Tokyo, Japan, 4-5 February 2013
Abu Dhabi Weqaya Programme Tackling NCDs: Application to Low and Middle Income Health Markets
Reehan SheikhTechnology Strategist
Platform [email protected]
m
ITU Workshop on “E-health services in low-resource settings:
Requirements and ITU role”
(Tokyo, Japan, 4-5 February 2013)
Tokyo, Japan, 4-5 February 2013 2
Abu Dhabi has been ideal market for innovation in health data
2.1m lives: “Big enough to matter, small enough to manage…”
Highly strategic government with broad-based popular trust
Extreme pace and depth of socio-economic development – very high burden of NCDs
Plural and diverse payers and providers
Relatively well-resourced health system enabling innovation
Abu Dhabi’s greatest health challenge
Tokyo, Japan, 4-5 February 2013 3
Implementing the Dubai declarationGCC Council of Ministers
Addresses at least six of the eight objectives
# Objective Relevance
1 National pol icies , prevention and treatment Yes, di rect
2 Health awareness Yes, di rect
3 Promoting a heal thy l i fes tyle Yes, di rect
4 Women, pregnant women and chi ldren Pending
5Empowering patients and promoting dia logue with care providers
Yes , di rect
6 Stopping di scrimination Indirect
7 Res earch and studies Yes, di rect
8Monitoring s ys tems and monitoring health and economic burden
Yes, di rect
UAE: World’s 2nd highest prevalence
of diabetes
Modeling suggests rapid cost increase
Predicted costs of UAE National diabetes treatment, AED
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Direct healthcare cost
Societal cost
Delivering model at scale: Overview of Weqaya
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Interventions
Population•Standard clinical care•Nutrition (trans-fats, food labeling)•Physical activity (gyms, AD UPC)•Tobacco control
Group•Workplaces and schools•Local communities, families•Segments: Disease groups e.g. diabetics
Individual•Clinical care•Encourage: Weqaya reports•Enable: Website/call centre
Population
Group
Individual
Approach
Screen Screen individuals iteratively97% adult Emiratis screened (>190,000)
Plan Clinical Standards, website/call centre
Act Clinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco)
1
2
PLAN
SCREEN
ACT
An individual score and customized call to action
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Principles of data feedback
Patients should have access to their own health data:
- Personal Health Record (secure paper mail-out)
- Electronic Health Record (www.weqaya.ae)
- Smart Portable Health Record (Weqaya Data Architecture)
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Pay for Quality and Pay for Health
• Based on compliance with evidence-based care pathways and clinical quality indicators
• Mechanism set-out in Standard Contract (between Healthcare Facilities and Health Insurers)
• Expectation it will affect base payment by <10%• “Compliance with high quality care receives a bonus”
Pay for Quality
Pay for Health
• Based on individual health status • Health initially defined as 10-year risk of cardiovascular event (heart
attack or stroke)• Contract between individual and Disease Management Programme• AED1,000 per 1% reduction in risk to maximum of AED5,000 (5%)• “No health improvement – no money”
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In AD eHealth systems are a platform for health
Everyone can know their numbers…
2008 2009 2010
… and the numbers can change health outcomes
Control
Weqaya
% engaged with care*
% with HbA1c <7.5%
% with LDL:HDL ratio <3.5
Control
Weqaya
Control
Weqaya
Two domains of Weqaya action
Healthcare Sector• Clinical care standards• Patient empowerment• Customer-centred services• Research and Innovation
Health Guardians• Nutrition• Physical activity• Tobacco control• Alcohol control• Employers and schools• Urban Planning
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We set clear targets based on global evidence
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Type Objective Baseline 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2030
Input Screening 94% 50% 90% 100% 50% 90% 100% 50% 90% 100% 100% 100%
Programme engagement* 6% 30% 50% 60% 75% 75% 75% 75% 75% 75% 75% 75%
% obesity 35% 35% 36% 36% 35% 34% 33% 33% 32% 31% 28% 26%
% Weqaya population with pre-diabetes 26% 26% 26% 26% 26% 26% 25% 25% 25% 24% 24% 23%
% Weqaya population with diabetes 18% 19% 20% 20% 21% 21% 20% 19% 19% 18% 18% 15%
% diabetes with HbA1c <7% 15% 25% 40% 50% 60% 70% 75% 75% 75% 75% 75% 75%
% smoking 11% 12% 12% 11% 11% 10% 10% 9% 9% 9% 8% 6%
OutputReduction in predicted incident cardiovascular mortality
0% 1% 2% 5% 8% 12% 15% 18% 20% 24% 30% 80%
* Weqaya account activation and/or % eligible population engaged with DMP
Process
Target risk reduction
Annual Weqaya targets
Screening: Adaptations for medium and low income countries
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$1
$2
$15
• Non-clinical staff• Train the trainer• SMS-based reporting
• Clinical/para-clinical staff• Train the trainer• SMS-based reporting
• Personal Health Record
Per person cost Adaptation
Data Exchange in low and medium income countries
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Data capture (mobile device)
•Unique identifier (patient, clinician, etc.)•(Simplified) diagnosis, treatment provided, outcome, etc.
Standardised data
•Kilobyte range (works with 2G mobile phone)
Data store
•Donors•Clinicians•Programme managers•Academia•WHO•UN – Development Goals (MDGs)
A B C
Option to create “central health philanthropy bank” to administrate
Range of data systems enable secure ubiquity
Measuring health
• Opt-out screening• Opt-in data sharing
Taking health promoting action
• Ubiquitous Weqaya Programme
• Point of decision prompts (e.g. Weqaya label on healthy food)
• At home monitoring• Secure data
sharing
Standardized and Centralized Health Data
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Health & Wellness data can be capture in the field using basic mobile technologies
1
All Health & Wellness information is saved centrally for population and individual level analysis
2Healthcare workers can immediately access data captured in the field and begin a two-way dialog
3
In healthcare facilities, providers can get a full view of the patient
5Personal health/wellness tracking and intervention can be tied to clinical information allowing a view into effectiveness of intervention and patient behaviour change
4
