Digital Innovation for Integrated care, Silver economy

Ilias Iakovidis, PhD

DG CONNECT European Commission

Brussels 27 January 2016 COCIR HEALTH SUMMIT

on Integrated care

eHealth –Progress so far DIGITISATION & CONNECTIVITY Health information networks, Hospital & patient record systems, Biobanks, telemedicine INTEROPERABILITY...still struggling

Mobile broadband , Wearable and portable systems , mHealth Apps, in hands of patients and carers

Better understanding of the impact of the Ageing society and of Chronic diseases (NCD)

NOW WHAT

MEASURING THE RETURN OF THE DIGITAL INVESTMENT IN HEALTHCARE

• BETTER HEALTH OUTCOMES

• PATIENT SATISFACTION

• PROFFICIENCY OF OUR STAFF

• SYSTEM EFFICIENCY / EFFICACY

• COST SAVINGS, COST EFFICIENCY

• ECONOMIC GROWTH & JOBS

Will the change & disruption happen even before there an agreed assessment methodology

and evidence at large scale?

SCALING UP DIGITAL INNOVATION – CRITICAL FACTORS:

• INFRASTRUCTURE

• USER DEMAND/ACCEPTANCE

• BUSINESS MODEL

DSM IMPORTANT FOR ALL THREE

Number of chronic disorders by age group

Source: Barnett et al. 2012. Lancet 370: 37-43.

To get Savings Go Where the Money Is

U.S. population, by magnitude of

expenditure, 2009

1% 5%

10%

45%

65%

22%

50%

97%

$90,061

$40,682

$26,767

$7,978

Annual Mean

Expenditure

• 10% of patients account for 65% of costs

• Focus efforts on patients with highest

costs

• Three part strategy:

– Primary care/delivery system reform

– Payment reform

– Health information technology

E. Mossialos, LSE

https://agenda.weforum.org/2015/10/what-are-the-economic-implications-of-ageing-populations/

Representative (public) spending and tax profiles by age

Integrated care What this means for patients

Hospital

Home Care services/Nur

ses

Primary Care Practitioners Allied Health Professionals

Specialists

Long-Term Care Homes

7 7

Community, Social Services, Informal carers

Common principles for

coordinated care plans

so all complex patients

will have the same

experience

Help for patients and

families to navigate the

health system

Listening to and

involving the patients,

families and caregivers

in all stages of the care

process

••• 8

What is Integrated care

Integrated Care: is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.

• Kodner & Spreeuwenberg (2002)

The management and delivery of health and care services so that citizens receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health and care system.

Related terms:

Chronic Disease Management, Telehealth, Telecare, eHealth, Patient monitoring, Independent Living, Ambient Assisted Living

Need to adapt the living environment

Integrated care Best Practices

https://webgate.ec.europa.eu/eipaha/library/index/show/id/728

Good practice examples

in Integrated care

(from EIP on AHA

partners)

Examples of CDM, Integrated Care

• Germany: Techniker Krankenkasse offer integrated care models

to improve the treatment of back pain. 3.000 patients, in 32

locations in 15 federal states.

• Spain: The Region of Valencia deploys a programme to

improve the management of chronic patients through the use of

new technologies and integrated care practices. Target

population: 12.000 chronic patients

• The Netherlands: A preventive integrated care model for the

frail elderly, the Walcheren Integrated Care Model (WICM) is

available to 22.000 elderly.

Examples of CDM, Integrated Care

Radboud University Nijmegen Medical Centre, ParkinsonNet, Improving Parkinson care though regional networks of

primary and secondary care around hospitals, physiotherapists working according to evidence-based guidelines.

• An improvement in the quality of care for those patients

• 50% reduction in hip fractures

• A reduction in hospitalization

• A substantial cost reduction (€20 million annually in NL)

South Denmark: SAM:BO a regional agreement of coherent care

pathways for citizens and patients as well as an integrated system backed by an infrastructure and ICT services Demonstrates potential savings of e-referral on national level:

• It saves 1 million € each year over paper based systems.

• If all referrals were sent electronically this could rise to 3.5 million € per year.

Examples of CDM, Integrated Care

Puglia, Italy: Telecardiology programme to support patients

affected by cardiovascular diseases both in case of acute events and management of chronic conditions.

• - Over 550.000 ECG performed,

• - significant reduction of avoidable death,

• - 60% underwent appropriate treatment and no hospitalization unless urgent (only 11%)

Basque country: Chronicity strategy

Risk stratification of patients

- the entire population (2.2mio) included

- 100% of health professionals know what care

- approach the patient need in relation to their risks

- 11,000 hospital stay reduction & saving of €8.9mio (entire strategy)

Northern Ireland 150,000+ receive the service, >97,500 are 65+

• Reduced length of stay (2 days - 20% decrease)

• Return on Investment £5 for every £1 invested

• Reduced medication errors at admission (4.2)

• Reduced errors at discharge (20%-<1%)

Integrated Medicines Management

European Innovation Partnership on Active & Healthy Ageing

health & quality of life of European

citizens

growth & expansion

of EU industry

sustainable& efficient

care systems

+2 Healthy Life Years by 2020

A1: Improving prescriptions and adherence to treatment

A2: Better management of health: preventing falls

A3: Preventing functional decline & frailty

B3: Integrated care for chronic conditions

C2: ICT solutions for independent living & active

ageing

D4: Age-friendly cities and environments

Actions Groups

connecting & engaging stakeholders across sectors, from private & public sector

• https://webgate.ec.europa.eu/eipaha/

Contact for the Action Groups: promoters@proeipaha.eu

EIP on AHA

Region Skane

University Hospital Olomouc

City of Oulu

Coimbra

Southern Denmark

Collage (3)

