TELUS Talks Health...i The Digital Revolution comes to US Healthcare, Goldman Sachs, July 2015 ii...
Transcript of TELUS Talks Health...i The Digital Revolution comes to US Healthcare, Goldman Sachs, July 2015 ii...
TELUS Talks Health
In November 2015, the annual TELUS Talks Health event
welcomed 250 leaders from across Canada’s healthcare
ecosystem to attend a compelling keynote from our
internationally esteemed guest, Dr. Mark Britnell, Chairman
and Partner of KPMG’s Global Health Practice. He is an
advocate of patient engagement and author of In Search of
the Perfect Health System, in which he shares first-hand,
compelling observations of health systems in 25 countries.
Of Canada, he notes: “Canada’s health system, or rather its 13 provincial and territorial health systems, needs to find more urgency
and resolve for solutions to its healthcare sustainability challenge. A measure of tough love will be needed not only to maintain
enduring values, but also to change outdated delivery models. Canada stands at the crossroads and needs to find the political will
and managerial and clinical skill to establish a progressive coalition of the willing.”
In my own experience speaking with health leaders across the country, there is no dispute that the sustainability of our health
system is the primary concern keeping people up at night. As governments, health authorities, care providers and vendors traverse
these crossroads, patient engagement is as top of mind for leaders in Canada, as it is globally.
This TELUS Health position paper leverages insights shared by Dr. Britnell, among others and discusses the advantages of patient
engagement in two ways: the management of chronic conditions – an area well-known to deliver return on investment; and prevention
to reverse or head-off preventable health issues and avert further undue strain on the health system.
Canadian healthcare 3.0Traversing the crossroads with patient engagement
December 2015 Edition
Paul Lepage
President, TELUS Health
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The third wave: digital health, disruptive innovation
Canada is poised to embark on its third wave of healthcare delivery. The first wave, at the turn of the 20th century, was focused on
addressing infectious disease. The second wave in the 50’s and 60’s was centred on establishing a system to deliver more effective
acute care. This is the foundation of our current healthcare system; one that is now overburdened by the demands of today’s larger
and aging population. The third wave – Canadian healthcare 3.0 – is fuelled by technology, focused on patient engagement and
harnesses digital information to involve people in managing their own health and wellness.
Disruptive innovation in healthcare
Lifestyle Behaviors
Chronic Diseases
Over 50% of Deaths
low costlow tech
low access
high costhigh tech
low access
digital carelow costhigh tech
high access
Past Present Future
Physical inactivityPoor nutritionSmoking
DiabetesHeart diseaseLung diseaseCancer
Source: Goldman Sachs Global Investment Research
In Goldman Sachs’ 2015 analysis of the Internet of Things (IoT),
the firm notes that digital health is the disruptive innovation that
will lead to a future of lower cost, higher access care. This
means that technologies like remote patient monitoring and
telehealth that bridge digital and physical worlds to change
physician and patient behavior will define the future of primary
healthcare delivery. In addition, digital health tools and apps
are becoming paramount in supporting new, healthier and
preventative behaviors for citizens at large.
Goldman Sachs calculates potential savings in the US by
adopting IoT for remote patient monitoring, telehealth, and
behavior modification to be approximately US$305 billion,
two-thirds of which come from improvements to chronic
disease managementi.
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What engaging patients (aka ‘people’) looks like
Engaging patients and citizens is at the heart of digital health
and is fast becoming an integral component in designing
this brave new world – not only in Canada, but around
the world. However, there is no single model for patient
engagement. Rather, the idea reaches across a spectrum of
care: from disease management for those living with chronic
conditions, all the way to wellness and prevention to help
anyone lead an active and healthy lifestyle.
Disease management and prevention each targets a different
segment of Canadian health consumers. Each employs
different tools and technologies. However, both agendas
are aimed squarely at equipping Canadians themselves
to proactively participate in making our health system
more sustainable.
In a recent poll, KPMG found that 72% of global leaders believe
empowered patients create better value care. This has certainly
proven to be the case with chronic disease management in
Canada, as elsewhere. In Ontario for example, pilots show that
the use of telemedicine has reduced emergency room visits and
hospital visits by 50 percentii. Similarly in BC pilots, the use of
home health monitoring has decreased health system utilization
by 76% and resulted in cost savings associated with inpatient,
emergency and physician services.iii
But we’re not there yet. Eighty-nine percent of health leaders
globally believe their health systems are designed around
organizations’ – not patients’ – priorities and they are not very
satisfied they are meeting patients’ needs.iv
Patient engagement becomes more than a buzzword when
the people-factor is front and centre. This sentiment was
echoed by a KPMG-commissioned global survey of patient
representative and advocacy groups. To them, patient
engagement means “people engagement,” i.e:
Being seen as a person, not a condition or intervention site
Being an informed and empowered partner in care
Not feeling abandoned due to fragmented care
(especially after discharge)
This is an important reminder that patient engagement does
not mean technology engagement. Rather, technology is for
enhancing collaborative care between a patient and their health
providers; not transferring the onus of care to the patient alone.
Easing the high cost of chronic conditions
Chronic conditions come with a very high emotional cost to
individuals and their families and their crippling financial impact
to the health system is well known. Forty percent of Canada’s
overall population – and 80 percent of those over the age of
65 – live with chronic disease and caring for this population
accounts for close to half of our provincial budgets. As the aging
population increases from 16 percent today to 25 percent within
the next 15 years, the impact on health system sustainability
will be untenable.
