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Healthcare Convergence and The emergence of “Digital innovation”
Ash ShehataPrincipalKPMG LLPGlobal Healthcare Center of Excellence
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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ASHRAF W. SHEHATA, KPMG LLP Principal Global Healthcare Center of Excellence Principal US Healthcare & Life Sciences Advisory Leadership Team
Professional and Industry Experience
Ash is a highly experienced healthcare professional at the cutting edge of information technology (IT) advances and business strategy in the sector. In a career spanning over 25 years, Ash has worked for some of the world’s leading IT and consulting firms, using technology to drive improvements such as telemedicine, e-commerce, membership systems, customer service, claims analytics and healthcare management.
As Senior Executive Director Healthcare for Americas with Cisco, he was responsible for payers, providers and life sciences accounts including the Mayo Clinic, WellPoint, Cigna, Wellcare, J&J, GSK, Medtronic and Kaiser. He led the development and deployment of telemedicine solutions with key clients and government agencies.
Prior to this, Ash was Vice President Health Solutions for Wellpoint, supporting over 32 million members (one in 10 Americans) in enterprise applications. He also held senior positions with KGT Global Technologies, IBM and Accenture, leading executive teams in the U.S. and around the world through major change programs in hospitals, medical service providers, physician group practices and managed care organizations.
Ash’s breadth of experience is typified by his first two roles: first as owner of his own consulting and medical management business, and then with The University of Cincinnati Medical Center in the U.S., where he managed a $250 million annual budget for several departments including Radiology, Nuclear Medicine, Lab Medicine, Managed Care, Cancer and Pharmacy.
Technical Skills
Over 25 years experience working with notable healthcare and life science companies, developing and executing strategies, leading operational changes, and managing successful business development efforts.
Experienced in leading executive teams in change management in large hospital settings, medical service organizations, physician group practices, and managed care organizations.
Conducted more than 50 executive business strategy sessions, leading companies and boards through the opportunities and risks associated with decisions around technology enablement, selecting new products, managing cost benefit
Other Activities
Presenter and author of articles on topics such as E-business and technology, IT strategy, role of performance management in healthcare organizations, Convergence, Changing role of Life Sciences and ERP implementation.
ASHRAF W. SHEHATA, BA, MHA, MBAPrincipal, Advisory Management Consulting
KPMG LLP312 Walnut StreetCincinnati, OH 45202
Tel 513-763-2428ashehata@kpmg.com
Function and SpecializationAsh is a U.S.-based Advisory executivespecializing in healthcare IT, includingmeaningful use achievement, health informationexchanges, longitudinal clinical records, cloudbasedhealthcare IT, and clinical and otherhealthcare business intelligence.
Education, Licenses & Certifications Masters in Hospital & Health Administration, MBA and BS in Psychology, Xavier University Adjunct Faculty
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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The changing healthcare landscape
Contents
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Adapting new solutions for new healthcare systems
What is driving healthcare convergence?
The Digital World
Digital examples
Where are you currently positioned?
Q&A
Contents
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Coordinated care (in own home)
Non-integrated care (institutions)
Focus on quality and value
Addiction to “volume”
Wellness, Prevention and Disease Mgmt
Treating episodes of sickness
Horizontal networksVertical networks
Patient Focused(consumerism)
Client Focused
Real Time and Predictive
Retroactive
Today Tomorrow
Transformational Imperatives affecting the Industry
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Convergence is affecting all market participants
The healthcare industry is experiencing accelerated disruption and convergence due to advanced market drivers. Change is inevitable for all entities, but preparation dictates impact and outcomes.
