Business Models for eHealth: - World of Health IT Conference
Business Models for eHealth: - World of Health IT Conference
Business Models for eHealth: - World of Health IT Conference
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<strong>Business</strong> <strong>Models</strong> <strong>for</strong><br />
<strong>e<strong>Health</strong></strong>:<br />
Results from an EU Project<br />
Lorenzo Valeri (RAND Europe)<br />
Patrick Jansen (Capgemini Consulting)<br />
Daan Giesen (Capgemini Consulting)
Overview <strong>of</strong> the presentation<br />
• <strong>e<strong>Health</strong></strong>: understanding business models <strong>for</strong><br />
going beyond financial issues<br />
• Sizing the <strong>e<strong>Health</strong></strong> market<br />
• Applying business models approaches to<br />
<strong>e<strong>Health</strong></strong><br />
• Concluding remarks
e-healthcare business models: going<br />
beyond financial issues<br />
- Evolution <strong>of</strong> healthcare delivery-<br />
Socio-Economic<br />
Trends<br />
<strong>Health</strong> Specific Trends<br />
Aging Funding complexities<br />
Chronic Diseases Patients Mobility<br />
Un-healthy behaviour Standardisation<br />
<strong>Health</strong>y and<br />
independent lifestyle<br />
- Affecting Trends-<br />
Cultural differences<br />
- Challenges <strong>for</strong> <strong>Business</strong> Modelling <strong>for</strong> <strong>e<strong>Health</strong></strong><br />
• Financial sustainability<br />
• <strong>e<strong>Health</strong></strong> systems <strong>for</strong> efficiency and<br />
effectiveness <strong>of</strong> pre-existing<br />
services<br />
• Financial (and operational)<br />
sustainability also via change<br />
management<br />
• Extended timings <strong>for</strong> the <strong>e<strong>Health</strong></strong><br />
system development
EU 27+2 – Total <strong>e<strong>Health</strong></strong> market 2008<br />
& 2012
EU 27+2 – <strong>e<strong>Health</strong></strong> growth rates per<br />
segment 2008-2012
<strong>Business</strong> models: Identifying the<br />
interactions<br />
Resources<br />
Offer<br />
PROF<strong>IT</strong><br />
Financial Per<strong>for</strong>mance<br />
Customer<br />
<strong>e<strong>Health</strong></strong><br />
Value<br />
Proposition<br />
Interactions<br />
Change<br />
management<br />
Data collection
Mapping <strong>e<strong>Health</strong></strong> <strong>Business</strong> <strong>Models</strong><br />
KEY<br />
PARTNERS<br />
What can partners do<br />
to leverage your<br />
business model (better,<br />
at lower cost)?<br />
COST<br />
STRUCTURE<br />
KEY<br />
ACTIV<strong>IT</strong>IES<br />
What key activities do<br />
you need to per<strong>for</strong>m<br />
and how easily can you<br />
do this?<br />
KEY<br />
RESOURCES<br />
What key resources<br />
does your business<br />
model require?<br />
What is the cost structure <strong>of</strong> your business<br />
model and is this in line with the core<br />
values <strong>of</strong> the business model?<br />
VALUE<br />
PROPOS<strong>IT</strong>ION<br />
Which <strong>of</strong> you clients’<br />
problems do you solve<br />
and which needs are<br />
satisfied?<br />
REVENUE<br />
STREAMS<br />
RELATION PATIENT /<br />
USER /<br />
What kind <strong>of</strong> relations<br />
does your<br />
patient/user/doctor<br />
expect and which kind<br />
do you maintain?<br />
CHANNELS<br />
Through which means<br />
do your clients want to<br />
be reached and which<br />
means do you utilize?<br />
DOCTOR<br />
SEGMENTS<br />
What are your<br />
patients’, users’,<br />
doctors’ needs,<br />
problems, desires, and<br />
ambitions?<br />
What value are your clients willing to pay<br />
<strong>for</strong> and what is the preferred payment<br />
mechanism?
