Turismi ve Dinamikleri Kongresi

Ankara,

October 2

Willem Oosterom

Seamless Personalised service delivery for elderly people

PwC

Our welfare and healthcare depends on how well we can adapt to 5 megatrends …

Technological breakthroughs

Demographic shifts

Accelerating urbanisation

Climate change and resource scarcity

2

Shift in economic power

Why the 20st century designed healthsystems

don’t have the answer for ageing societies

PwC 4

Expenditure is directed at the costliest part of the healthcare system – the hospital

COMMUNITY CARE

Assisted living

Skilled nursing facility Intensive care unit

Specialty clinic

Community hospital

HOME CARE

Healthy,independent living

Chronicdisease management Family

doctor

Communityclinic

Specialty pharmacy

Cost of care

Qu

ali

ty o

f li

fe

HOSPITAL CARE

PwC 5

Primary, hospital and community care are largely organised as separate systems or silos

Social care

Short-term care

Long-term care

Housing

Disability aids

Housing

Health promotion & maintenance

• Healthcare professionals are educated and operate in an environment that encourages specialisation and segregation

• There’s no single service and care coordinator or agency accountable for costs or outcomes

Our current hospital and medical

intervention driven healthsystems

can not provide the services elderly people

need in ageing societies

PwC 7

So we need to push care back from the hospital to the home and integrate delivery around elderly people

COMMUNITY CARE

Assisted living

Skilled nursing facility

Intensive care unit

Community hospital

Specialty clinic

HOME CARE

Healthy,independent living

Chronicdisease management Family

doctor

Communityclinic

Specialty pharmacy

Cost of care

Qu

ali

ty o

f li

fe

HOSPITAL CARE

Short term care

Social care

Disability aids

Housing

Elderly

Health promotion & maintenance

Long-term care

Core elements new service delivery

for elderly people

PwC 9

The core features of a new care model

The core featuresof a new care model

Focuses on wellnessand prevention, notjust care and cure

Brings care as close tothe citizen as possible

Puts the individual atthe heart of the system

Treats health as ashared endeavour

Measures and rewards outcomes, not activities

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The perception gap on the state of health older people

Health is usually defined in terms of ‘disease’, and older people have more diseases than younger people do.

So, from a clinical perspective, the elderly suffer more illness – the solution doctors provide is more healthcare.

But older people view things differently.

Two-thirds of the respondents – irrespective of age – said their general state of health was good or very good. They didn’t see themselves as sick and didn’t want to be medicalised.

  

How older people see their own state of health

100

90

80

70

60

50

40

30

20

10

0

Re

sp

on

de

nts

%

55-64 65-74 75+

How is your general state of

health?

Age group

Source: Medical Delta, ‘Shades of Grey: Ambitions of 55+’ (May 2013).

PwC 11

Meebeslissen over zorg

Openstaan voor wensen

Client: Staat de zorginstelling open voor uw

wensen?

Medewerker: Ik luister goed naar wensen en ideeen van

clienten

30% 40% 50% 60% 70% 80% 90% 100%

56.0%

47.8%

70.2%

80.0%

Answers “always”

Expected

joint

ambition

Solving the perceived quality gap between clients and staff is an industry challenge

Clients (N = 51.006)

Employees (N = 53.985)

Client has a voice in the care he or she needs

Being open for client’s request

Source: ActiZ Benchmark in elderly care 2012

Bron: The Kings Fund, ideas that change health care

Listen to personal life story

Share professional insights

Information sharing

Agreed upon Quality of Live plan

Each client & family contact

A new consultation approach

Ask for state of affairs first

Deliver care & support and

update Quality of Live plan

Redesign organisation

Co-produce personalised

services based on self

perceived quality of live

Res

po

nsi

ve c

om

mis

sio

nin

g

Care p

rofe

ssion

als co

mm

itted to

p

artnersh

ip w

orkin

gEngaged, informed citizens

Train consultation

skills and attitudes

Integrated, multi-

disciplinary team and expertise

Enhance senior buy-in

and local champions

A new consultation approach for delivering better services and outcome for elderly people

What will it take to create a

personalised integrated service delivery

in ageing societies?

PwC 14

Keep elderly people at the right place at the right time

Source: PwC

Family

Neighbourhood

& peers

Pro

fess

iona

l Postpone

Promote out flow as soon as

possibleZiekenhuis

Prevention, early detection

& effectiveinterventions

Smart home and living environment

Prevent unnecessary hospital visits

Nursing home

Primary carePharmacy

Hospital

In patientsEmergency care

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It will be necessary to reallocate resources from the secondary care sector to other sectors

Number of hospital beds per 1,000 people, 2014

United States

United Kingdom

Spain

Portugal

New Zealand

Netherlands

Japan

Italy

Ireland

Germany

France

Belgium

Australia

Best practice

2.82

2.89

3.08

3.30

5.97

3.14

12.33

3.83

2.32

5.96

6.30

6.26

3.77

1.57

Source: Business Monitor International;

PwC 16

New financing models will likewise be needed to promote care that’s based on value, not volume

• Several innovative funding mechanisms have emerged in countries that are in the vanguard of integrated care:

Healthcare payers in England, Germany and Australia have been road-testing performance-based incentives.

The Danish and Dutch governments are piloting bundled payment schemes.

The United States is experimenting with accountable care. When an accountable care organisation succeeds both in delivering high-quality care and in cutting costs it receives a share of the savings.

