August 29, 2014Radisson Blu HotelCebu City, Philippines

Worldwide Hospital Management Thinking

& Experience

HMA 2014 Presentation

The Future of Healthcare Careers

Technology Impact and ASEAN

Draft

August 2014

Klaus Boehncke

South East AsiaConsulting (SEAC)Health Technology & Innovation Lead

boehncke.klaus@my.pwc.com

PwC24 July 2014

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Topics Covered

• The Impact of Technology

• Changing Old Roles & New Roles

• ASEAN

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Two Drivers for Change: Continuing cost pressures and innovation

Chronic conditions are reaching a boiling point, the IOM suggested. Calling it an "epidemic," IOM said chronic illness is

steadily moving toward crisis proportions. "Yet maintaining or enhancing quality of

life for individuals living with chronic illnesses has not been given the attention it deserves by health care funders, health systems, policy makers, and public health

programs and agencies," the report summary states. "Moreover, the

aging of the population will only increase coming challenges."

Ratings agency Standard & Poor's warned it may downgrade "a number of highly rated Group of 20 countries as of 2015 if their

governments fail to enact reforms to curb rising health-care spending and other costs

related to aging populations.

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Two Drivers for Change: Continuing cost pressures and innovation

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Technology driven innovation is happening across the value chain

• Leverage efficiency and productivity drive to hospitals to HIMSS Level 7

• Telehealth to extend reach e.g. post-discharge

• IT EMR in nursing homes to mirror primary and acute care

• Online chronic disease behaviorchange

• Hospital in the home

• mHealth and Telehealth

• In practice EMRprevalent, cross practice EHR/HIE

• Pharmacy based virtual primary care

• mHealth and telehealth to run primary care

• Online chronic disease behaviour change

• Increased focus on mHealth and telehealth

• New entrants driven by sensor technology and wearables

New entrants across spectrum eg owning the disease

Government and private sector push for care integration

Government and private sector analytics to drive info and best practice

Trends by Care Setting

Prevention & Wellness

Primary & Community Acute Step Down &

Home

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Online behavior change programs will increasingly utilize health coaches

• Discovery / Vitality long running proprietary sports/wellness online program. This program has 5.5 million members globally and integrates brick-and-mortar providers with online incentives

• New innovative lifestyle change programs such as newNRG.com are emerging that are purely online where development and operations can be outsourced – but also potentially integrate telemedical health coaching which could be offered from the Philippines or Malaysia into English speaking countries

Source: Discovery / Vitality Annual Report , newNRG

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Primary healthcare everywhere – in the Pharmacy…

• In large supermarkets and shopping malls

• Good parking availability

• Often open 24/7

Convenience and accessibility

MinuteClinic Revenue Growth

• Fixed catalog of treatments, very low standard costs

• Often more than 50% lower cost than a comparable doctor visit

• Supported by IT decision support system

• Carried out by nurse practitioners

Cost Reduction and Go-To-Market

Clinic Growth

Latest trend – delivered via telemedicine kiosk using licensed medical doctors – done e.g. by Medgate in Switzerland

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Primary healthcare - on the phone: Teladoc, Medgate, American Well

• 24/7 access to a GP, including prescriptions

• Audio only (traditional telephone) but also Video (eg Skype) or Apps (egAmerican Well)

Convenience and accessibility

Teladoc Customer Development

• Medgate is 10% lower cost – a big savings for insurance companies (7 out of 10 private health insurance companies are their customers), but savings are even higher with gatekeeping fuctions

• Teladoc markets to employers that have significant productivity gains. Customers include e.g. Accenture, AT&T, Aetna, and many other blue-chip companies

Cost Reduction and Go-To-Market

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Post-hospital telehealth is another future trend

Case Study: Telehealth induced reduction of readmission rates in Hong Kong

The telehealth center was set up in 2004 and has since developed more than 28 telephone triage protocols and more than 50 clinical protocols with which to engage the patients over the telephone. When the evaluation was done, the center conducted 2,300 calls a month of which 78% were outbound (initiated by the Hospital Authority) and the rest inbound (initiated by the patient).

The results were impressive: post 28 days….

• ED attendance and admissions was reduced by more than 35%• Unplanned readmissions were reduced by over 22%• Bed days for the cohort were reduced by roughly 30%• … and post 90 days the mortality relative risk decreased by nearly 50%

According to HA sources, the center saves 100x its operational costin reduced treatment expenses

We can expect more payor organizations to leverage these findings (as is already happening in Europe and the US)

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All (most) hospitals will soon have clinical IT

10

Base Case: current beddays, current episodes, current costs

With EMR: 66% of beddays, 73% of episodes, cost reduction approx. 30%

• Faster results• Faster treatment• Fewer errors• More than 200 lives saved• Elimination of duplicates• Less time searching for

information (up to 60 minutes per shift)

Earlier discharge Lower cost per order events

PwC Hospital IT Benefits Modelling

New capacity: 34% beddays

Source: PwC Benefits Modelling with results based on peer reviewed academic research, case studies and some client data