Centro Unico di Prenotazione-<br />
Umbria<br />
Environment<br />
Main drivers to change<br />
<strong>Business</strong> Model<br />
Solution<br />
Key Success Factors<br />
<strong>Business</strong> Model<br />
• Booking/cancellation/rescheduling and payment by patient <strong>of</strong> specialised visit or tests also via<br />
pharmacies<br />
• Integration with Umbria’s local radiology in<strong>for</strong>mation system, laboratory in<strong>for</strong>mation system and<br />
hospital in<strong>for</strong>mation system<br />
• Direct link with Italy’s Ministry <strong>of</strong> Economic and Finance<br />
• Multichannel access <strong>for</strong> patients to book/cancell/rescheduling <strong>of</strong> specialised test or visit<br />
• Facilitation <strong>for</strong> rural areas<br />
• Efficiency in the collection <strong>of</strong> payments <strong>for</strong> test (tickets)<br />
• Financial incentives <strong>for</strong> the involvement <strong>of</strong> private pharmacies<br />
• Client/Server solution via regional Intranet solution managed by Umbria’s in-house <strong>IT</strong> company<br />
Webred<br />
• Actors involved: 2 Regional Hospitals (Perugia/Terni), 4 local health authorities (Citta di Castello,<br />
Perugia, Terni, Foligno) and 266 pharmacies (144 in rural areas, 122 in urban areas) and 487<br />
specialist doctor or approved laboratories<br />
• Potential users: over ca. 880.000 citizens, <strong>of</strong> which 140.000 <strong>for</strong>eigners (650.000 in the Province <strong>of</strong><br />
Perugia and 230.000 in the Province <strong>of</strong> Terni)<br />
• Direct involvement <strong>of</strong> all actors in the development <strong>of</strong> the system<br />
• Financial incentives <strong>for</strong> private pharmacies to link-up to the system<br />
• Centralised <strong>IT</strong> infrastructure<br />
• <strong>IT</strong>IL-aligned approach with <strong>IT</strong> support call centre (especially <strong>for</strong> private pharmacies) and <strong>for</strong> specific<br />
operational issues (e.g. suspension <strong>of</strong> booking by a single laboratory/diagnostic centre due to long waiting<br />
lists)
CUP: Changing the <strong>Business</strong> Model<br />
CUP without pharmacies CUP with pharmacies<br />
Outpatient<br />
Radiology<br />
Departments<br />
2 Regional<br />
Hospitals<br />
Outpatient<br />
Laboratories<br />
4 Local<br />
<strong>Health</strong><br />
Authorities<br />
Hospital<br />
Radiology/Laboratory<br />
2 Regional<br />
Hospitals<br />
Outpatient<br />
Radiology<br />
Departments<br />
4 Local<br />
<strong>Health</strong><br />
Authorities<br />
Outpatient<br />
Laboratories<br />
Web-Red <strong>IT</strong> infrastructure Web-Red <strong>IT</strong> infrastructure<br />
2<br />
4<br />
1<br />
3<br />
A144 Rural<br />
Pharmacies<br />
Citizen/Patient Citizen/Patient<br />
1: Request <strong>of</strong> test/specialist by patient/citizens<br />
2: Automatic check on availability and assign date/time <strong>for</strong> visit<br />
3: Response back on availability/available time<br />
4: Booking/rescheduling complete-Payment <strong>for</strong> visit by patients<br />
3<br />
2<br />
4<br />
1<br />
Hospital<br />
Radiology/Laboratories<br />
A122 Urban<br />
Pharmacies<br />
A15 GPs
CUP: Changing the Value Proposition<br />
KEY<br />
PARTNERS<br />
Hospital wards<br />
Diagnostic Tests<br />
144 Rural Pharmacies<br />
122 Urban Pharmacies<br />
15 GPS<br />
Web (TBD)<br />
KEY<br />
ACTIV<strong>IT</strong>IES<br />
6 locations <strong>for</strong><br />