The Government of Valencia has contracted Bupa-Sanitas to provide primary, specialist and long-term care in Manises, using a capitation model with a fixed fee per patient irrespective of the number of treatments received.

The Alzira ModelBenefits

reserved for thecritically ill

Quality measurement

Published health outcomes allow both the general public and the government to compare and contrast the quality of care provided

IncentivesInterdependent incentiveswhich together drive thesuccess of the overall model

GovernmentHOSPITAL

€Hospital -34%

Diagnostic support

can be provided by the diagnostics departmentof the hospital, facilitatingout-of-hospital community care

27% decrease incost per capita

34% reduction inhospital readmissions within 3 days

Primary care centre

€specialists

Transfer of financial riskNetworked clinicians

Specialists can consult with local care professionals, forming a networkof clinicians, drawing specialist knowledge out of the hospitals and to the patients in the community

Long-term capitated budget

Healthcare system incentivised to keep people out of hospital and in the least care-intensive and most cost-effective setting

Patient

local care

professionals

Average electivewaiting time reduced by 55%

54% reductionin average A&Ewaiting time‘Money follows the patient’

principle

Reimbursement received only by the healthcare system that provides the care to the patient

The provider is incentivised to maintain and drive up the quality of care to encourage patient loyalty

91%

91% patientsatisfaction

Average lengthof stay reduced by 20%Integrated Care Record

Single electronic patient record, accessible in all healthcare locations

Care record system encouragespatient awareness and communication between healthcare professionals

Patient Staff

93%

Patient choice

If the quality of care is inadequate then the patient can choose touse another healthcare provider.

Visible and clear performanceindicators

Hospital staff are aware of the indicators that they’re measured on

Performance indicators help to drive performance, as quality information is publically available and activity managed

93% staffsatisfaction

Electronic patientrecords for all patients

?

Out of area providers

Out of area providers

‘Money follows the patient’ principleAll statistics relative to hospitals - in the Valencia region -outside of the Alzira model

Source: PwC and Ribera Salud

prev&evitc

ao

rperacevitatne

17

PwC 18

This may entail using new contractual structures to incentivise care providers effectively (1)

Commissioning body

Prime contractor

Subcontractor Subcontractor Subcontractor

It’s not always feasible to bring every care provider under the same roof. One option is to borrow from the various contractual models used in the private sector.

Commissioning body

Joint venture

Care provider Care provider Care provider

The prime contracting model The joint venture

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This may entail using new contractual structures to incentivise care providers effectively (2)

Social care commissioning

body

Care provider

Clinical commissioning

body

Care provider

Care provider

Alliance for service delivery

The alliance model

PwC 20

Integrated IT systems will be vital to share information, plan service delivery and manage capacity …

Cli

nic

ian I have immediate access

to my patient’s clinical and social history

I have information on all my patient’s visits and treatment in every care setting

I have information on both individual patients and populations

I don’t need to recapture information that already exists

So

cial

wo

rker I have immediate access

to my client’s clinical and social history

I have information on all my client’s visits and treatment in every care setting

I have information on both individual clients and populations

I don’t need to recapture information that already exists

Pat

ien

t The person I’m seeing knows my clinical and social history, including the medicines I take and my preferences

I have my own record, which keeps me abreast of what’s happening, helps me manage my health and reminds me when to do things

Ch

ief

Op

era

tin

g

Off

ice

r I have the information I need to manage performance across the care pathway

It is easy for me to report internally and across the care pathway

I have the information I need to let me meet my quality targets

Ch

ief

Fin

an

ce

O

ffic

er I have readily accessible

information on financial flows across the care pathway

I have readily accessible information on our contractual achievements

It is easy for me to report internally and across the care pathway

Ch

ief

Ex

ec

uti

ve

O

ffic

er I have readily accessible

information on our overall financial performance

I have readily accessible information on how well we’re meeting our targets

It is easy for me to report internally and externally

PwC 21

Multidimensional performance measurement and benchmarks focued on results and outcomes

Environment

Resources

History

Strategy

On 3 levels:

Organisation

Team or ward

Individual

Client experience

Benchmark building blocksInput Results

Employeeinvolvement

Financial performance

Strategic insightsto improve quality &

reduce costs

Bench-marks

Source: ActiZ & PwC benchmark team

PwC 22

But the biggest changes required to support the transition to integrated care are cultural…

• Integrated care entails knocking down the walls between different forms of care, collaborating closely and sharing accountability. Strong leaders will be essential to overcome old habits, vested interests and professional frictions.

• These leaders must also be able both to communicate the rational case for change and to appeal to people’s emotions, since this is where the impetus for real, sustained organisational transformation lies.

• The balance of power is simultaneously shifting, as new players from the retail, consumer products, technology and telecommunications industries enter the arena. These companies are democratising healthcare – and helping to reshape the dialogue between care provider and patient in the process.

• Older patients – like other patients – will increasingly demand an equal say in determining the care they receive. So care providers everywhere will need to embrace the concept of shared care – where patient and provider work together.

To summarise

PwC 24

App-Store

Smart home

21 century dynamics reshape ageing societies

Self rated life

satisfaction

New contractua

l structures

Integrated information systems

Governance &

performance measure-

ment

New payment models

New X-industry service delivery with trusted professionals as

coaches

Reallocation of resources

Megatrends

Personalised approach

Consequences

Adjusted education and professional

craftsmanshift

Redesignthrough political

vision and courage &

transformational leadership

Family & neighbourho

od peer support

Demographic shifts

Technological breakthroughs

Big data driven transparency &

citizens engagement