Impact and Management of Consumer Driven Clinical Services

Paradigm Shift in Service Delivery?Paul Ryder

What are the impacts of changing consumer demands on service delivery models & ITAre we prepared?

Emergence of Consumerism

A survey conducted by Deloitte in the US recognised

different healthcare consumer types:

1. Casual and Cautious (34%) – not engaged in their own health, no immediate need to consume healthcare service and cost conscious

2. Content and Compliant (22%) – happy with their provider and service delivery. Tend to be compliant with care plans and direction.

3. Online and On-board (17%) – keen to learn about health services online, happy but looking for alternatives and new technologies

4. Sick and Savvy (14%) – looking for alternative options and services. Communicate and partner with treatment decisions

5. Out and About (9%) – looking for alternatives options and prefer to tailor the services

6. Shop and Save (4%) – Looking to save money, willing to switch products and services for better value.

As the computer literate generation of Consumers are becoming more informed and seeking greater say in their health and wellness, the consumer distribution is changing

We can’t sit still, we need to accept the issues and facilitate the change:

• The cost of healthcare continues to rise at an alarming rate.

• Demand for services isn’t diminishing.

• We need to better understand how we can maximise the available resources, including providing alternative service delivery methods, e.g. Chronic disease monitoring, immunization, etc. provided through local pharmacy

• The attitude, approach and priorities of the different type of consumer will impact the way they address health and wellness issues, and how they consume products and services.

• How we service these requirements will influence future organisation structures, communities and, most of all, healthcare costs.

• Need to be clear what Consumer we want to target! Which may be different depending on service organisation

Consumer Target

eHealth Consumer Commerce Market Potential

Do we understand the commercial proposition, do we care?

Healthcare Vision

To change the way Providers and Patients

Consumers interact:

Can be achieved: Through People-centered Innovations

Having Interoperability across healthcare ecosystem

By promoting Standards and Policies

By creating a Coordinated Health Alliance

By providing Consumer access to records

Organisational Changes

There will be impacts on Healthcare Organisations:

Managing regulatory changes and maintain compliance

Being able to provide care without adversely impacting costs – we need to fully understand the implications

Endorse and support a move to personalized healthcare

Need to be able to better harvest person centric clinical information and provide real-time analytics in support of research

Facilitate availability & reliability of services – need to maximise available resources

Ensure that we can secure provider and consumer relationships

Maintain provider affiliation

Create clinical and financial data transparency

Healthcare Reform

We need to recognise where and how we can reform:

Impact of a changes to reimbursement model for service and care delivery

Address State and Commonwealth healthcare payment issues

Ensure we provide the necessary focus on large ticket items, e.g. chronic disease and aged care management

Create sustainable Business Models through partnering across disparate care delivery entities, GP’s and pharmacists working as a single entity

Recognise the risk to healthcare if there is lack of support for coordinated or aligned delivery of care

Legislation issues around expanding healthcare service delivery of existing provider’s. e.g. pharmacy reforms around access to extended services

Connected Healthcare Community

Healthcare is a complex process that involves many different professionals and organisations

• Patients receive care not by one person but by a multi-disciplinary array of care providers often in different locations.

• Care delivery is most often reactive and delivered based on priorities and availability of providers.

• Patients are disempowered by the system and are left wondering if the care that they get is correct, appropriate and cost efficient.

Connected healthcare is a key component in the evolution of healthcare delivery, benefits include:

Reduction in cost Increase in patient safety Improved coordination in delivery of care

It enables the move from a reactive model to a proactive and preventative model of healthcare delivery

Increased engagement by patients leads to better self management and consequently better outcomes

Collaborative Care requires communication and collaboration:

Limitation of Current Initiatives

Collaboration can only be delivered through ICT:

Hospital and Specialist Care needs to link with Primary & Community based care rather than continuation of silo based healthcare

Collaboration and Coordination across care providers should be mandatory not optional

Healthcare IT is essential to deliver accurate and timely patient information access

Clinical Data Repositories provide the mechanism for sharing of information

Managed Clinical Information provides the proactive management needed to reduce costs and improve outcomes

We have the Solutions

Does this mean we have a new IT headache?

