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© CGI Group Inc.
Innovation Opportunities for Health
Kelowna Health Summit June 23, 2015
Canada underperforms relative to other countries.
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AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US
Overall Ranking (2013) 4 10 9 5 5 7 7 3 2 1 11
Quality Care 2 9 8 7 5 4 11 10 3 1 5
Effective Care 4 7 9 6 5 2 11 10 8 1 3
Safe Care 3 10 2 6 7 9 11 5 4 1 7
Coordinated Care 4 8 9 10 5 2 7 11 3 1 6
Patient Centered Care 5 8 10 7 3 6 11 9 2 1 4
Access 8 9 11 2 4 7 6 4 2 1 9
Cost Related Problem 9 5 10 4 8 6 3 1 7 1 11
Timeliness of Care 6 11 10 4 2 7 8 9 1 3 5
Efficiency 4 10 8 9 7 3 4 2 6 1 11
Equity 5 9 7 4 8 10 6 1 2 2 11
Healthy Lives 4 8 1 7 5 9 6 2 3 10 11
Health Expenditures / Capita, 2011** $3,800 $4,522 $4,118 $4,495 $5,099 $3,182 $5,669 $3,925 $5,643 $3,405 $8,508
Country rankings
Top 2*
Middle
Bottom 2*
Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010.Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).
Drivers of healthcare expenditure growth between 1995 and 2009 in OECD countries
Healthcare expenditure growth
1. Population Growth & Aging
2. Price Inflation of Health Goods &
Services & Physician Expenditures
3. Inefficiencies in Health System Delivery
Health Costs are rising faster than Inflation
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Source: National Health Expenditure Trends, 1975 to 2014, Canadian Institute for Health Information, Oct. 2014
How do we sustain our Healthcare system?
Healthcare will absorb 69% of total revenues available to provinces / territories by 2037 (compared to 44% today) at current rate, and the system will not be sustainable at current levels unless we implement:
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Significantly increase GDP growth
Increase taxes / healthcare usage fees
Reduce/Cut Other Government Programs
Lower cost methods of healthcare delivery
Source: Sustainability of the Canadian Health Care System and Impact of the 2014 Revision to the Canada Health Transfer, Canadian Institute of Actuaries, Sept. 2013
Invention
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Traditional management methodology
Innovation
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New approaches to innovation Innovation
North America’s first fully Digital Hospital
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Benefits
Building Automation
Fire System
RTLS AGVs
Pharmacy Robotics
Wayfinding Security
CCTV
Nurse Call
Unified Communications
Mobile
Laptops / Bedside
Person Directory
Email EHR
RFID
Medical Equipment
Connect
Patient Flow Code call workflow Equipment Utilization Self Registration
Action situational awareness Intelligent Agents
Know me…who, where, what Follow me…across devices, channels Serve me…search, inform, act
100+ vendors 40,000 endpoints 1,000s events / day M’s digital transactions / day
X X =
Patient & Family Engagement
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Coordinator Manager
Relatives
Client, Patient
360° care
Clinician
Impact
• Time dedicated to clients has increased 30% • The feeling of safety has increased amongst patients, clients and care
providers; Security of clients homes improved with wireless door locks • Reduced Hospital (re) admissions by 10% to 30%
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Targeted Disease Prevention
Early Disease Detection
Accelerated Diagnosis
Targeted Therapy
Improves Outcomes
ê$
Precision Medicine in Clinical Care
Achieving Full Value from Analytics
Diagnostic Analytics
Predictive Analytics
Prescriptive Analytics
Descriptive Analytics
What happened?
Why did it happen?
What will happen?
How we can make it happen
in the best feasible way?
Analytics Maturity
Measurable Business
Value
Prescribe an alternate more cost effective course of action, preapprove payments for preventative therapy such as life style courses
Bus
ines
s In
telli
genc
e A
dvan
ced
Ana
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s
Adapted from Davenport & Harris’s Competing Analytics: the New Science of Winning (2007)
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Optimizing Performance
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16% increase in access to inpatient
beds
2000 fewer unnecessary ED
visits annually
Annual cost savings of up to $18M CAD
Increase in 1000 elective procedures
annually
“The findings of the proof-of-concept are not exact results but are derived from real data and scenarios and do show direction and comparability of the impact of the scenarios.”
Jewish General Hospital, Montreal • 637-bed university teaching hospital • 23,000 admissions, 300,000 outpatient
visits, 67,000 emergency visits, 4,000 births annually
Key challenges with ED Visits • Fixed funding • Inability to turn patients away • Numerous discharge barriers
What is the impact across the hospital of changes to clinical service programs and how can we optimize operations?
Funding: Sources of Capital in US, UK, Canada Limited funding sources in Canada beyond Governments1
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Model Description Risk Ownership
Government financed
Funded through government tax revenues or government-issued debt Government
Philanthropy Gifts from donors and fundraising efforts through healthcare foundations’
campaigns Healthcare institution
Working Capital Self financing of capital project from healthcare institutions’ own reserves/
operating margin Healthcare institution
Design-build-finance-maintain
(DBFM) P3
Integration of multiple phases of a capital project into a single contract that shifts project risks to a private consortium in return for a risk premium
Private consortium
Debt capital (bonds, etc.)
Debt issued directly by healthcare institutions, technically unsecured by government
Healthcare institution
Equity offerings Equity issued by healthcare institutions Investors
Financial Engineering
Vendors bundle cost of capital expenditure in “per use model” limiting up front capital expenditures. Arrangements where capital is provided in
exchange for longterm contracts, etc. Shared
Social finance A partnership agreement between government, private investors, and agencies with social outcomes targets as basis for financial returns
Shared
1Capital Spending in Healthcare: A Missed Opportunity for Improvement, CFHI, June 2013
Examples of funding innovation
How do Health systems afford Innovations given our fiscal constraints?
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P3 / DBFM Leveraging private financing to include ICAT solutions in a new Hospital build.
Benefits funded Innovation Leverage analytics & technology to reduce overhead costs; re-direct Capex & Opex funds towards Innovation.
Hitesh Seth Global Health Industry hitesh.seth@cgi.com 416-716-9630
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