a challenge?

1

Techno-economic evaluation of innovative eCare projectsFrederic Vannieuwenborg – Ghent University / iMinds1st International Summer School on eCare, August 25 - 29, 2014, Ghent, Belgium

A challenge?

0

90

1881 1986 2003 2020 20501881 1986 2003 2020 2050

0

90

OUR SOCIAL challenge!

1881 1986 2003 2020 2050

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90

OUR SOCIAL challenge!

More elderly &

less young active people

More costs for care & cure with LESS

resources!

Source: the perfect storm – Schoors & Peersman

Source: FOD Economie, K.M.O., Middenstand en Energie, Algemene Directie Statistiek en Economische Informatie

Prevention Adapted homes Health monitoring Data mining to predict changes of… Prevention programs

Optimization of current practice Lean in healthcare (costs) Data sharing / administration Cost efficient practices

New and better treatments Nanotechnology Pharmacology 3D printing eCare …

OUR SOLUTIONS!

Your interests (and mine…)

Market barriers

Nascent market

Entrance implications and barriers

1. Financing

2. Regulations

3. Lack of medical evidence

4. Standardization and uniformization

5. Support by the care givers

6. Cultural acceptance and support by the care receivers

7. Service offer and knowhow

8. Unclear ROI-models

Need for Techno-Economic research?

Nascent market

Entrance implications and barriers Opportunities

1. Financing

2. Regulations

3. Lack of medical evidence

4. Standardization and uniformization

5. Support by the care givers

6. Cultural acceptance and support by the care receivers

7. Service offer and knowhow

8. Unclear ROI-models

Identifying:

Potential economic impact

Potential impact on quality of life (QoL)

When?

At an early stage of the research/development phase

Table of content

Introduction in the societal challenge Need for economic and impact research in

an early stage Case research:

Monitoring Heart Failure patients CareClouds: Keeping elderly longer at home

by enhancing the communication between caregivers

9

Monitoring Chronic heart failure patients

Chronic Heart FailureOverview

Heart is to weak to pump normal amount of blood → accumulation of blood in lung veins

High mortality, low quality of life

High economic consequences: Cost of hospitalization {(re)hospitalizations}

Leading cause of hospitalizations for people above 65 years → number will grow because of the aging population

p. 10

Telemonitoring of Chronic Heart Failure patients

Telemonitoring of CHF patients: WHY Prevent (re)hospitalization Improve the quality of life More cost efficient control

method (#patients controlled ↑)

Telemonitoring of CHF patients: HOW Daily monitoring:

Weight(1), blood pressure (2), heart rhythm(3)

Parameter out of bounds → Alarm to care provider

Contact by care provider Action

p. 11

Model

Evaluate

Refine

Scope

Subdivide problem

Collect input

Process input

Processes

Investment analysis

Sensitivity analysis

Value network analysisp. 12

Revenues

Case CHFOverview

Developing a model? What to investigate?

What are the costs components Evolution of costs for next 10 years

Who is involved? Value network

What to compare? Scenario 1: Actual treatment Scenario 2: Telemonitoring results

analyzed by GP Scenario 3: Telemonitoring results

analyzed by HF nurse

p. 13

Scope

Subdivideproblem

Simplified Value network

p. 14

Scope

Subdivideproblem

Data Sources?General input 15000 new patients/year Mortality: 26% year Avg. hospitalization: 9 days Cost of hospitalization: 200

euro/day Cost of visit to GP: 23 euro Cost of monitoring System:

40 euro/month Cost of Heart failure nurse:

50000 euro/year …

p. 15

Scope

Collectinput

Official databases: Federal Government Flemish Government Eurostat RIZIV

Interviews with actors Cardiologists General Practitioners

Pilot studies? IM3 Virga Jesse

Literature study

Actual process

p. 16

Model

Processes

Telemonitoring Process

p. 17

Model

Processes

Multi-actor analysis

Revenues and costs

p. 18

Model

Numeric Model

p. 19

Model

Scope

Impact of telemonitoring

p. 20

Evaluate

Investmentanalysis

1 2 3 4 5 6 7 8 9 100

1000000

2000000

3000000

4000000

5000000

6000000Total time in medical facilities

Actual Process: No Telemonitoring

Process with Telemonitoring

year

tim

e in

med

ical

fac

iliti

es (

Mill

ion

ho

urs

)

1 2 3 4 5 6 7 8 9 100

5000000

10000000

15000000

20000000

25000000

30000000

35000000

40000000Total Cost for Insurance



year

To

tal C

ost

fo

r in

sura

nce

(M

illio

n E

uro

s)

1 2 3 4 5 6 7 8 9 100

5000000

10000000

15000000

20000000

25000000

30000000

35000000

40000000

45000000Total Cost



year

To

tal C

ost

(M

illio

n E

uro

s)

Conflict in Value network !!!!Need to define other scenarios

p. 21

Evaluate

Value networkanalysis

1 2 3 4 5 6 7 8 9 100

50000

100000

150000

200000

250000

300000

350000

400000

450000

500000Total amount of hours GP



year

To

tal a

mo

un

t o

f h

ou

rs G

P

(Th

ou

san

d h

ou

rs)

1 2 3 4 5 6 7 8 9 100

200000

400000

600000

800000

1000000

1200000

1400000Total receivings GP



year

To

tal R

ecei

vin

gs

GP

(T

ho

usa

nd

eu

ros)

1 2 3 4 5 6 7 8 9 100

5

10

15

20

25

Ratio 2: Receivings per contact hours (GP)



year

rece

ivin

gs

per

co

nta

ct h

ou

r (e

uro

/ho

ur)

!!

