© PA Knowledge Limited 2014 1

DEPLOYING DIGITAL HEALTH TECHNOLOGY AT SCALE

dHealth 2014

George MacGinnis

1 April 2014

© PA Knowledge Limited 2014 2

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

© PA Knowledge Limited 2014 3

Diabetes: Most NHS costs wasteful,

says Diabetic Medicine The majority of NHS spending on diabetes is avoidable, says a

report in the journal Diabetic Medicine. It suggests that 80% of

the NHS's £9.8bn annual UK diabetes bill goes on the cost of

treating complications

BBC 25 April 2012

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Many people experience unwanted or avoidable care encounters

• High costs and poor accessibility may mean putting off seeking care when

early intervention would be better

• Many chronic patients are poorly served by care in hospitals – yet for many

that is where they end up

• Systems often reward activity regardless of the overall outcomes

Infectious diseases

1900-1950

Episodic care

1950-2000

Personalised care

2000-

Health needs are evolving yet services have been slow to catch up

© PA Knowledge Limited 2014 5

PA sees 3 key themes emerging that are critical for this change:

• Creating and deploying

stratified medicine

• Challenging established

structures through

commercial model innovation

• Including greater patient

insight

• Changing reimbursement to

reward population health

Delivery of more effective

patient outcomes based

on the integration of new

technologies, business

models and partnerships

Patient Centric Healthcare

• Removing cost and improved

access to new models of

healthcare delivery.

• Patients becoming active

partners in care management

• Accessing new data and

information

• Developing eHR, medical

devices, virtual health and

wider technical infrastructure

Effective use of digital

technologies is enabling

a shift from

curative/reactive

healthcare to prevention

and health management

Intelligent Health

Delivering health reforms

to create healthier

communities and

maintain universal access

Healthcare Reforms

• Keeping universal access

affordable

• Re-organising health

services around people’s

needs and expectations

• Securing healthier

communities

© PA Knowledge Limited 2014 6

Attention focuses on coordinated care to improve quality and outcomes

The Patient

A Patient Centric perspective provides the driver for growth in digital health

Acute care

provided in more

specialised

hospitals

Where possible,

care moves

closer to the

patient

Improved self care and prevention

to stem rising demand

© PA Knowledge Limited 2014 7

‘Paying for cures’ means understanding the impact of each intervention on the individual level

Improving outcomes 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

© PA Knowledge Limited 2014 8

Digital health introduces a new dynamic in fielding solutions

New paradigms challenge the traditional drug

/ medical device innovation model:

• Technology innovation outpaces ability to

gather traditional forms of evidence

• Economics governed by service

implementation rather than product design

• Impact and risk is harder to assess 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’

© PA Knowledge Limited 2014 9 PPT presentation template V1-12.ppt

Developing new digital health markets

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The pace of innovation is moderated by the complexity involved

There is a significant drive for innovation:

• 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

© PA Knowledge Limited 2014 11

Reform is driving providers along a staged move to new models

Maximizing efficiency

of current operations

Managing key

business risks

Optimising population

health outcomes

• 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

© PA Knowledge Limited 2014 12

Exploiting the dynamics of different markets

There are opportunities to build business arising from:

• Focusing on unregulated markets such as wellness

• Identifying where the user is the payer and is able to pay

• Looking at sectors that don’t need the same burden of proof

• Targeting areas with strong clinical leadership

• 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

© PA Knowledge Limited 2014 13

Regional differences exist, creating opportunities for new offerings

Regional differences in need, reimbursement, regulation and infrastructure offer

opportunities to incubate a business while waiting for reforms elsewhere

US: Highly regulated.

Hospitals have significant

power. Policy is moving

towards entitlement reform

and providers looking to get

ready for the future while

maintaining revenues.

Gulf: Emerging market for health

infrastructure/ regulation. Mix of

social provision & powerful

consumer base including non-

nationals. Growing markets in

medical tourism.

India: Relatively few regulatory

restrictions: Strong growth of mobile

technologies. High appetite for

innovation. Powerful consumer

base developing while also having

pressing issues of access to basic

care.

Africa: Focus mainly on basic

health needs: infectious diseases,

childbirth and nutrition. Poor

access to care, much of which is

donor funded. Little regulation

and significant supply chain

issues.

EU: Highly regulated. Public

policy led health with

significant variations. Some

countries with a significant

eHealth infrastructure.

© PA Knowledge Limited 2014 14

Competitors or collaborators: New entrants challenge current notions of the market

Healthcare reform is attracting the attention of global players as connected health drives

convergence between industries within healthcare:

• Pharma – looking to find a new ‘value add’

• Mobile – opening up the last untapped enterprise market with capabilities in meeting

consumer demand

• Insurance – looking to move to new business models.

• Media/Entertainment – bringing the customer revolution to healthcare

• Utilities – moving to offer services enabled by smart metering

Who will be the winners and losers in the battle for a consumer health brand?

© PA Knowledge Limited 2014 15

Implications for deployment at scale

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There is an essential tension between ambition and capability

Growing services means getting three key aspects right:

• Clarity on the focus of the service

• Choosing an achievable scale to drive further adoption

• Establish a platform for future growth – recognising that demands will change as services

grow

© PA Knowledge Limited 2014 17

Beware – some business models are barriers to scale

Give me all your data

Our business is really

integration

I own the customer

© PA Knowledge Limited 2014 18

Closing thoughts

Changes in healthcare are challenging established concepts of who the customer is and

what they see as a value proposition:

• Governments and payers are seeking to reward positive outcomes, shifting risk onto

healthcare providers and their suppliers

• The customer is changing and bringing more complex buying behaviours

• Solutions, rather than products, will be the key to defining value propositions

• Collaborations involving innovative commercial models will become an engine for growth

• Early growth markets in connected health may not be the traditional innovators

© PA Knowledge Limited 2014 19

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