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Developing the Transparency and
Participation Call to Action
EXPO 20144 March 2014
Agenda
2
Time Item Lead
2.30 Welcome Chris Outram
2.35 Introducing NHS England’s strategic vision – purpose, ambition and structure
Chris Outram
2.45 Modelling of opportunity for digitally-enabled participation and transparency: summary overview
Stephen Moran, McKinsey & Co
3.05 Further questions/discussion All
3.25 Next steps and close Chris Outram
Strategic Vision: Summary
3
NHS's biggest asset is people – both its patients and staff. We need both more empowered patients who are more in control of the healthcare decisions and choices and more motivated staff delivering higher quality of care.
Key enablers in achieving this vision include:
• Information and Data – joined up, real time and analysed data and information to enable more informed choice; and
• Technology – to generate efficient service delivery, enhanced consumer convenience and patient and provider empowerment.
Transforming delivery
Active and empowered
citizens
Better outcomes and greater efficiency
Goal
Productivity improved by automation and
transparency on outcomes
Enabling the digital tools and support to take greater control of health and care
choices to help reduce demand
Transforming the way people
interact with the NHS
Supporting initiatives
and technologyexamples
• ePrescriptions, eReferrals
• Summary care records, IDCR
• HSCDS, Patient Online
• CQRS, FFT
• Remote monitoring devices
• Mobile health monitoring and management apps
• Secure connectivity at home
The Transparency and Participation journey
4
Developing the Transparency and Participation Call to Action: strategic context
5
PurposeTo clearly describe strategic vision and direction for commissioners and the wider NHS, illustrating the benefits of supporting the active and empowered citizen as a key part of transforming the quality and efficiency of the NHS.
Underpinning evidence baseUsing contributions from world-class experts, work has begun to develop a clear evidence base for the economic contribution of data, technology and participation to help bridge the NHS’s quality and funding gaps. Local case-studies of innovative transparency and participation in practice will also help inform our strategic vision.
Next Steps
6
We will:
• engage with you to get your comments, views and feedback on the ambitions, scope and content of the emerging Call to Action
• continue to work with you and your teams to begin to identify what, in local communities, is occurring that could be used as case-studies of creativity and innovation of transparency and participation in practice
Modelling of opportunity for digitally-enabled
transparency and participation
EXPO 20144 March 2014
The aim of this work is to:
Provide an evidence base to inform better investment decision making in relation to the use of data, patient participation and transparency.
Support NHS England’s vision of modernising customer services through patient participation, better data and effective use of information technology.
The NHS is facing a serious funding gap
859095
100105110115120125130135
Funding£b
£44b
£28b
2021/2220/2119/2018/1917/1816/1715/1614/1513/1412/1311/122010/11
Real terms freeze through 2014/15 followed by increase with real GDP (2.4%)
Real terms freeze
Historical Funding pressures on the NHS in England (~4%)
SOURCE: Nuffield Trust: The funding pressures facing the NHS from 2010/11 to 2021/22: A decade of austerity?
1 The forecast spend assumes pressures continue to rise in line with patterns observed prior to 2010/11 and that policy-makers and managers take no action to improve efficiency and reduce costs. This estimate is based on the rising pressures on the NHS from 1) Demographics (principal population projection from ONS), 2) Health care activity (Chronic demands on acute 04/05-09/10; MH 08-10/11; primary care 95/96-08/09; prescribing 08/09-11/12) and 3) Health care costs (Pay 2% a year over GDP deflator; drugs in line with GDP). Assumes NHS funding continues to grow with inflation (GDP deflator)
Project deliverables
Estimate opportunity from data and transparency - both demand and supply
Evidence base - nationally and internationally
▪ Model assumptions
A business case to prioritise
The new digitally-enabled NHS could look very different
People may… Providers may… Commissioners may…
Talk to their doctor online
Automate routine tasks
Monitor their own health via an online portal
Share informa-tion to improve patient care
Use deep insights to incen-tivise providers
Book appoint-ments and get prescriptions online
Use information to improve their operations
Use risk stratifi-cation to direct resources efficiently
Others?
ILLUSTRATIVE EXAMPLES
Approach
Modelling approach4
3
Transparency and Participation interventions(evidence base)
5NHS impact & strategic choices
2 Demand levers
Supply levers1
Supply productivity
13
Medium termQuick win Long-term
~1%
~5%
~1%
?
