2

“Even small healthcare institutions are complex, barely manageable places. . . Large healthcare institutions may be the most complex organizations in human history.”

Peter Drucker

Post-Capitalist Society. New York, Harper and Row, 1993

What is self-management?

“The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.”

What is self-management support?

Making and refining the health care system to facilitate patients and families managing chronic health problems self-management. This includes at the level of patient-provider, patient-health care team, patient-health care system and the community.

Glasgow et al

A philosophical shift

Professional - patient

Professional - Patient

Patient - Professional

Patient - professional

Person - professional

Person-Person

Adapted from Tom Janisse

Current Healthcare System is based on acute care episodes, Not Better Health

Health Condition

Continued Health

Healthy Consumer

No Hospitalization

Acute Care Episode Efficient Successful

Outcome

Complications, Infections,

Readmissions

High-Cost Successful Outcome $

Reducing Costs Without Rationing: Can It Be Done??

Reducing Costs Without Rationing: Prevention and Wellness

Health Condition

Continued Health

Healthy Consumer

Reducing Costs Without Rationing: Efficient, Successful Treatment

Health Condition

Continued Health

Healthy Consumer

No Hospitalization

Acute Care Episode

Efficient Successful Outcome

Complications, Infections,

Readmissions

High-Cost Successful Outcome

Reducing Costs Without Rationing: Avoiding Hospitalizations

Health Condition

Continued Health

Healthy Consumer

No Hospitalization

Acute Care Episode

Reducing Costs Without Rationing: = Better Quality

Health Condition

Continued Health

Healthy Consumer

No Hospitalization

Acute Care Episode Efficient Successful

Outcome

Complications, Infections,

Readmissions

High-Cost Successful Outcome

Better Outcomes/Higher Quality

Drivers of Readmissions

Differences Between Acute and Chronic Conditions

ACUTE CHRONIC

Beginning Rapid Gradual

Cause Usually one Many

Duration Short Indefinite

Diagnosis Certain Long term

Diagnostic

tests

Immediate Repetitive

Treatment Cure

common

Inconsistent

Differences Between Acute and Chronic Care Roles

ACUTE CHRONIC

Role of

Professional

Select and

conduct

therapy

Teacher/coach

and partner

Role of Patient

Follow orders

Partner/ Self

Manage

The patient journey: care continuum, literacy, and personal health information

Health Care Provider

Patient input to the medical record

Treatment decision

Diagnosis Consideration of

treatment options

Adhering to therapy

Monitoring therapy

Presentation

& evaluation

Patient

Engageme

nt/Awaren

ess

Clinical

knowledge

Patient

4

Patient/caregiver

research

Leverage

digital/mobile

communications,

share data

2 1

Symptoms,

Personal

preferences,

Family history

Shared decision-

making w/provider

3

16

Opportunity: Significant Reduction in Rate of Hospitalizations

Examples: • 40% reduction in hospital admissions, 41% reduction in ER visits for

exacerbations of COPD using in-home & phone patient education by nurses or respiratory therapists

J. Bourbeau, M. Julien, et al, “Reduction of Hospital Utilization in Patients with Chronic Obstructive Pulmonary Disease: A Disease-Specific Self-Management Intervention,” Archives of Internal Medicine 163(5), 2003

• 66% reduction in hospitalizations for CHF patients using home-based telemonitoring

M.E. Cordisco, A. Benjaminovitz, et al, “Use of Telemonitoring to Decrease the Rate of Hospitalization in Patients With Severe Congestive Heart Failure,” American Journal of Cardiology 84(7), 1999

• 27% reduction in hospital admissions, 21% reduction in ER visits through self-management education

M.A. Gadoury, K. Schwartzman, et al, “Self-Management Reduces Both Short- and Long-Term Hospitalisation in COPD,” European Respiratory Journal 26(5), 2005

Source: Manhattan Research, Cybercitizen Health® U.S. 2013, fitbit, Pebble watch, Nike

General Well-being Motivates Health Self-Tracking

Among those who are online, Young & health- Age 18-34, in good or excellent overall health and has not been personally diagnosed with a condition. Old & Sick- Age35+, in fair or poor overall health and has been personally diagnosed with a condition

Pebble watch

fitbit

Nike+

FuelBand

50% of consumers track or monitor their health, wellness, or fitness

measurements

19

The Digital Wireless Revolution: A New Type of Band-Aid

A Band-Aid-like adhesive strip worn on a patient’s wrist or skin will monitor vital signs, physical position and activity.

• Determine which type of monitoring (e.g., complete vitals, heart rate alone, glucose for diabetics) fits best with your facility’s strategic direction.

• Determine which beds outside of ICU should be equipped for routine patient monitoring.

• Provide the necessary IT backup.

20

The “Digital Plaster” • A device meant to be embedded in ordinary

plaster that includes sensors for monitoring health-related metadata such as blood pressure, temperature and glucose levels.

• The “digital plaster” contains a Sensium silicon chip, powered by a small battery, which sends data via a cellphone or PDA to a central computer database.