booking/payment/reschedule<br />
/cancellation <strong>of</strong><br />
lab.test/specialised visit/ 281<br />
locations<br />
KEY<br />
RESOURCES<br />
Diagnostic centres<br />
Hospital/Local <strong>Health</strong><br />
Authorities<br />
Patients<br />
Pharmacies<br />
COST<br />
STRUCTURE<br />
Personnel<br />
Direct cost (printing, etc…)<br />
Education & Training <strong>for</strong> pharmacies<br />
<strong>IT</strong> Call centre<br />
<strong>IT</strong> system integration<br />
<strong>IT</strong> support <strong>for</strong> pharmacies<br />
VALUE<br />
PROPOS<strong>IT</strong>ION<br />
High quality service<br />
Efficiency and<br />
effectiveness<br />
Multiple access points<br />
especially <strong>for</strong> rural<br />
areas<br />
Customer<br />
retention/additional<br />
revenues <strong>for</strong><br />
pharmacies<br />
Management <strong>of</strong> the<br />
results <strong>of</strong> health<br />
awareness campaigns.<br />
REVENUE<br />
STREAMS<br />
CLIENT<br />
RELATION<br />
Distant relation<br />
Closer to needs <strong>of</strong><br />
patients<br />
CHANNELS<br />
Hospital structures<br />
Local <strong>Health</strong>care<br />
authorities<br />
Pharmacies<br />
GPs<br />
Doctors<br />
GPs<br />
Patients<br />
Pharmacies<br />
Pharmacies:<br />
2 EURO per booking<br />
Better cash flow <strong>for</strong> pharmacies<br />
PATIENT /<br />
USER /<br />
DOCTOR<br />
SEGMENTS
Tactus: Serving Alcoholics online<br />
Environment<br />
Main drivers to change<br />
<strong>Business</strong> Model<br />
Solution<br />
Key Success Factors<br />
<strong>Business</strong> Model<br />
• Tactus delivers care and treatment to addicts with alcohol, drugs, medicine, gambling, and eating<br />
problems<br />
• Especially alcoholic abuse has a stigma: people are ashamed; it is a taboo<br />
• Tactus per<strong>for</strong>ms 5,500 units <strong>of</strong> care per year and the 2007 result was €1,605,000 (budget <strong>of</strong> €57<br />
mio)<br />
• 10% <strong>of</strong> all Alcoholics ever got help<br />
• Research pointed out that preventive actions should indicate better results<br />
• The behavioral change side <strong>of</strong> the treatment needs to be easily accessible<br />
• Structured asynchronous Internet treatment program (Tactive) with a focus on cognitive<br />
behavioral therapy through one-to-one counseling <strong>of</strong> a pr<strong>of</strong>essional assistant:<br />
• Two-sided treatment (diagnostics & behavioral change)<br />
• In<strong>for</strong>mative website<br />
• Forum <strong>for</strong> online contact with fellow-sufferers<br />
• Internet-based treatment (on a secured plat<strong>for</strong>m)<br />
• Aftercare chat module<br />
• Three executing organisations: Tactus, Mondriaan, and Symphora Group<br />
• Research that underpins the benefits <strong>of</strong> the service, and gives opportunities to adjust<br />
• Personal counseling relation between pr<strong>of</strong>essional assistant and alcoholic is key<br />
• Price from M&ICT <strong>of</strong> €650K<br />
• No transportation needed, freedom in time and place
Tactive: Changing the <strong>Business</strong> Model<br />
Alcoholic treatment be<strong>for</strong>e Alcoholic treatment after<br />
Local, regional,<br />
national<br />
government<br />
Knowledge<br />
Quality & Control; Subsidy<br />
Tactus<br />
Orders & Leads; Money<br />
Feedback<br />
Provide treatment &<br />
care to clients<br />
<strong>Health</strong>care<br />
Insurer<br />
Treatment<br />
Pr<strong>of</strong>essional<br />
Assistants<br />
Internet-based<br />