Global research shows that patients who are less engaged cost
the health system from 8 to 21 percent more than those who are
engaged.v Furthermore, patients managing chronic conditions
do so for about 5,800 waking hours each year while typically
spending fewer than 10 hours with a healthcare professional.vi
Imagine the potential value that can be delivered when we
bolster patients’ ability to engage and collaborate with their
circle of care during those 5,800 hours. The technology exists,
the demand is there and the opportunity to impact system
sustainability is staggering.
Behavior is another key pillar. It plays a major role in deaths
associated with chronic disease. According to the Oxford Health
Alliance 3-4-50 initiative, three lifestyle behaviors lead to four
chronic conditions that account for over half of deaths worldwide.vii
Lifestyle Behaviors
Chronic Diseases
Over 50% of Deaths
low costlow tech
low access
high costhigh tech
low access
digital carelow costhigh tech
high access
Past Present Future
Physical inactivityPoor nutritionSmoking
DiabetesHeart diseaseLung diseaseCancer
Complications associated with chronic disease are largely due to addressable lifestyle behaviors.
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This is why prevention should be an important thrust in recasting
our health system. When we are able to support people in making
life-saving lifestyle changes, we will be able to ease the burden
of chronic disease on individuals and system sustainability.
Prevention mindset – the missing link
Prevention and individual accountability for maintaining healthy
behaviors is often overlooked in the conversation around health
system sustainability. This may be because prevention is not
associated with primary or acute clinical care. Or it may be
because, culturally-speaking, prevention is an individual versus
a systemic pursuit. Whatever the case, research suggests that
adopting healthy behaviors – proper nutrition, adequate sleep,
and regular exercise – are the primary levers that enable
individuals to re-set their health trajectory.
The prevention mindset is alive and well in other jurisdictions,
most notably the Nordic countries (Denmark, Finland,
Iceland, Norway and Sweden) that share well-developed public
health and illness prevention strategies that are connected
not only between national bodies and local municipalities but,
increasingly, between the public and private sectors, tooviii.
Taking this a step further, Sweden recently embarked on
implementing an electronic personal health record for its citizens.
The Swedish government’s goal is to contribute to improved
healthcare by providing a secure personal health record with
tools to increase engagement and empower people to take
greater control of their own health. Swedes can use the
interactive platform to gather their health information from multiple
parties and even connect wearable devices. Overall, the intent
is to support greater engagement by individuals in their own
personal health development.
Here at home, Alberta is set to launch a similar program,
making tracking tools and access to healthcare data available
to its citizens; a bold step toward facilitating wellness and
prevention for its population.
We can all learn from these examples as individual accountability
for maintaining healthy behaviors will become more and more
important as the nation works to improve its health system.
Innovating with courageous patience
Leadership guru, Warren Bennis, describes successful innovation
as requiring ‘courageous patience.’ And, as Canada traverses
the crossroads of health system sustainability and patient-
people-engagement, it will take the courageous patience of an
entire digital health ecosystem comprised of entrepreneurs and
established vendors alike to bring about a new standard of care.
After all, healthcare is a team sport and digital consumer
technology is driving expectations for the same level of service
in healthcare. With access to online banking and travel booking,
why not have access to lab results, medication information, a
record of visits with care providers and care plans?
Seventy six percent of Canadians say digital health can make
accessing health care services easier and more convenient.ix
More than 80 percent of Canadians would take advantage
of digital health solutions, if available, by viewing their own
information (laboratory tests, immunization records,
prescriptions and medication history) and accessing services
(making appointments, requesting prescription renewals,
seeking more information about their care).x
According to a new report published by MarketsandMarkets, it
seems the market is poised to deliver on these expectations.
The global forecast for mobile health solutions is anticipated to
reach US $59.15 billion by 2020. This includes:
Connected devices, such as blood pressure monitors,
glucose meters, pulse oximeters
Apps, including those for weight loss, women’s health,
Personal Health Record, and medication
Services, including remote monitoring, consultation,
and prevention
telushealth.com
i The Digital Revolution comes to US Healthcare, Goldman Sachs, July 2015ii Remarks to the Canadian Club of Toronto By Dr. Ed Brown, OTN CEO, November 6, 2014iii Impact of Home Health Monitoring on Clients with Heart Failure. Cheryl Beach, BSc(PT), MSc, PhD; Oluseyi Oyedele, BSc, MSc, PhD, MPH; Dion Bedard, BSc; Mark Lazurko, BSc(Pharm),
MBA, 2014iv KPMG Global Healthcare Conference 2014, pre-conference survey v Hibbard J H, Greene J, Overton V (2013) ‘Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”.’ Health Affairs, 32, no (2013): 216-22.
(Quoted in KPMG, ‘Creating new value with patients, carers and communities’)vi Department of Health, Research evidence on the effectiveness of self-care support (DH, 2007), as cited in In Search of the Perfect Health System, Britnell, 2015vii As aboveviii In Search of the Perfect Health System, Britnell, 2015ix Harris/Decima Annual Survey for Canada Health Infoway, March 2014x Ipsos Reid Omnibus Survey for Canada Health Infoway, May 2015
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Patients at the heart of care
In closing, it is important to underscore that
delivering patient-centred care has always been at
the heart of what healthcare providers do. What has
changed is the level of proactivity that patients and
individuals expect to have.
As Canada takes further strides to enable patients
to self-serve, this will not only address expectations;
it will take significant burden off of the health system
and promote a culture of prevention and individual
accountability at the same time.