D14 Digital Health & Care Session Speaker

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WHAT’S DRIVING
UPTAKE OF DIGITAL
HEALTH AND CARE?
D14 – Digital Health and Care
George MacGinnis
30 May 2014

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PA has considerable recent experience in delivering
digital health initiatives
A top-tier pharmaceutical
company
Policy and regulation for
innovation in mobile
health
Establishing a pan-US
virtual health services
business unit
Making Telehealth a reality –
delivering a technology
innovation programme
Market entry strategy for
connected health
propositions
Supporting development
of the Irish connected
health market
Developing a drug-
device mHealth service
Adviser on implications of
telehealth for revision to the
EU Medical Device Directive
Member – dallas
interoperability steering
group
Delivering investments
to promote innovative
information sharing
Leading global industry group
work to identify need for new
standards in connected health
Adviser to a project
developing innovative,
low-cost telehealth
Supporting delivery of
successful telehealth
initiatives for the NHS in
Bexley, and Lewisham
Global medical
device
company

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• What’s driving changes in economic
models
• Early movers

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Attention focuses on coordinated care to improve quality and outcomes
The Patient
A Patient Centric perspective provides the driver for growth
Acute care
provided in more
specialised
hospitals
Where possible,
care moves
closer to the
patient
Improved self care and prevention
to stem rising demand

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Digital health introduces a new dynamic in fielding solutions
‘Digital’ challenges the traditional dynamics of
the health market:
• Technology innovation outpaces ability to
gather traditional forms of evidence
• Economics are governed by service
implementation more than product features
• Impact and risk is harder to assess,
particularly in ‘preventative’ care
Contrasting environments are reflected in two
very different regulatory regimes which now
have to work together
Patient Centric
Safety First
Demonstrate efficacy
‘at least, do no harm’
Market Centric
Maximize consumer
value
Foster competition
‘Just enough’

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Pursuing Digital Health
and Care implementations
as pilots or IT projects
fails to adequately
account for the care
delivery transformation

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Reforms are taking providers along a staged move to new models
• Improving referral
rates
• Maximising clinical
throughput
• Reducing length of
stay
• Reducing re-admissions
• Improving adherence
• Patient-centric care
package
• Evidence based pathways
• Payment for
outcomes
• Accountable care
The challenge is developing capability ahead of the reforms by
• Designing for scale
• Making it easy to buy
• Joining a value network
Maximizing Efficiency
of Current Operations
Managing Key
Business Risks
Optimising Population
Health Outcomes

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Finding early movers

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Designing for scale –
The pace of innovation is moderated by the nature of the change
There is a significant drive for innovation in most healthcare
systems but often limited capacity for change:
• Services that improve the efficiency of existing provision
have an immediate case
• Services that change the location of existing provision
involve changing professional working practices, requiring
investment in facilities and training.
• Services that look to change the process of healthcare
to achieve improved outcomes are likely to be disruptive to
existing reimbursement, organizational and professional
structures - and require significant reforms

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Designing for scale - An approach for large scale deployment
Background – a very large overseas hospital provider, also
interested in offering new models of care
The challenge: A large portfolio of apparently successful pilots
with no follow-on adoption.
The Solution: A central digital health organisation to support local
implementations, based around some guiding principles:
• Technology is best bought centrally – to secure best deals,
drive consistent standards, enable greater resilience and
provide effective technical integration
• Clinical services are best delivered within locally – so that
the operating costs and benefits are managed within the same
area
• In additional to common technology platforms the central
service should provide common operating procedures,
training and accreditation to support local delivery

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Making it easy to buy – the move towards ‘Paying for cures’
‘Paying for cures’ means understanding the impact of
each intervention on the individual level.
Typically this involves:
• Better targeting through personalised medicine and
care packages
• Maximising efficacy by understanding adherence
and effect for each patient
• Ensuring best clinical practice is applied
Information drives performance and opens the way for
innovative new approaches, and also requires whole
new capabilities in the supply chain

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Making it easy to buy - A spectrum of product-to-service offerings
offers a route-map to secure greater value as health systems evolve
Classic ‘product’
play typically
using a channel
partner
Managed service
for supply, install
and management
solution.
Managed clinical
service including
e.g. patient
assessment.
Often attractive to
care providers
Bundled clinical
solution that
provides
commissioners /
payers with a
comprehensive
solution
Clinical care
service with
revenue linked to
individual patient
outcomes
Maximizing Efficiency
of Current Operations
Managing Key
Business Risks
Optimising Population
Health Outcomes
Option1
Product
Supply
Option 2
dHealth as a
Service
Option 3
Clinical Fee-
for-Service
Option 4
Bundled
Solution Fee-
for-Service
Option 5
Clinical Fee for
Outcome

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Think about Digital Health in the context of a value-creating network, where cooperation
between different players adds more value that can be achieved by any one of them on their
own.
In this context, purchasers are increasingly wary of some aspects of business models that
marked the early stages of the development of the market
Joining a value network – some business models are barriers to
scale
“Give me all your data”
“Our business is really
integration”
“I own the customer”

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Exploiting the dynamics of different markets
There are opportunities to build business arising from:
• Targeting areas where strong clinical leadership can overcome reimbursement and
evidence barriers
• Looking at care sectors that don’t need the same burden of proof
• Focusing on unregulated markets such as wellness
• Identifying where the user is the payer and is able to pay
• Building volume through consumerisation of medical offerings
This challenges conventional paradigms for the spread of innovation –
with the potential for reverse innovation spreading from emerging economies

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Telehealth: Catholic Health Initiatives
Please find me a
physician more
prepared to move
with the times”
Quote from an 85 year old patient whose
rheumatology physician refused to do a
teleConsult with her at Thayer County
Critical Access Hospital, Nebraska
requiring her to make the 2.5 hrs.
journey into St Elizabeth’s Medical
Center in Lincoln, Nebraska