Making Care Mobile:

Shifting Perspectives on theVirtualization of Health Care

ATA Fall ForumLuncheon KeynoteSept 10, 2013

@willfalk

slides available on Twitter

PwC

Who I am

Will Falk

Managing Partner – Healthcare, PwC Canada

Executive Fellow, Mowat Centre for Policy Innovation

Adjunct Professor, Rotman School of Management

william.f.falk@ca.pwc.com

Twitter: @willfalk

2

PwC

Making Care Mobile: Shifting Perspectives on the Virtualizationof Health Care

• Report explores Canadians’ attitudes towards pertinentissues in the health care industry

• Provides analysis of what citizens expect decision makers tokeep in mind when thinking of the future of health care inCanada

Goal of the report

• What improvements are citizens looking for in health care?

• What channels are citizens using to access health care andinformation now, and in the future?

• What innovations are citizens ready to use that can makehealth care delivery more efficient?

• What are the future possibilities in health care delivery?

Key Questions

www.pwc.com/ca/virtualcare

3

PwC

Making Care MobileShifting perspectives on the virtualization of health care

More than 2,400 Canadians participated in our research to address thecentral question, “What does the future of health care delivery look like?”

4

PwC

Virtual assessments via apps are good options inthe right situation…

52%of patientsindicate thatfaster access tocare is theprimaryappeal ofvirtualassessment

1%

8%

15%

20%

21%

36%

No answer

Not sure

None of the above

You use an app for an initial assessment

You send it to your doctor using an app

Doctor takes the photo and communicates withdermatologist

77% of Canadians were comfortable with virtual mole assessment appscenario – although, at this time, most prefer doctor-controlled option.

5

PwC

Canadians told us they are ready for virtualmonitoring for chronic conditions…

79%of Canadiansindicate thatthey arecomfortablewith virtualmonitoring forchronicconditions

Most Canadians indicated they would be comfortablehaving a chronic condition monitored virtually...

36%

43%

10%

5%

4%

2%

Yes, definitely

Probably

Not likely

Definitely not

Not sure

No answer

... and 62% of caregivers indicated that virtual healthcare would help them to provide care for someoneelse (e.g. parent/ child)

6

PwC

… and virtual visits for post-surgical follow-up.

54%of Canadiansindicate thatvirtual visits,homemonitoring,and virtualwards are goodcare deliveryoptions

24%

43%

17%

11%

5%

0

Yes, definitely

Probably

Not likely

Definitely not

Not sure

No answer

The majority of Canadians indicated they would becomfortable having post-surgical follow-up visitdone by video conference.

7

PwC

Q: Are mHealth and vHealth different?

Consumer mHealth is exploding in part as a result

8

PwC

Telemedicine and mobility are coming togetherfacilitating delivery of virtual care anywhere

Telemedicine mHealth Virtual Care

9

PwC 10

many small pilots 25%

By 2020, more than 25% of care will be deliveredvirtually (with provider and patient in separate places).

- Dr. Ed Brown, 2012

PwC

Virtual Health Care: We have been throughsimilar shifts before…

InpatientCare

OutpatientCare

VirtualCare

1992…More people leave

hospital after procedurethan remain overnight

202X?…More virtual visits than

physical visits

Each transition involved people, process, and technology changes.Major shifts in how we organize our care delivery services and assets

11

PwC

Virtualization improves health system access,quality, productivity, and sustainability…

Access Quality Productivity Sustainability

• Deliver care overlong distances

• Reduced traveland wait times

• Re-distributionof HHR – accessto scarcespecialties

• Better waitingrooms

• Auditability ofdecisions

• Use ofmanufacturing,QI, and QAtechniques

• Lower infectionrates/ Infectioncontrol

• Automatedscheduling

• Elimination of“politeness time”

• Asynchronousconsultations

• Ability toaggregatevolumes

• Avoidance ofgreenhouse gases

• Ability tosubstitute lowercost care providers

• Auction pricingmechanisms

• ArtificialIntelligence

12

Specialists’ OfficesRegional Hospitals

On-Call Emergency PhysiciansPublic Health Units

Mental Health and Addiction Treatment Centres

Primary CareFamily Health TeamsCommunity HospitalsCancer CentresFirst Nations CommunitiesPsychiatric HospitalsCCACsMental Health FacilitiesFederal and Provincial PrisonsRural Nurse PractitionersLong-Term Care Homes

Referring Clinician Consulting Clinician

eReferral

4. eConsult (ask a question)

3. eConsult (full assessment)

2. Clinical Videoconference

1.Face-to-Face

Provider to Provider: The Future

PwC

Virtual Care solutions will be segmented by cost ofdelivery, and offer benefits to specific segments

14

High cost solutionssupported by high

clinical value

Cost-value tradeoff

Cost level can onlybe supported using

consumerelectronics

10,000

01,000

001oo

010So

luti

on

cost

/ben

efit

($)

Population (%)

5% 100%50%

PwC

Focusing on “frequent flyers” both helps andhinders developing an at scale virtual care system

1%

34%

5%

66%

10%

79%

50%

99%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ontario Population Health Expenditure

Figure 1. Health Care Cost Concentration:Distribution of health expenditure for the Ontario population,

by magnitude of expenditure, 2007

$33,335

$6,216

$3,041

$181

ExpenditureThreshold

(2007 Dollars)

Source: ICES

15

PwC

The drug delivery system may provide a model forthe organization of apps and devices

Take 2 Apps andCall Me in theMorning

Tech Rx

Apps Pharmacy not Apps Store

Apps Formulary

AliveCor Cardiac

Withings Blood Pressure

bant Diabetes

Pain Squad Pain Mgmt

MyIBD Crohn’s Disease

16

PwC

We need a process and standards for selection,and a taxonomy for regulation of apps

Front ofStore

Over theCounter

Prescription

ControlledSubstance

Criteria for evaluation include:

• Operability

• Privacy & Security

• User Data Safeguards

• Functional Validation

• Clinical Efficacy

17

PwC

Front of store apps are mHealth ‘vitamins’ thatsupplement a healthy lifestyle

Front ofStore

Over theCounter

Prescription

ControlledSubstance

18

PwC

Over the counter apps may be dispensed after anassessment of the patient's needs

Front ofStore

Over theCounter

Prescription

ControlledSubstance

19

PwC

Prescription apps: plan of care written byphysician or other health professional

Front ofStore

Over theCounter

Prescription

ControlledSubstance

20

PwC

Front ofStore

Over theCounter

Prescription

ControlledSubstance

Controlled apps: require close supervision ofmanagement and use

21

PwC

Virtual care and Apps fulfillment is now a newclass of service offerings

Front ofStore

Over theCounter

Prescription

ControlledSubstance

In this stage of theirdevelopment, the‘prescription’ and

‘fulfillment’ ofmHealth Apps need

not be separated

22

Thank you.

@willfalk

* slides available on Twitter

This content is for general information purposes only, and should not be used as a substitutefor consultation with professional advisors.

© 2013 PricewaterhouseCoopers LLP, an Ontario limited liability partnership. All rightsreserved.

PwC refers to the Canadian member firm, and may sometimes refer to the PwC network. Eachmember firm is a separate legal entity. Please see www.pwc.com/structure for further details.