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Topics Covered

• The Impact of Technology

• Changing Old Roles and New Roles

• ASEAN

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Drivers of the change in the delivery of healthcare

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Social Networking

Technical Advances

CostPressures

Ageing Population

IncreasingAccountability 24/7 Society

Source: Jennings / Miller / Materna 1997

Globalisation

$

c $

c

Medicine 2.0

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Technology is changing the roles at all levels

Expanded Strategic Impact of Technology• Strong CIO role, ideally someone with a medical and IT background• Management team driving, involved and using the technology• Making sure champions are identified and driving change• Inspire change, innovation and quality

Role Change to Facilitator• Changing role (facilitator, rather than knowledge master)• Expecting to use technology, rather than resisiting change• Generational mindset

Role Change to Expanded Activities• Increasing broadening of role to more and more of the job of a medical

doctor (with decision support)• Active users of technology• Continuous improvement mindset

Manage-ment

Medical Doctors

Nurses

Read

iness an

d O

pen

ness to C

han

ge

The advantage in Asia is that there generally seems to be a higher appreciation of technology vs. Europe and the Americas

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Example: the physician’s world will be different

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Doctors work as individuals

Doctors work in teams Shared Health Records

Doctors is on top within his/her institution

Doctor is part of a complex wide organisation

Integrated Care

Source of knowledge is expert opinion

Source of knowledge is systematic review of evidence

Decision Support Tools

Most of what doctors know is in their heads

Doctors must use information tools constantly Decision Support Tools

Patients do not have easy access to knowledge base of doctors

Patients have as much access to the evidence base as doctors Apps, Medicine 2.0

The doctor is smartest Often the patient is smarter(And often, the crowd is smartest)

Apps, Medicine 2.0

Old World New World Potential Enabler

Treatment guidelines and best practices are revised only infrequently

Treatment guidelines are changed in realtime and updated in the systems for all

Data Analytics

Source: Adapted from Richard Smith, BMJ Editor

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Example: new nurse role as “knowledge navigators”

SingHealth hopes to have 400 patient navigators by 2018, with each one of them looking after around 100 patients.

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In the next 20 years we can expect the same rate of change as in the past 100!

“Most long-range forcasts […] dramatically underestimate the power of future developments […] because they are based on an “intuitively linear” view of history”

“The [past 100 years] of achievements are equivalent of 20 years of progress at the rate of the year 2000 (thereafter 14, 7 etc.)”

“We won’t experience one hundred years of technological advance in the twenty-first century, we will witness on the order of 20,000 years of progress (when measured by today’s rate of progress).”

Source: Ray Kurzweil, The Singularity is Near, website

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We can make one prediction: change will continue to accelerate and therefore, flexibility and change management will become a crucial element of successful institutions and their staff

Change is the single biggest challenge – it is not about the technology

• Australia: Northern Territory – very successful Shared Electronic Health Record focused on Aboriginal population – worked closely with community

• Australia: Northern Territory – implementation of medication management solution

• Australia: Queensland – eHealth program with major focus on change

• Australia: NSW – advanced digital rostering program, major focus on change

• Australia: National PCEHR – major change consortium including e.g. consultants, training firms, event management firms, communications specialists

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Topics Covered

• The Impact of Technology

• Changing Old Roles and New Roles

• ASEAN

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In an ASEAN world, staff will become more mobile in a competitive landscape – Europe shows this

… so one definite risk is an increased “brain drain” out of some ASEAN countries into others with higher pay

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The competition will happen in all areas – not just in jobs and pay, but also in training.

Nanyang Polytechnic has enhanced its nursing education to include high-tech Electronic Medical Records from a number of vendors

State of the Art Facilities at Nanyang Polytechnic, Singapore

• Ultra-modern nurse training, with sophisticated simulation systems and live functioning equipment including OR and home facilities for care integration

• Unique HIMSS-initiated partnership (through the former Asia VP Steven Yeo) that has leading EMR vendors showcase their products there which can also be used for nurse training

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And ASEAN is expected to open up new business opportunities – also in healthcare

http://www.reuters.com/article/2013/08/09/research-and-markets-idUSnBw095392a+100+BSW20130809http://business.inquirer.net/152043/healthcare-segment-of-bpos-on-the-rise

Global Healthcare IT Outsourcing Market: CAGR

7.6%, $50.4bn in 2018 up from $35bn in 2013

North America Asia Pac Health Outsourcing Market:

CAGR 8.1%

Philippines expected to account for $1bn in

revenues by 2016, with employment level 100k

Example: Projected Healthcare Outsourcing Growth into the Region

Based on lessons from Europe the “magic” from healthcare integration won’t happen overnight –there are of course significant barriers in terms of labor, socio-cultural, infrastructure and economic conditions

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A final thought – if there’s one thing to remember from my presentation it’s the openness to change!

Man gehe mit der Zeit, sonst geht man mit der Zeit!

(You have to go with the times, otherwise you’ll be gone in time)

German Proverb