~10%
>2%
~2%
Allocative efficiency- Which diseases?
Stop clinical interventions low value
Prevent hospitalization (Integrated care)
Self care
Internal administrative efficiency
More productive providers -
hospitals, primary care etc
Wage freeze
SOURCE: McKinsey quantification of UK health value pools, based on 10/11 data
1. How you allocate
resources
2. Technical efficiency
3. Input costs
~5%Estates optimisation
>2%Reduce procurement costs
At risk popula-tion
Mostly healthy people
Demand management
1 Combined Predictive Model; predicts risk of an emergency admission in the next 12 months based on previous acute admissions and age
SOURCE: McKinsey
High
Low
Average risk of emergency admissions
Share of populationin each stratum
High risk
Very high risk
Moderate risk
Low risk
Very low risk
0.5%
4.5%
15%
30%
50%
Present
ACTIVATED PEOPLE
1
2
People with LTCs1b
Population segment Lever
Frail/ elderly people (no LTCs)
1a
Primary and secondary prevention
2a
Self-care for minor ailments
2b
Avoid unnecessary elective procedures
2c
The way we see patients will need to change
Populations
Predictive
Patient power
15
Increasing data transparency▪ Alliance of 46 countries to promote transparency in
government, launched 2011
▪ Government-sponsored provider of quality and service information about healthcare providers
▪ 8 million unique users per month
▪ US government insurance and health reform portal, launched in 2010 for public health literacy
▪ Public information service which helps users navigate available healthcare services
▪ Used monthly by 40% of Stockholm’s residents
▪ Payor-driven site providing information on physician tariffs, reimbursement
▪ Independent infomediary comparing prices and services across healthcare and other industries
▪ Independent infomediary providing comparative information about hospitals, doctors, treatments
16
ZocDoc/Teladoc enables on-demand access to doctors in minutes via phone video calls
From … To …
Call to make appointments/days or weeks to see doctors
(Zocdoc/Teladoc) on-demand access to doctors in minutes or same day/in person or via phone video call
Technology supplementinghealthcare professionals …..
Monitoring patients Say hello to intelligent pills – digital system tracks patients from the inside out
Nature
The doctor is out, but new patient monitoring and robotics technology is in
Scientific American
Metavision is a patient care IT platform which supports tablets; it has several applications including ICU
SOURCE: Metavision website http://www.imd-soft.com/
IT patient care platform, including an ICU specific application
Link to all tablets and mobile devices
The Maccabi Healthcare System in Israel is Highly Digitalised
▪ Maccabi Central Electronic Medical Record
▪ Every transaction computerized
▪ E-Laboratory
▪ E-Prescription
▪ E- Consultation
▪ Telemedicine
▪ Alerts and Reminders
▪ Registries
▪ Patient Website
Kaiser Permanente's mobile health portfolio aspires to improve health and relationships between patients and their doctors
Location finderMessagingAppointment scheduling
Electronic medical record
Test result viewer
SOURCE: Kaiser Permanente
Patient information…
Online patient communities Helping patients find trials
DNA testing for more than 100 diseasesInteractive access with peers and physicians
22
Singapore “Fish n’ Steps” used a gaming approach to achieve an increase in physical activity
SOURCE: Lin et al., Fish'n'Steps; Loke et al., Developing Virtual Patients; McKinsey
Online health information
Increase in physical activity (steps) under "Fish 'n' Steps" programDaily steps per person
Presented as game
Competitive elements
6,760
8,034
After programBefore program
+19%
Kick Buts, an Agile Health solution, uses a simple, evidence-based text messaging program to support patients in quitting smoking
SOURCE: Agile Health company website, PR Newswire: http://www.prnewswire.com/news-releases/agile-health-adds-smokeless-tobacco-cessation-support-to-kick-buts-program-221153541.html
A 2011 controlled study with 6,000 participants showed significant impact smoking quit rates at 6 months: 10.7% Intervention vs. 4.9% for Control
Kick Buts is an interactive, text-messaging smoking cessation program that works through mobile phones and supports patients via clinically validated text messages
Kick Buts is a SMS based approach…
… with significant impact
Discussion
"What do you feel are the biggest opportunities through use of digitally-enabled participation and transparency and what examples of impact have you seen?"
Project concludes in next 6 weeksProject concludes in next 6 weeks