Saxony

Ile-de-France Pays de la Loire

Lower-Rhine Council Languedoc-Roussillon

Liguria Campania

Friuli Venezia Giulia Emilia-Romagna

Piemonte

Northern Netherlands Twente

Province of Gelderland and Overjssel

South Holland Province Noord-Brabant:

Slimmer Leven

Galicia Basque Country

Madrid Catalonia Valencia

Andalusia

Liverpool Scotland

Northern Ireland Wales

Yorkshire

Reference Sites - coverage

EIP on Active & Healthy Ageing

15

Outcome

Indicators

on

intervention

/

commitment

level

Triple Win Sustainability Quality of Life Innovation &

Growth

Headline Target

HRQoL

Risk

factors

Falls

Frailty

Cognitive

decline

Functional

status

Adherence

Mental

health Nutrition

Mortality

Physical

Activity

Incremental change

in resources used

(Local) unit cost for

resources

x Nr. of

implemented

technologies

Nr. of new

SMEs

Nr. of users

of new

technologies

Nr. of created

jobs

• Hospital (re-) admissions

• Length of hospital stay

• Emergency visits

• Primary care visits

• Specialist visits

• Institutionalisation

Measuring impact of Digital Innovation

What you do NOT measure you do NOT get

MAFEIP Monitoring & Assessment

Framework

Societal Challenge

Major Opportunity

••• 17

Dependency Ratio

•From 1:4 to 1:2

•80+ doubles by 2025

Cost of Care

•Up by 4-8 % of GDP by 2025

Human Resources

•Shrinking work force •Lacking 20 million carers by 2020

Empowerment

•Active Ageing

New Care Models

•Home based

•Integrated care

•Large Efficiency gains

Growth and Markets

•3000 B€ wealth

•85 Million Consumers - and growing

• Large scale uptake of digital innovation

17

DEMOGRAPHIC CHANGE IN SC1

Demographic change in a 'storm of crises'

ICT for Active & Healthy Ageing

EU Silver Economy Strategy (Launch March 2015)

http://bit.ly/1yiVfF2

Vision: Turn the Demographic Change into an opportunity for Europe

SILVER ECONOMY FROM MAINSTREAM DEBATE

G7 ICT Ministerial April 2016 Japan

SILVER ECONOMY TO POLICY DEBATE

EU Silver Economy Strategy, March 2015

http://bit.ly/1yiVfF2

2 Million € prize in 2016 for the best solution to address ageing challenge

In early 2016 the European Commission will launch a Horizon Prize that rewards the innovator or team who comes up with the best solution to address the challenges and opportunities of ageing and to improve the quality of life of senior citizens. Their breakthrough will receive €2 million from Horizon 2020. http://europa.eu/!ck76Xw

The other challenges were: Childhood obesity, Citizens for clean energy Integration of immigrants in the labour market Women entrepreneurship and women-led enterprises

DSM & HEALTH CARE

• The Commission will launch an integrated standardisation plan with key priorities with a focus on technologies/domains critical to DSM, including essential sectoral interoperability and standards in areas such as health (telemedicine, m-health).

• The Commission will revise and extend the European Interoperability Framework.

• The Commission aims to support an inclusive DSM in which citizens/businesses have skills & can benefit from interlinked and multi-lingual e-services, e-health.

• Consumers should be aware of online rights & have means to enforce them. All citizens need to participate actively in society & benefit from digital services (eHealth, eCare).

• Digital technologies for health & care offer opportunities for citizens, health care providers & industry. Digital solutions can empower citizens to manage their health, while health - care systems can improve their efficiency & cope with increasing demand from ageing population.

• For European industry, they constitute a promising market, serving the public sector & citizens, creating high quality jobs/growth by combining the high-tech, healthcare.

DSM & HEALTH CARE

• EU legislation in place or under review applicable to e-health includes Data Protection Directive, Regulation on electronic identification & trust services for e-transactions in the IM, Medical Devices, General Product Safety, e-Commerce directives & Cybersecurity Strategy.

• Directive 2011/24/EU on application of patients’ rights clarified the legal framework for patients to be reimbursed for cross-border healthcare.

• Under Horizon 2020 many research, innovation & development actions have been implemented to test solutions (e.g. ICT chronic diseases and independent living) for EU market.

Staff Working Document (Analysis & Evidence) on DSM – eHealth / eCare

• The European Innovation Partnership on Active and Healthy

Ageing (EIP AHA) has formed a community across many EU regions of over 3,000 stakeholders with considerable expertise in innovative solutions for ageing well, such as m-health, telehealth and integrated care.

• By sharing and replication of good practices, common interoperability specifications and joined-up procurement of digital solutions, the EIP AHA promotes stronger collaboration of national & regional authorities on the implementation of innovative products & services for health and social care under its Scaling-up Strategy

Staff Working Document (Analysis & Evidence) on DSM – eHealth / eCare

Further information

• H2020: http://ec.europa.eu/research/participants/portal/desktop/en

• Calls 2016-2017: http://ec.europa.eu/research/participants/portal/desktop/en

• IMI: http://www.imi.europa.eu/

• AAL: http://www.aal-europe.eu/

• EDCTP: http://www.edctp.org/

• EIT KIC on Healthy living and Active Ageing

• http://eit.europa.eu/eit-community/eit-health

• Joint Programming Initiatives: http://www.neurodegenerationresearch.eu/

https://www.healthydietforhealthylife.eu/

http://www.jp-demographic.eu/

http://www.jpiamr.eu/