Economic pressure to cut costs
Increase in regulations that require compliance
Increase in patient expectations of services
Massive IT investments underway and exponentially increasing number of solutions to evaluate
Provider change fatigue
Enhanced care coordination required across the continuum
Implications of Convergence
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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We Believe There Are Several “Game Changing” Factors That Could Significantly influence Competitive Dynamics in the Industry
Trend/Dynamic
Shift from volume to value based reimbursement
New Economic
Model
New Commercial
Models
Challenge to traditional revenue model
New detailing strategies
Healthcare Reform Aggregate Spend
Regulatory Reform/ Scrutiny
Increased Focus on
Compliance
Requirement to proactively monitor partnerships
Attention on local market practices
Consumer driven healthcare plans
Online access to global supply
Healthcare Consumerism
Patient Driven
Consumer making own health decisions
Consumers purchasing globally
Emerging markets introduce new opportunities and new competitors
“Reverse” Innovation
Disruptive
Players from emerging economics may introduce cheaper products
‘Retail’ healthcare provider models expanding from pharmacy
Disruptive Market
Entrants
New Industry Players
Shifts in primary point of care Technology powering insight/choice
Internet of everything 25 billion connected devices by
2015
Data Volume and Access
Decentralized Information
Increased opportunity for innovation
‘Monetization’ of health data
Key Considerations ImplicationKey Examples
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Data will be the key to unlocking inefficiencies and improving quality?
The inability to collect, share and use data from a variety of sources is a leading reason that the global healthcare system has the highest potential for improvement.
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Adapting new solutions for new healthcare systems
Three crucial strategies to consider in the new healthcare environment:
Understand the customer and what they want
Reshape offerings to provide enhanced product value and broad value based distribution
Anticipate shifting power structures in the wider healthcare system
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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What is driving healthcare convergence?
Healthcare convergence is the thesis that all stakeholders in the healthcare ecosystem will increasingly need to work more closely together to achieve one aim: better patient outcomes at lower costs.
Outcomes vs. inputs New healthcare ecosystems are centered on the patient
Source: KPMG International, 2012
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Key healthcare policy trends driving healthcare convergence
Paying for outcomesRecent healthcare reform acts focus on improving patient outcomes while cutting costs
US 2010 Patient Protection and Affordable Care Act (PPACA)
Trend Description Example
Comparative effectiveness
Assess the additional value of a medical device relative to treatment alternatives.
Patient-Centered Outcomes Research Institute (PCORI) in the US
Real world evidence
Emergence of a Big Data that integrates traditional clinical trials data with claims and EHR to measure value and improveAdverse event reporting
Oncology, Auto Immune Disease, Pain Mgmt, Hep C are great examples of RCT and RWE data leveraging observational and retrospective data
Value-based pricing (VBP)
VBP used to increase market share for the first entrant in a new therapeutic category or in response to budgetary pressures.
US Healthplans are reviewing medical effectiveness based on overall clinical episodes and DRG groupings
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Partnership examples
Finding ways to help improve outcomes and patient engagement align the interests of the industry with those of the patient, healthcare professional and provider: a win for all invested parties.
Trend
■ Develop companion diagnostics to improve outcomes
■ Improving Patient Communications
■ IT and Big Data
■ Mobile health
■ Clinical professional services units
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Understand the customer and what they want
Life sciences companies will need to become better at identifying who their new customers are, what they want and how they want it delivered.
Old model: Customer was prescribing physician, the patient the recipient of direct-to-consumer advertising
New model:Customer includes ultimate bill payer, e.g. government, physician group, informed patients
Old model: Customer was influencing physician; patient the recipient of direct-to-consumer advertising
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Anticipate shifting power structures in the wider healthcare system
■ Rising engagement ■ Increased cost-sharing
and decision-making■ New technologies and
access to information ■ New products and
services■ Redefine and
differentiate product offering
Patient Payers
■ Leverage knowledge and databases of patient and disease profiles
■ Position business as part of the solution
■ Prevention and appropriate treatment
■ Improve patient engagement
Healthcare professionals
■ Change old attitudes by demonstrating the industry is an ally, not enemy, nor merely a source of funding
■ Increase investment in education at all levels to train the next generation of healthcare professionals
Opportunities for the life sciences industry to respond to drivers of change in healthcare systems:
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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What is the Internet of Everything?