• If the results show any worrisome signs, patients and doctors alike would be notified of the change in the data patterns. They also plan to add a motion sensor to the device so it could additionally serve in the role of “granny monitor” by detecting things like falls or complete inactivity.

[The Toumaz Digital Plaster]

The Digital Wireless Revolution: iPads Meet Healthcare

iPads or other tablet-type devices will be widely used as point-of-care aids and as versatile administrative tools. • Provide tablets and the appropriate medical and

healthcare apps to key members of the clinical staff.

• Have IT staff routinely monitor the development of new hardware and software applications.

• Make sure that wireless connections are strong throughout your facility.

22

Wearable Insulin Pumps • The catheter at the end of the

insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.

• Dosage instructions are entered into the pump's small computer and the right amount of insulin is injected in a controlled manner.

[Medline Plus]

The Digital Wireless Revolution: Pocket Imagers

Pocket-sized imaging devices will provide high-resolution results in any location at a fraction of the cost of inpatient scans. • Strategic plans should address the future of your

inpatient imaging center.

• Consider using pocket-sized ultrasound devices in a variety of settings.

24

The Digital Wireless Revolution: Apps for Patients

Hospitals will routinely provide patients with apps for wireless devices that can be used for the registration process, scheduling follow-up visits and accessing health information. • Be prepared to address any confidentiality concerns that

patients may have.

• Use apps to promote your facility’s strengths and contribution to community health.

• Incorporate the creation and use of apps into strategic and marketing plans.

25

General Well-being Motivates Health Self-Tracking

Among those who are online, Young & health- Age 18-34, in good or excellent overall health and has not been personally diagnosed with a condition. Old & Sick- Age35+, in fair or poor overall health and has been personally diagnosed with a condition

Reasons for tracking health

measurements:

Source: Manhattan Research, Cybercitizen Health® U.S. 2013, fitbit, Pebble watch, Nike

Source: WHO

“Number of people with

diabetes will double

in 25 years”

Home Healthcare is a $ 85bn Industry in the US

>25mn patients in the US receive Home healthcare annually

Apria/Amedisys/Gentiva/Lincare

Pioneers in the Indian Specialty Home Healthcare sector

FOUNDED IN 1996

We are….

Medwell Ventures acquired Nightingales in April 2014.

The Indian Healthcare Scenario

200 Million or more will be over

the age of 65 by 2018

40 million lose their lives

to chronic diseases

every year

Lifestyle and

eating habits have changed

drastically

Personalized

healthcare has become the

need of the hour

Estimated at

$2 billion, the Indian Home

Healthcare Market

is growing by

20% annually

THE INDUSTRY

Home Healthcare in India

An estimated

65% of hospital

visits in India involve

healthcare that can

be provided in the

home.

Home health services delivered annually

250,000+ Subscribers

12,000+

We have…

600+ Employees

3 Cities

Bengaluru Hyderabad

Mumbai

9+ Branches

Branch model across

the city for better reach Catering to 24x7 home

health requirements

24x7 Call center for the subscribed

members

Focus on specialty services from Mental to Physical Wellbeing

Our model…

We provide Home-based medical

services. Focused on Out-of hospital

services

Pay per usage model with basic annual subscription fee

Dementia

care Pulmonology

Vaccinations

Infusion Therapy

Physio at home & at Clinic

Stroke

Management Wound care

We offer…

Dental Care

Delivery of medicines

Caregivers

Medical Equipment

on hire Wellness Plans

Doctor on call Nurse on call

Hospital Association

Better Service Delivery model for patient

Continuum of care – seamless integration from

Hospital to Home

Adherence to care protocols at home

Periodic follow up’s with the treating doctor / Specialist

Retention of patients and great CRM initiative

Avoids high investment cost in running home care

program

Manpower issues associated with Home

Care

Speciality home care for chronic cases helps better

ARPOB for Associate Hospital

Cost Effective

Hospital Association

Hospital Tie-up – Advantage: Heart Failure Clinic

Patient walks into the Clinic

Data Management will be done on cloud and the clinician will have access to the

patient record on line

Care Plan is created by the cardiologist and follow up is done by Nightingales team

Nightingales team will follow up on Care Plan created by

clinician and do ECG and Blood Investigations at home

Proposed package will have PT INR, Serum Electrolytes ECG,

paedel edema, weight monitoring etc... Which will be

carried at home

Adherence to care protocols at home

Associate Hospital will provide space in the

hospital

Associate Hospital will inform all stake holders about the association

and all discharge summaries will have a recommendation for

home care

Nightingales will have a dedicated kiosk

manned by a customer care team

Nightingales will take the leads from the hospital / doctor’s

Separate ID will be issued for associate Hospital patients for better tracking along with a welcome kit

Patients will be engaged right from the

discharge process

Care plan will be reviewed with the treating physician/ specialists before

implementing the same at patients home

Periodic updates to the clinicians on the patient condition

Billing will be done by Nightingales

Monthly report will be submitted by 5th of

every month

How it works

Our Partners

Here we go again….

1917, 1935, 1948, 1965, 1970, 1994

2009