A move to Consumer based solutions doesn’t require a Paradigm shift in technology it requires a shift in approach, all parties are involved in the design, control and service delivery

We need to utilise the systems we have to build trust and a more collaborative environment with participation that includes:

• Government• Health Service Providers• N.G.O’s• Industry• But most of all …..Consumers

We need to better utilise the information available rather than reinvent new data capture solutions

We require agile solutions that are tailorable, provide flexible personalized user portals delivering information at the point of need, integration is essential to maximise information usage.

We also need to incorporate other services that consumers are demanding, such as complimentary and alternative medicines.

• More of us than ever are using the web to seek help about an ailment before or instead of visiting the doctor.

• There is a plethora of health-related websites, tools and social networks available to support the demand.

• Unfortunately, the Internet allows anyone to share, sell or post information, and there is no control on reliability or accuracy of information or services offered.

• Only 25% of people check the reliability of health information they find online by looking at the credibility of the source.

• A typical online medical consultation follows this trajectory:

• 1) I have a problem,

• 2) I do a Google search,

• 3) I believe the first result that confirms my expectations.

• Smoking helps a person's brain work more effectively, 'It helps with cognition, stimulation and relaxes” …. fact or fiction

The Digital Age

Dr “Google” will see you now…

Creating a Consumer Healthcare Marketplace Community Nurse

Care Agencies

Doctor

Diagnostic Centres

Healthcare Websites

Consumer

Support Group

Pharmacy

Health Care Insurer

Consumers interact with a variety of agencies, people and systems to manage their healthcare needs. Most consumers cannot navigate through this environment with

ease leading to distress, poor outcomes and large expenses.

A curated approach:

• A system that constructs a consumer healthcare profile based

upon available clinical assessments and personal data, it is used

to curate or filter a marketplace of services matching need.

• Enables consumers to be appropriately informed and take

control of their own healthcare requirements.

• The system uses assessments to initiate care activities based

upon pre-defined protocols, care plans and modalities of care,

to manage care such as: reminders, appointments, medications,

vital signs, weight, etc..

• Consumers create their own care networks, similar to social

networks, to include relatives and friends and the system ensure

that these networks are notified of shared important healthcare

based events.

• Ensuring those with long term conditions, the elderly, receive the

help and support from their own care networks.

A Curated Healthcare Marketplace

This model creates an Integrated Care Management approach, which assesses and evaluates an individual’s needs, aligning them to care plans and suggested services.

Integrated Care Management understands:

• WHAT is required – based on needs aligned with service delivery

• WHEN it is required – schedule intervention based on care pathway and best practice

• WHO is required – identify and notify the providers responsible for delivering service intervention. Consumers are also informed on pending care activities.

Providing Integrated Care Management

Patient Portal - PHR Professional Portal

eHealthStreetHealthcare Marketplace

curatedby CareVigilance

eHealthStreet curates the Healthcare marketplace. Products, services, tele-

consults that are available and matches the requirements

and preferences of the consumer based upon their individual health profile and

health needs.

New SolutionConsumer PortaleHealthStreet

Consumer Portal

Mobile Access

eHealthStreet

Consumer Portal

1. ‘My Health’ page appears after a consumer logs in.

2. Information is populated from their personal health record and other sources.

3. Information is used

to curate and control the products and services offered to the consumer.

4. All information is private to the consumer and only shared after consumer consent.

eHealthStreetMy Health Record

My HealthCurated Offering

A Physician can be selected along with date time and mode of consultation. The consumer can limit the

information that the physician can access.

Access to Providers Curated to your issues

Based upon consumer health profile and preferences,

service offerings are presented.

They can be requested on-line with prices based on

health plan or other eligible discounts.

Curated Service Offerings Available online

Shared view of Consumer’s health data