•The Internet of Everything (IoE) is the emerging global network that connects people, processes, data and physical devices to transform structured and unstructured information into real time insight and decision making.
•Physical devices or things are embedded with sensors and actuators are linked through a combination of wired and wireless networks
Vendors have different points of view on the Internet of Everything –
• IBM tends to focus on the data.• Cisco tends to focus on the
network.• Service providers focus on the
connectivity to devices.
We are of the opinion that the common thread in this conversation is information.
Physical devices (Things)
Connectivity(Protocols, Network infrastructure etc)
Structured and unstructured information
Real time insights and alerts
Decision making and business strategy
Applications and Services
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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The Future of Connected Healthcare
In fifty years’ time, I believe that we will consider the rise of mobile technology to be one of the greatest medical advances the world has ever seen.
Armed with the newest devices and technologies, patients will enjoy better health outcomes, doctors and medical professionals will be more effective and efficient, costs for payers and governments will be slashed and populations will – for the most part – be more health conscious.
Indeed, by coupling the power of mobile devices with rapidly-maturing technologies such as cloud, health systems around the world are starting to awaken to an entirely new way of delivering health services.
How mobile devices will revolutionize healthcare
Anson Group
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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What is the Internet of Everything? Scale of the Internet of Everything
It is predicted that there will be 25 billion devices connected to the Internet by 2015 and 50 billion by 2020.
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Operationalizing the Digital Strategy
Infrastructure
What will all of this mean form a technical infrastructure point of view? How do I ensure security, access and performance of the solution?
Governance
What are the principle processes and the organisational structure required to ensure integrity and the continuous alignment of information to the business needs?
Performance Management Process and Reporting
How can I improve my financial planning and business performance management? What are the KPIs and reporting requirements of my business? How can I best execute my financial consolidation?Integrated Information Management
What is the information content and date model required to support my reporting requirement? Where are the value creation opportunities in standardisation of KPI and master data?
BI Platform
What is the right application to support information delivery, financial consolidation, planning and performance management? How can I succeed in delivering the applications implementation and make the overall solution really deliver value to the business?
Business Alignment
What information is key to delivering our strategy? How will I deploy this in a manner which maximises business performance in a cost-effective manner?
Industry and Regulatory Standards
Industry and Regulatory Standards
How can the organizational model to operationalize IoE align with the overall industry and regulatory standards?
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Care Continuum Coordination Solution Set required elements
No matter what your challenge (i.e. ACOs, PCMHs, CINs etc) developing capabilities to enable Care Continuum Coordination is essential to drive quality and cost improvements for new “outcomes-based” reimbursement models.
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Care Coordination Maturity
The pathway of maturity can include many of the required elements and necessitate progressive and interdependent advancement. Each organization’s model is unique based upon local factors but require addressing the same key elements to be successful.
Develop Operational and Technical Capabilities
Defining the people and roles that are necessary for success
Assessment of the ability to capture meaningful data with the right technologies
Identification of the Patient populations that can generate return on investment in the short term
Introducing standards to operations and technology will enable efficient growth and program scalability
Expand and Grow with Technology Enablement
Deploy game changing technologies to grow data sets and interoperability for data exchange
Improve timeliness of response to mitigate high cost care solutions
Develop how populations are targeted and programs are advanced by expanding Care Continuum Coordination solutions
Optimize to become Market Leading with Intelligence
Leverage technology to drive performance with valuable analytics and quality improvement
Innovate programs and care delivery with support from business intelligence
Achieve results of improved quality, service, care and cost
Identifying Care Needs
Providing Population Health Management
Care Coordination
Measurement & Quality Improvement
Program Management
Transition of Care Management
Gaps in Care Analysis
Remote Monitoring & Management
Readmission Management
Patient Education
Authorization of Care
Comprehensive Utilization Review
Standards & Compliance
Analysis of Utilization
Costing & Savings Analysis Report
Patient Diagnosis
Follow-up Management
Hospital Provider Efficiency
Improved Patient Convenience
evidence-based standards
Core Performance Measures
Patient Experience Measures
Practice Performance Reporting
Reporting Performance Publicity
Expand on Phase 1
Capabilities
Expand Phase 2 and Optimize
Phase 1
Phase 1: Develop
Care Continuum Coordination Maturity*
Infrastructure (IT, HR Governance, Finance, Compliance, Operations)
Phase 2:Expand
Phase 3: Optimize
*Representative sample of elements
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Impact of Technology Enablement
Capture: Data is collected through activities conducted throughout the Care Continuum cycle. Various systems are needed to support the different processes.