Sensitivityanalysis

Sensitivity analyses A lot of parameters → Uncertain Degree of importance of the

parameter?

↓

Sensitivity analysis to check the influence of variation of certain parameters

p. 22

Refine

• Model

• Evaluate

• Refine

• Scope

Process iteration 2 Does the development process of the model

stop here? → NO! Assumptions made:

Only new patients Only savings on frequency of hospitalization No natural transition in NYHA-stages

2nd Iteration: Incorporate natural transitions of NYHA Incorporate the effect of shorter hospital stays

Possible new model

p. 23

Lessons learned and conclusions

General conclusions on eCare services Do not count on direct

reimbursement to build your business case.

Do some initial economic research before developing the product/service

Surround you with enthusiasts and early adopters.

p. 25

CHF case

Telemonitoring could reduce costs while keeping quality high!

Conflicts in the Value network = Unsustainable solution

Less hours in medical facilities = more quality time for patients

Thanks for your attention!

Any [email protected]

http://www.ibcn.intec.ugent.be/te/

mailto:[email protected]

mailto:[email protected]

http://www.ibcn.intec.ugent.be/te/

27

CareClouds

OCareCloudS: Service definition & Added value for the users

OCCS basic services as standard packages, but open for additional services

Added value care receiver: Better care

Added value care provider:Better support

Added value care organization:Better service delivery

OCareCloudS: Methodology

Cost Structure Revenue Streams

Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships


Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships


Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships

Cost Structure Inkomstenstromen

Key Partners

Waarde voorstell

en

KlantenSegmen-

tenKey

Resources Channels

Key Activities

Klanten-relaties


Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships


Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships


Key Partners

Value Pro-

position

Customer

SegmentsKey

Resources Channels

Key Activities

Customer Relation-

ships

Kostenstructuur Revenue Streams

Strat. Partners

Waarde voorstel

Customer

SegmentsMensen en

Midellen Channels

Kern-activiteiten

Customer Relation-

ships

TECHNO-ECONOMIC MODELLING

Inkomstenmodellering

Pote

ntial

impa

ct q

uanti

ficati

on

Kostenmodellering

t

# gebruikers

Kwantitatieve + kwalitatieve analyse

Pote

ntial

Impa

ct

eval

uatio

n

t

euro

-100% 100%

Param. 1

Param. 2

Param. 3

Param. 4

t

Kosten/gebruiker

Kostenstructuur Inkomstenstromen

Strat. Partners

Waardevoorstel

Klanten Segmen-

tenMensen en middelen Kanalen

Kern-activiteiten

Klanten-relaties

Actor A

Kostenstructuur Inkomstenstromen

Strat. Partners

Waardevoorstel

Klanten Segmen-

tenMensen en

middelenKanalen

Kern-activiteite

n

Klanten-relaties

Actor BKostenstructuur Inkomstenstromen

Strat. Partner

s

Waardevoorst

el

Klanten Segmen-ten

Mensen en

middelen

Kanalen

Kern-activiteit

en

Klanten-relaties

Actor C

€

€

Dienst

Hardware

1.Bu

sine

ss m

odel

ana

lysi

s

Voelt zich goed?

+

Kijkt historie

van patient na

risico op HF?

+

Elke dag monitor

en

alarmgeneratie

+

Monitoring van de

toestand en ingrijpen van

arts

+naar huis

+

Opname in hospitaal

neen

ja

Neen,

Resultaat

Nog onregelmatigheden

Toestand OK

Ontslaan uit hospitaal

Monitoringstap gedaan

Contact opneme

n met arts

Contact opneme

n met patient + uitleg

Analyse resultaten

ja

Resultaten OK

Resourceverbruik Besparingsmogelijkheden

RESOURCE USAGE &

BENEFITS

Invloed van ICT-integratie kwantificeren

oCareClouds service

2. G

o To

Mar

ket s

trat

egie

s

OCCS

Go To Market Strategy 1




3. M

igra

tion

path

s

OCCS?STEP 1

Current situation

STEP 2

STEP 3

STEP 4

Detecting viable GoToMarket scenarios

non-reimbursementscen.

• OCCS by care org• OCCS by service flat

• Billing & scheduling tool for care org?reimbursement

scen. • Platform for cost-effective healthcare

Scenario 1: OCCS offered by care organization(Value network)

Scenario 1: OCCS offered by care organization(Value streams)

IS THE MARKET READY? Support and readiness of Care receiver?!

Support and readiness of Care organisations?!

Cross organisational cooperation: Culture change Structural change

Care process digitization just started…

• Support and readiness of Care receiver?!- Technical barriers, USP not clear

• Support and readiness of Care organisations?!- What’s in it for us? Low USP.

• Cross organisational cooperation: • Culture change• Structural change

- today no/little cooperation• Care process digitization just started…

- Under financial pressure

OPEN THE MARKET BY…

Increasing the USP for a central actor

= Care organization

HOW?

Step 0

Step 1

Step 2

Step 3

OCCS as billing & scheduling tool

Patient centered

Patient involvement

Step 4

… a billing & scheduling tool as a first step integration

Migration path proposition

Step 0

Step 1

Step 2

Step 3

Step 4

OCCS as billing & scheduling tool

Internal (+ informal) use of shared care record

Cross organizational use of shared care record

OCCS as facilitating tool for patient centric care

Patient centered

Patient involvement

a challenge?

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