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A challenge?

Techno-economic evaluation of innovative eCare projects Frederic Vannieuwenborg – Ghent University / iMinds 1st International Summer School on eCare , August 25 - 29, 2014, Ghent, Belgium. OUR SOCIAL challenge!. A challenge?. OUR SOCIAL challenge!. More elderly &

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A challenge?

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

  2. OUR SOCIALchallenge! A challenge?

  3. OUR SOCIALchallenge! More elderly & less young active people Source: FOD Economie, K.M.O., Middenstand en Energie, Algemene Directie Statistiek en Economische Informatie More costs for care & cure with LESS resources! Source: the perfect storm – Schoors & Peersman

  4. OUR SOLUTIONS! • 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 • …

  5. (and mine…) Your interests

  6. Market barriers • Nascent market • Entrance implications and barriers • Financing • Regulations • Lack of medical evidence • Standardization and uniformization • Support by the care givers • Cultural acceptance and support by the care receivers • Service offer and knowhow • Unclear ROI-models

  7. Need for Techno-Economic research? • Nascent market • Entrance implications and barriers Opportunities • Financing • Regulations • Lack of medical evidence • Standardization and uniformization • Support by the care givers • Cultural acceptance and support by the care receivers • Service offer and knowhow • Unclear ROI-models • Identifying: • Potential economic impact • Potential impact on quality of life (QoL) • When? • At an early stage of the research/development phase

  8. 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

  10. 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

  11. Telemonitoringof 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

  12. Case CHFOverview Subdivide problem Scope Collect input Process input Processes Refine Model Sensitivity analysis Revenues Evaluate Investment analysis Value network analysis p. 12

  13. 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

  14. Simplified Value network p. 14

  15. 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 • … • Official databases: • Federal Government • Flemish Government • Eurostat • RIZIV • Interviews with actors • Cardiologists • General Practitioners • Pilot studies? • IM3 • Virga Jesse • Literature study p. 15

  16. Actual process p. 16

  17. Telemonitoring Process p. 17

  18. Multi-actor analysisRevenues and costs p. 18

  19. Numeric Model p. 19

  20. Impact of telemonitoring p. 20

  21. Conflict in Value network !!!! Need to define other scenarios p. 21

  22. 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

  23. 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 • Scope • Refine • Model • Evaluate

  24. 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. • CHF case • Telemonitoringcould reduce costs while keeping quality high! • Conflicts in the Value network = Unsustainable solution • Less hours in medical facilities = more quality time for patients p. 25

  25. Thanks for your attention! Any questions? Frederic.vannieuwenborg@intec.ugent.be http://www.ibcn.intec.ugent.be/te/

  26. CareClouds

  27. OCareCloudS: Service definition & Added value for the users Added value care receiver: Better care Added value care provider: Better support Added value care organization: Better service delivery OCCS basic services as standard packages, but open for additional services

  28. OCareCloudS: Methodology

  29. Detecting viable GoToMarketscenarios • OCCS by care org non-reimbursement scen. • OCCS by service flat • Billing & scheduling tool for care org ? reimbursement scen. • Platform for cost-effective healthcare

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

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

  32. IS THE MARKET READY? • Support and readiness of Care receiver?! • Support and readiness of Care organisations?! • Cross organisationalcooperation: • Culture change • Structuralchange • Care processdigitizationjuststarted… • 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

  33. OPEN THE MARKET BY… Increasing the USP for a central actor = Care organization HOW? Step 4 Step 3 OCCS as billing & scheduling tool Step 2 Step 1 Patient involvement Step 0 Patient centered

  34. … a billing & scheduling tool as a first step integration

  35. … a billing & scheduling tool as a first step integration

  36. … a billing & scheduling tool as a first step integration

  37. Migration path proposition Cross organizational use of shared care record Step 4 OCCS as facilitating tool for patient centric care Internal (+ informal) use of shared care record Step 3 OCCS as billing & scheduling tool Step 2 Step 1 Patient involvement Step 0 Patient centered

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