Exchange: Information is exchanged to multiple systems that support the Care Continuum. Highly effective Clinical Decision Making and Care Coordination requires timely access to integrated data (claims and clinical) to perform timely interventions and maximize outcomes.
Use: Using analytics, collected data is aggregated to minimize risk and improve workflows. Data can be utilized to improve clinical care and further research initiatives. Targeted ROI can be increased and accelerated by selecting the greatest breadth of relevant data to acquire and by aligning to this core transformational model .
Achieving the healthcare transformation outcomes of Cost Reduction, Increased Quality and Improved Access requires investment in technologies that will effectively enable clinical data Capture, Exchange and Use.
CAPTURE
Clinical data with EMR
EXCHANGE
Clinical data with IE or HIE
USE
Analytics to drive Clinical Intelligence
Examples
Electronic Medical Record (EMR), Patient Portals, Patient Access
and Financial systems
ExamplesInformation Exchanges (IE),
Health Information Exchanges (HIE ) and Electronic Master
Patient Index (EMPI)
Examples
Analytic engines, presentation layers, rules libraries
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Common Technology and Data Exchange Challenges for CIE
Challenge Description
Flexibility Many EMR Systems
Imperfect Standards
Variance among implementation of standards
Monitoring Volume of data exchange will overwhelm ability to manually track success/failure/issues.
Future State HIE Interaction
State HIEs are using different platforms and approaches.
Poor Data Quality
Poor data quality results in extra work for analytics team.
High Level Summary of relevant CIE and PCMH Technologies and Limitations
EMREMREMR EMR
CCD
CCD
CCD
data
data
data
data
HIE1 HIE2 HIE3
data
data
data
data
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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High Level Conceptual CIE Technology Architecture
External Sources
HIEs, CMS, etc.
External EMRs, CCDs
Etc.QualityRegistries
Ancillarysystems
HIMRegistration
(MPI)Enterprise
EMRs
Quality andCompliance
Analytics
Second Line Clinical Staff
Rapid Response
Front LinePrimary Providers
Patient ThroughputAnalytics
073.5
Quantity083.1
Growth114.4
Finance
Quantitative & Qualitative Measurements Across the
Enterprise
BALANCED SCORECARD BEST PRACTICES AND EVIDENCE BASED BENCHMARKS
DAILY USER INTERACTION AND COLLABORATION
Data published to the Analytics Platform will come from the CDW or the legacy application (s) depending on timing of CDW refresh
Clinical DataWarehouse
ETL & Integration
RevenueCycle
Analytics
Case Management
Analytics
Intelligence Layer
External Data Sources
HISPLATFORM NEUTRAL
BPM BPM
The conceptual model below shows how BPM was used in conjunction with the EHR and multiple data sources to create a solution to improve care planning and delivery for high risk pregnancies
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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KPMG/Cynergy created an mobile front end application for an EHR system used by an innovative healthcare delivery system for Medicare-eligible patients. This system is recognized as an industry leader in medical risk management, highly effective disease management and chronic care programs, and healthcare delivery services.
