turismi ve dinamikleri kongresi ankara, october 2 willem oosterom seamless personalised service...
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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
PwC 10
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
PwC 15
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
PwC 19
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