pricingmechanisms
• ArtificialIntelligence
12
Specialists’ OfficesRegional Hospitals
On-Call Emergency PhysiciansPublic Health Units
Mental Health and Addiction Treatment Centres
Primary CareFamily Health TeamsCommunity HospitalsCancer CentresFirst Nations CommunitiesPsychiatric HospitalsCCACsMental Health FacilitiesFederal and Provincial PrisonsRural Nurse PractitionersLong-Term Care Homes
Referring Clinician Consulting Clinician
eReferral
4. eConsult (ask a question)
3. eConsult (full assessment)
2. Clinical Videoconference
1.Face-to-Face
Provider to Provider: The Future
PwC
Virtual Care solutions will be segmented by cost ofdelivery, and offer benefits to specific segments
14
High cost solutionssupported by high
clinical value
Cost-value tradeoff
Cost level can onlybe supported using
consumerelectronics
10,000
01,000
001oo
010So
luti
on
cost
/ben
efit
($)
Population (%)
5% 100%50%
PwC
Focusing on “frequent flyers” both helps andhinders developing an at scale virtual care system
1%
34%
5%
66%
10%
79%
50%
99%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ontario Population Health Expenditure
Figure 1. Health Care Cost Concentration:Distribution of health expenditure for the Ontario population,
by magnitude of expenditure, 2007
$33,335
$6,216
$3,041
$181
ExpenditureThreshold
(2007 Dollars)
Source: ICES
15
PwC
The drug delivery system may provide a model forthe organization of apps and devices
Take 2 Apps andCall Me in theMorning
Tech Rx
Apps Pharmacy not Apps Store
Apps Formulary
AliveCor Cardiac
Withings Blood Pressure
bant Diabetes
Pain Squad Pain Mgmt
MyIBD Crohn’s Disease
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PwC
We need a process and standards for selection,and a taxonomy for regulation of apps
Front ofStore
Over theCounter
Prescription
ControlledSubstance
Criteria for evaluation include:
• Operability
• Privacy & Security
• User Data Safeguards
• Functional Validation
• Clinical Efficacy
17
PwC
Front of store apps are mHealth ‘vitamins’ thatsupplement a healthy lifestyle
Front ofStore
Over theCounter
Prescription
ControlledSubstance
18
PwC
Over the counter apps may be dispensed after anassessment of the patient's needs
Front ofStore
Over theCounter
Prescription
ControlledSubstance
19
PwC
Prescription apps: plan of care written byphysician or other health professional
Front ofStore
Over theCounter
Prescription
ControlledSubstance
20
PwC
Front ofStore
Over theCounter
Prescription
ControlledSubstance
Controlled apps: require close supervision ofmanagement and use
21
PwC
Virtual care and Apps fulfillment is now a newclass of service offerings
Front ofStore
Over theCounter
Prescription
ControlledSubstance
In this stage of theirdevelopment, the‘prescription’ and
‘fulfillment’ ofmHealth Apps need
not be separated
22
Thank you.
@willfalk
* slides available on Twitter
This content is for general information purposes only, and should not be used as a substitutefor consultation with professional advisors.
© 2013 PricewaterhouseCoopers LLP, an Ontario limited liability partnership. All rightsreserved.
PwC refers to the Canadian member firm, and may sometimes refer to the PwC network. Eachmember firm is a separate legal entity. Please see www.pwc.com/structure for further details.