treatment<br />
Local, regional,<br />
national<br />
government<br />
Forum<br />
Tactive<br />
(Alchoholdebaas.nl)<br />
Tactus<br />
Pr<strong>of</strong>essional<br />
Assistants<br />
In<strong>for</strong>mative<br />
website<br />
Aftercare chat<br />
module<br />
<strong>Health</strong>care<br />
Insurer<br />
Source: Interview Hans Keizer, Tactive / Tactive Documentation
Tactive: Changing the Value Proposition<br />
KEY<br />
PARTNERS<br />
Local, regional and<br />
national government<br />
Tactus<br />
TheFactor.e<br />
<strong>Health</strong> insurer<br />
Mondriaan<br />
Symphora Group<br />
COST<br />
STRUCTURE<br />
KEY<br />
ACTIV<strong>IT</strong>IES<br />
Give care & treatment<br />
Supervise assistants<br />
Provide addict care<br />
Develop internet-based<br />
plat<strong>for</strong>m<br />
KEY<br />
RESOURCES<br />
680 Pr<strong>of</strong>. assistants<br />
20-25 Pr<strong>of</strong>. assistants<br />
Knowledge on diagnostics<br />
& behavioral change<br />
<strong>IT</strong> knowledge<br />
Personnel – Pr<strong>of</strong>essional assistants<br />
Education & Training<br />
Coaching on digital treatment<br />
<strong>IT</strong> application: development and<br />
maintenance<br />
VALUE<br />
PROPOS<strong>IT</strong>ION<br />
Tactive online treatments<br />
E.g. Alcoholdebaas.nl<br />
Provide in<strong>for</strong>mation,<br />
fellow-sufferer contact,<br />
treatment and aftercare<br />
assistance<br />
Roll-out to other areas:<br />
�Gambling<br />
�Drugs<br />
�Eating<br />
�Medicine<br />
REVENUE<br />
STREAMS<br />
RELATION PATIENT /<br />
USER /<br />
DOCTOR<br />
Need-oriented relationship<br />
Personal & Anonymous<br />
Patient has the control over<br />
his/her own treatment<br />
CHANNELS<br />
Front-end <strong>IT</strong> system<br />
Pr<strong>of</strong>essional assistants<br />
<strong>Health</strong> insurer<br />
SEGMENTS<br />
People with addicts<br />
Desired knowledge and<br />
experience around<br />
addictions<br />
Other target groups:<br />
�Anonymous patients<br />
�Policyholders<br />
�Companies<br />
�Self-payers<br />
Roll-out to other<br />
countries<br />
Client fee: fixed fee + fee per hour <strong>for</strong><br />
delivered treatment/care<br />
Franchise fee<br />
Resell <strong>of</strong> application to other countries<br />
Source: Interview Hans Keizer, Tactive / Tactive Documentation
Conclusions<br />
• Mapping business model<br />
• Long term commitment <strong>of</strong> senior management<br />
• Not about new service but about news ways <strong>of</strong> delivering a specific<br />
healthcare care specific service<br />
• Financial commitment<br />
• Stable financial support throughout project life line<br />
• Final support <strong>for</strong> supporting staff commitment<br />
• Patient’s needs<br />
• Patients viewed as “clients” or “customers”<br />
• <strong>Health</strong>care services aimed at providing more efficient services<br />
• Open standards<br />
• Explicit use <strong>of</strong> technical open standards to foster integration and followup<br />
extension <strong>of</strong> functionalities<br />
• Evaluation<br />
• Senior management commitment to a-priori and ex-post evaluation <strong>of</strong> the<br />
effects <strong>of</strong> <strong>IT</strong>-enhanced healthcare service
For more in<strong>for</strong>mation<br />
Pr<strong>of</strong>. Jo Chataway<br />
Director<br />
RAND Europe<br />
Westbrook Centre<br />
Milton Road<br />
CB4 1YG Cambridge<br />
Tel:00441223353329<br />
Email: chataway@rand.org
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