Development and Implementation of Mobile Front Ends for EHRs will continue to evolve
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Architecture for a telehealth system for 800 locations
Development of Architecture, Operating Model and Business Case for National Provider Network looking for scale
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Health & Wellness Care
Injury & Disease Prevention
At-Risk Medical Surveillance
Life Style & Behavioral Choices
Health & Fitness Incentives
Motivate, Measure, Monitor, Advise and Coach
mHealth and Tele-Health
Episodic Sick Care
Inpatient – Acute Hospital Care
Outpatient – Chronic Condition Care Management & Home Care
Diagnose, Treat, Monitor & Advise
Telemedicine, Tele-Home Care, Tele-Health & mHealth Network
Post Acute – Social Care
Assisted Living/SNF
Terminal Hospice Care
Independent Living with support
Support and Palliate
Tele-Health & TeleCare
$ $$$$$$ $$$$
The consumer forms the epicenter of the healthcare value chain for population health
Episodic sick care drives the highest near-term cost, and surveillance & care coordination of the “at risk” well population represents the greatest opportunity for long-term cost avoidance
NEW High Value Health and Healthcare Target PopulationsConsumers Lifecycle Continuum
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Amazon.com Drives Sales Through Integrated Customer Experience … Is there a future for something like this in healthcare?
“We make money when people use our devices, not when they buy our devices.”
Kindle provides a medium to deliver Amazon’s online content
■ Strategic move in both customer acquisition and retention
■ “People read four times as much as they did before they bought the Kindle”
The new Mayday feature is a single-click, hardware-support solution that lets users work with a remote tech
■ Virtual equivalent of having an IT support person in your living room
■ Allows for customer insight and rapid product development
■ Competitive advantage over Apple
Amazon.com, Inc. seeks to be Earth’s most customer-centric company, where customers can find and discover anything they might want to buy online, and endeavors to offer its customers the lowest possible prices.
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Enhancing the product through a digital experience
Sources: Nike; Fitbit; Swipesense.
When done well: Competitive
advantage Customer stickiness Creation of new
revenue streams
Connected wearable devices
“Track how much, how often and how intensely you move.”
Share activity with friends, compare your stats and set up competitions
Personalized Capture Devices
“Dedicated to helping you reach your fitness goals.”
Includes ability to record food and liquid intake
Monitoring Devices
example :SwipeSense
“Hospital-acquired infections cause 90,000 deaths/year.”
Combination had sanitizer/tracking device wirelessly tracks usage information
© 2014 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG CONFIDENTIAL.
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Advancing the Internet of Everything of Healthcare
1. mHealth will need to advance from pilot to sustainable program to provide a reliable delivery model for healthcare.
2. Applications will need to mature beyond simply replicating web services to personalized and real time relevant data.
3. Economic model for devices, sensors, consumer mobile devices and infrastructure will need to get more cost effective in order to accommodate the growth model. Unit costs need to dramatically reduce as volumes increase.
4. Cloud and technology providers will need to work with healthcare and life sciences organizations to define specific offerings for healthcare.
5. Involving patients, healthcare providers and payers to develop process, workflows and to innovate the delivery models.
6. The opportunity for the IoE to be a disruptive technology for healthcare is so large that we have to be clear about the business value, process quality and outcomes associated with the early solutions.
7. Patients and consumers will need to warm up to the idea that devices can be an integral part of their life in healthcare. Industry and technology leaders need to demonstrate this confidence through privacy and security measures for consumers and patients.
7 things that need to happen… for the Digital Environment to expand dramatically in Healthcare
© 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International.
The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act upon such information without appropriate professional advice after a thorough examination of the particular situation. Service offerings are subject to legal and regulatory restrictions. Some of the services included herein may not be available to KPMG's financial statement audit or other attest service clients.
Ashraf ShehataPrincipal, Healthcare & Life SciencesKPMG LLPashehata@kpmg.com513-763-2428
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