leveraging ehealth for transforming health services in the ... · health system gaps across all...

Copyright © 2013, Oracle and/or its affiliates. All rights reserved. 1

Jesús María Fernández Díaz MD International Director. Oracle Healthcare Former Vice Minister of Healthcare, Basque Country 2009-2012

Leveraging eHealth for transforming health services in the Basque Country


Agenda: Transforming health care in the Basque Country 2009-2012

1. The Challenge 2. The Strategy 3. The Results 4. Your questions


The Basque Country healthcare landscape • 2.2 million population (19% > 65 years; 39%

expected by 2050).

• High Life expectancy: 77,2 for men and 84,3 for women

• Highest public health expenditure (1.500 €) and GDP per capita (30,830 €) in Spain.

• Public Health Expenditure represents 7% of GDP (USD 4,2 billion)

• High level of self-government and taxation power; two official languages

• Osakidetza – Basque Health Service, a Public Integrated Health Care organization offering comprehensive and universal coverage with high quality standards . 98,9% revenues from Govnt


The Basque Country has also other attractions


The increasing burden of chronicity and dependence

• Chronic disease prevalence

extending

• Co-morbidity and

Dependence come together

as population ages


Fiscal Revenues collapsed while healthcare expenditures continued to grow

9 205

9 907

11 265

12 552

13 772

12 834

10 792

2 114

2 266

2 478

2 662

2 961

3 284

3 566

2 000

2 200

2 400

2 600

2 800

3 000

3 200

3 400

3 600

8 000

9 000

10 000

11 000

12 000

13 000

14 000

2003 2004 2005 2006 2007 2008 2009

million €

Fis. Rev. Public Health Exp.


The compression of chronic disease burden and cost

RUB Nº people %

Population

Primary Care Prescriptions Hospital outpatient Emergency hospital Inpatient

5 23.883

4 80.168

3 720.644

2 527.441

1 311.862

0 628.303

77% 2,5% 6,7% 7,6% 6,3%

1%

4% 60%

12% 11,4% 12,4% 3,5%

21% 27% 17,7% 4% 31% 31,4%

36% 19% 20,6% 7% 18% 23%

35% 24% 27,5% 11% 2,6% 13,6%

27,4%


Health System gaps across all OECD countries

20-40% of total health spending is wasted due to: (i) Overtreatment; (ii) Failures of care delivery (i.e. poor adoption of effective preventive care, unsafe practices); (iii) failures of care coordination (i.e. readmissions); and (iv) administrative complexities One of every 10 hospital admissions are preventable by improving the

quality of care One of five hospitalized patients are readmitted within 30 days; more than

one-third are readmitted within 90 days The number of diabetics in UK who received all nine of their annual checks in

2010 ranged from 6 per cent to 69 per cent

Triple Aim Transformation to avoid dramatic cost-cutting measures


Chronic patients are not the problem but the solution …

Patient: • shows up … • get treated … • is discharged … • disappears … • gets complicated …


A Comprehensive Strategy to tackle chronic conditions

Patient Activation: • Expert Patient

Program • Patients Associations

Empowerment

Population Based Health:

•Patient Stratification •Population Based Integrated Health Plans

Prevention and Promotion: •Extended use of screening programs

•Community Health Focused Programs

•Multisectorial interventions on health determinants

Continuity of Care: • Integrated clinical care

• Shared Financing & commissioning

• New nursing roles • Social and health care continuum

Leveraging IC technologies:

• Unified EHR • Multichannel services • E-medication • Telecare • Chronic care

innovation center and bottom-up projects

Improved health, effective care and system’s efficiency


Osarean: The Basque Multichannel Health Services Center Service portfolio

Service portfolio

Patient - professional collaboration

New Appointment and demand management

Health Counseling

Patients remote monitoring

Prevention campaigns

C ustomer Services and administrative

procedures

Active Patient Engagement

Personal information

access

• Web 2.0 • CRM • IVR • BI


Osarean main components

Nurse call center Services portal

Population Management platform

Mobile Apps

Personal Health Record

Telemonitoring

http://www.youtube.com/watch?v=_y4izUSp5Gg


Personal Health Record Historia resumida QR Xxxx Xxxxxxx Xxxxxx

Coloca este código de forma visible colgándotelo del cuello, casco de la moto o en tu bicicleta.


A Growing need for Independent and Healthy Living Beti-ON, A Unified social and health telealert service: disability, chronicity and dependence attended together

Beti ON operator Primary Healthcare Practitioner

ALERTS

Family carer

Nurse center

Healthcare Emergency

Social worker

REINFORCING CARE PLANS


Oracle Healthcare Management Platform: A Complete, Open, Flexible Architecture

Oracle Web Center Middleware Integración CTI

Professionals Patients Community

Oracle Siebel Public Sector CRM

Oracle BI Apps

Oracle Fusion Middleware

Oracle Policy Automation

Clinical Data Sources

Other Sources

Content

Mgmt.

