Promoting innovation by scaling up: myth or fact?Basque Health System Life expectancy 85,7 years...
Transcript of Promoting innovation by scaling up: myth or fact?Basque Health System Life expectancy 85,7 years...
Esteban Manuel Keenoy
Director Kronikgune
CHALLENGES IN SCALING UP SOLUTIONS: THE BASQUE
COUNTRY EXPERIENCE
Promoting innovation by scaling up: myth or fact?
AAL Forum 2014
Palace of the Parliament
Bucharest, Romania
Demographic and epidemiological context
2
Basque Health System
Life expectancy
85,7 years
women
79 years
men Source: Eustat –Basque Institute of Statistics 2012
Population (2011): 2.183.615
≥65 years: 19%39% in 2050
BIZKAIA
GIPUZKOA
ARABA
Chronic diseases 80% of medical consultations
75% of the Health Budget
8.760 HOURS/YEAR
HEALTHCARE
HOME
1-2% contact with Healthcare System
In a system designed to treat acute problems:
episodic care
4
" More at home and PHC and less in hospitals“
• Technology key driver in Health Care change.
• Productivity gains for Health Care Systems
• Have to be aligned with complex Health System
STRATIFICATION: 100% population stratified
Population without chronic conditions 1.394.539
636.000
173.000
43.000
• General
population
• Chronic
patients
• High risk
patients
• Highly complex
multimorbidity
Prevention and
Promotion
Self management
support
Disease
management
Case management
Telehealth Pilots
BIZKAIA
GIPUZKOA
ARABA
1
Telbil A
Telbil T FRAIL
2
U4H CHF
3
Telepoc COPD
4
Respirratory
rehabilitation
5
Teki COPD 6
Tele diabetes
7
Frail Patients
CHF
COPD
FRAIL MM
DIABETES
SYSTEMS
Weight
Oxigen
saturation
Questio
nnaire
Devices and
services
Hardware
Software
Reception Base
HOME
EHR Osabide
Telecare
Blood
pressure
Manual
EXTERNAL
WEB
PLATFORM
Main findings
• Facilitates clinical decision making.
• Better relationship with professionals
• Sense of security and easeness, patients and
caregivers
• Patients greater role in self-care.
• Greater adherence to treatment.
• Increased satisfaction
• Avoid admissions and increases patients quality of life.
BUT EXTENSION AND SCALING UP?
CHF Management Protocol
HOME Telecare call centre
BetiOn
24X7 Health Counseling
call centre HACC
Emergencies
Specialist Consultant
Primary Care
Technical
Social alarm
Validated
Health related alarm
HACC Resolution
Referral to
Primary Care
(apppointment)
PC Resolution Resolution
With Specialist consultant
(teleconsultation)
Referral to Specialist Consultant
Activation alarm
2 1 5
4 3
4
5
Weight
Oxigen
saturation
Question
naire
Devices and
services
Hardware
Software
Reception Base
HOME+ BETI ON
HEALTH SERVICE
CRM
Process
management
Platform
Telecare
Blood
pressure
Manual Server EHR Osabide
Scaling up telehealth projects
Scaling up telehealth projects
Decision makers
involvement
Analisys telemedicine & telecare
pilots
Team: PC + Hospital, Call
Centers+ Managers Design the
clinical pathway
(who, when, where)
Logistics, funding and
ICT infraestructure
Dissemination Plan
Lessons learnt • Fragmented care delivery inertia protected by laws,
norms and interest groups
• Health care practices highly stable: network of
influences and constraints (knowledge, beliefs, attitudes,
habits, systems, incentives, …)
• No substitution effect in Service: new models require
extra resources and additional health workers, the former
practice remains!
• Integration telehealth and process management & EHR
platforms takes time
• Commitment and active role of politicians
• Involve managers and clinicians
• Integrate in clinical practice and information systems
• Combined top-down and bottom-up actions
Two points of view:
Pre- start:
• Solve most problems
• Matches Health System needs
• Promises a short development and deployment process
Pre- start:
• Single Payer Healthcare systems predicts Economies of scale.
• Historic Business Models based on individual projects
• Fidelization gives market advantage
Health System View Provider’s View
In the long term…
• It requires larger funding and time for adapting and updating
• Significant Transactional costs development and deployment
In the long term:
• Each Health system has different strategies, systems and processes
• Higher Transactional costs
• Budget shortages reduced margins
Crisis is an opportunity
Need to reallocate funding
PPIs : co-create global products and services
Redefine targets and timelines
It is not easy, ¡Keep going!
Thank you!