Operations Entitlement


Case management:

– Long-Term care management and Assisted living

– Transition management and care coordination (proactive e-appointments)

Disease management:

– Self-management support tools (mhealth)

– Community and social engagement

– Health coaching

– Prescription refills and Treatment adherence Population health

– Targeted Screening management

– Primary and secondary prevention: healthy lifestyles

– People’s awareness

Stratification of services with Oracle Healthcare Management Platform Oracle Health Management Platform enables:

Case Managem

ent

Management

Supporting care and self care 70 -

Population health

Care management

Case Mgt.

Healthy styles, Risks and health determinants

Disease management and self-care

Comorbidity and complexity, Disability


MAKING EASIER FOR PATIENTS TO STAY

HEALTHY

Inform me Engage Me Empower me


Patient Engagement Framework US National eHealth Collaborative

Inform Me Engage Me Empower Me Partner with Me

Support my eCommunity

•Information and way finding; service directories •e-tools (wikis, …) •Patient education

•On line advice •Healthy living tools and apps •Schedulling and reminders •Patient-specific education •Refilling medications •Personal Health Record

•Quality and safety reports •Care and wellness plans •Virtual coaching •Integrated EHR and PHR •Care experience surveys •Patient generated data

•Patient rating of providers •Coordination of care across providers •Adherence reporting •Shared management of action plans •Home monitoring and telemedicine •End of life advanced decisions

•E-visits •Chronic care self-management •Patient set privacy controls •Community support forums and resources


Future developments Advanced case management

– Collaboration tools between patients, professionals and carers; proactive monitoring of personal care plans

Interactive personal health record – Personalized access to active patient resources. Uploading of

personal clinical and heath information (self-management apps, …)

Advanced social and health integrated home services – smart personal devices for people with chronic conditions, disabilities

or dependence, tele-rehab ...,

Personal services on mobile platforms – chats and other health coaching means, new health and independent

leaving support Apps.


Osarean and the Basque Chronicity Strategy An international reference

European Innovation Partnership on Active and

Healthy Ageing

ec.europa.eu/active-healthy-ageing


Osarean 2-year process achievements • 25% e-appointments • 20% PHC encounters are now non-presential • 15,000 calls per month to health advice call center (almost 200,000 per

year); 85% resolution rate • 2,000 outreach calls per month to support home care programs • 29,000 social telealert users have now access to health advice and other

services from home • 3,5 million visits to the new health portal • 5 and growing active active patient programs online • Public health programs supported interactively: HIV, cancer screening, flue

vaccination, healthy life style, … • 20,000 accesses to Personal Health record in two weeks after launching


Basque Health Service Achievements Reduced Hospital admissions equivalent to 90 M € savings

80

90

100

110

120

130

140

150

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Alta

s to

tale

s en

mile

s

Acute hospital discharges. Osakidetza 2002-2012 Medical and Surgical DRGs

Tendencia DRGs Médicos

DRGs Médicos

DRGs Quirúrgicos

16,268


• The total investment of the Health Management Platform was approximately €11M including project management, licenses, hardware and integration service but excluding operational running costs

• Many other benefits cannot be calculated at this time; for example the substitution of face-to-face interaction, emergency room visits and reduced misuse of Drugs and indirect savings (productive days, …)

• The project is still ongoing and expanded so many additional benefits will emerge

Category Benefit Area Baseline Conservative Pragmatic Optimal Rationale

Cost effectiveness Consultation costs 118.000

nurse calls40%

€1.6M60%

€2.5M80%

€3.3M

118.000 calls to nurses with 85% resolution rate lead to 100.000 calls solved on-line by nurses instead of specialist. Oracle research estimates the hour rate of a nurse is €29 and specialist is €135 with an average interaction time of 20 min. Cost dif ference leads to savings with HMP contribution estimated between 40-80%

Clinical outcomes Less (re) admissions 16.000

admissions 10%

€9.6M20%

€19.2M30%

€28.8M

Previous slide: since start of project nr of medical admissions declined with approx 16.000. Average cost per admission is estimated at €6.000. Oracle estimates the contribution of the HMP between 10-30%

From An Economic Perspective This Leads To Significant Benefit Potential Reduce Costs with the Health Management Platform


Healthcare expenditures stabilized according to fiscal sustainability

9 205

9 907

11 265

12 552

13 772

12 834

10 792

11 700 11 481 11 408

2 114

2 266

2 478

2 662

2 961

3 284

3 566 3 561 3 448 3 414

2 000

2 200

2 400

2 600

2 800

3 000

3 200

3 400

3 600

8 000

9 000

10 000

11 000

12 000

13 000

14 000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

million €

Fis. Rev. Public Health Exp.


Change Management Success Factors in Basque Chronic Strategy

Developing a favorable policy environment: – clear agenda, continous leadership, implementation and investment plans

Stimulating system’s thinking with new models of care: – Chronic Care Model; Triple Aim; Risk Stratification

Aligning Top-down and Bottom-Up “integrators” Digital health at the service of clinical integration Encouraging a distributed leadership approach

“Make no little plans. They have no impact to stir men’s blood and probably will not themselves be realised”

Bengoa R. Transforming health care: an approach to system-wide implementation. Int J Integr Care 2013; Jul–Sep,


A WORLD OF POSSIBILITIES

FOR A BRIGHT, MODERN HEALTH SYSTEM

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