As the European population ages and the prevalence of chronic disease rises, it is becoming increasingly clear that we can’t deliver higher-quality, more affordable healthcare without aligning payment incentives and improving coordination across the many providers who care for a given patient. New capabilities and healthcare models are required, which results in challenges and opportunities for our medical community, as well as our patient-clients.
The impact of the ageing population
New projections for 2010–2060, published by the European Office for Statistics, state that the number of elderly persons will rapidly increase, with the 80+ population group doubling in size by 2050. From 2015 on, deaths are projected to outnumber births in the EU27 and almost three times as many people will be 80 years or older in 2060. In Belgium (population 10 million) there are more than 1,8 million people older than 65 and 0,5 million people over 80. Eighty percent of people over 65 have a chronic disease and in the 75+ age group 85% has more than three chronic diseases.
These demographics trends will also be accompanied by a rapid growth in the number of persons with physical disabilities - about 21% of the 50+ population has severe vision/hearing/dexterity problems. Diabetes is now talked of as the epidemic of the 21st century, and parallels the worldwide explosion of heart disease.
The ageing of the European population and the associated rise in chronic conditions will lead to a growing number of older people living alone and in need of care. Simultaneously there will be astonishing but expensive advances in diagnosing and treating diseases, in a very personalized manner.
In light of these trends it is clear that the problem of care and assistance will become increasingly important both from a social and an economic perspective.
Healthcare models need to change
These trends pose a double challenge to existing healthcare delivery models. Firstly, there is a growing mismatch between traditional services and new needs – health services for example were originally designed to deal with acute rather than chronic disease. Secondly, rising demand for healthcare services is placing tremendous pressure on healthcare budgets. In response, the healthcare model will need to change dramatically. According to the Institute for Healthcare Improvement, “many healthcare systems around the world will become unsustainable by 2015. The only way to avoid this critical situation is to implement radical changes”.
New economic opportunities
The required changes will also create new economic opportunities. There are 85 million consumers in Europe over 65 years old today and this is expected to grow to 150 Million by 2050. Their combined wealth and revenues are estimated to be over €3000 billion. Clearly there is a tremendous opportunity to help empower elderly people to stay active and live independently. There also will be significant opportunities in the use of innovative approaches to improve care and make it more efficient. For example, the telecare market is expected to exceed €5 billion by 2015 in Europe alone.
Healthcare is already expanding in scope
Some significant changes are already in progress. Healthcare – traditionally focused on institutional care and on curing diseases (diagnosis, treatment) – is expanding in scope in at least two ways. The site of care is expanding its boundaries by going outside the hospital and the clinical setting and moving towards the patient’s home. And care is enlarging its scope beyond the patient domains to also encompass the support of people with special needs such as the elderly and the disabled.
Beyond the institution
Healthcare is extending its “institutional” role and is becoming personal, ubiquitous and mobile. Informal caregivers (patient’s family, friends, volunteers) are complementing the tasks of the medical professionals, but they are also under increasing pressure and need more tools. All citizens are becoming users of these new healthcare services and will be motivated and empowered to manage their own health.
Currently we are witnessing a new wave of change: healthcare is pursuing a prevention objective, by focusing on health conditions through fitness, weight management and a generally healthier lifestyle.
The social behavior and lifestyles, as well as the identity of the individual elder person, will change. Their requirements and consumer behavior will change both in quantitative and qualitative terms. A patient-client will become a consumer.
New capabilities required: care coordination and outcomes measurement
The new care delivery models demand capabilities for care service coordination and an ability to track quality outcomes that were not previously required in healthcare. This should apply to all services, also home-based services. Accreditation of services needs to be approached in a much broader way and should be stakeholder driven.
The financial model needs to be reorganized; financial flows should be reallocated and become more outcome-driven. What matters are healthcare results and comfort levels; not the volume of medical interventions. The government should also investigate and rethink their financing role in building infrastructure where cost calculation should be based on life cycle costing and alternative financing should be explored.
To support the move to team-based models of care, healthcare systems must accommodate the information and workflow requirements of the many stakeholders and organizations involved directly or indirectly in patient care. Social dimensions should also be taken into account. The coordination of information between all actors involved is crucial.
In coordinated care the healthcare delivery system provides a continuum of evidence-based, quality driven healthcare services in a cost effective manner. Coordinated care requires a change in care culture, education, infrastructure, and in the relationships between patients, clinical staff, and caregivers. It calls for the creation of “accountable care cultures” that work together in coordinated, collaborative ways to drive better disease prevention, personalized treatment and positive outcomes. Technology can support this transformation by delivering vital information and tools that meet clinician and patient needs.
Healthcare will address new user groups other than the traditional patients: the elderly and people with special needs such as persons with disabilities. By taking into account the ageing of the population, this new and additional “assisting” role of healthcare will become increasingly important. Ambient Assisted Living refers to intelligent systems of assistance for a better, healthier and safer life in the preferred living environment and covers concepts, products and services that interlink and improve new technologies and the social environment. It aims at enhancing the quality of life (the physical, mental and social well-being) for everyone (with a focus on elderly persons) in all stages of their life.
Quality of Life will have a new, extended meaning where physical, psychological and social aspects are taken into account all together and the “way the patient perceives his/her overall health status” will become of paramount importance. Perception will be more dominant in the evaluation and acceptance of the services.
Hospitals – which play a significant role in the health system – should increasingly try to differentiate and complement their offerings. One-day interventions will increase and care hotels will be the place where patient recover and rehabilitate before going home.
We need to design for users; the solutions need to be user- and demand-driven.
Care initiatives should:
• Respect patients’ values, preferences and expressed needs
• Coordinate and integrate care across boundaries of the system
• Provide the validated information, communication, and education that people need and want
• Guarantee physical comfort, emotional support, and the involvement of family and friends; the social component.
The user-as-producer transforms the relations between consumers and markets and among citizens themselves. Furthermore, it is opening up the possibility of reconfiguring the production process around the user. In many sectors there is a gradual incorporation of users into the process of production.
All the stakeholders (patients and their families, medical professionals, policy makers, health organisations, industry, institutions, insurance companies, the overall community) need to find a way to cooperate in a common effort to create solutions for a new economy and added value for the patient.
Healthcare is an ecosystem – not a factory
The efficiency and effectiveness of healthcare services are certainly becoming a major priority. More integration of information is needed, as well as integration of the logistical processes through the whole value chain and core trajectory. But we need to be careful in comparing healthcare management approaches with those used in industry. While some processes (e.g. some logistical processes) are reasonably universal and hence can be standardized, care processes don’t always lend themselves to such standardization. Care processes are very often unpredictable and unplanned. We could best describe the healthcare model as an eco system. The intelligence is in the total care-system itself. There is chemistry to the way care functions; it a complex, adaptive system—and many aspects of care are distinctly artisanal in character. All actors in the healthcare delivery process should take that paradigm into account.
The opportunity for creating new solutions and the needed delivery models should be part of such an ecosystem, where catalyst intelligence binds the demand and delivery elements. Health technology assessment and multi-sector innovative approaches will be needed to bring value added care towards customers and to create new business opportunities. As such, it is in this context that the idea of “we care” gains multiple dimensions—we care for people with our brains, hands and heart.
Unfortunately the implementation of new approaches in healthcare is hampered by various challenges and restraints; they deal with technological issues and lack of standardization but also – and in some case preponderantly – with political, legal, financing and cultural issues.
About Rudy Mattheus
A computer scientist by training, Rudy Mattheus has twenty years experience working in the healthcare and ICT sectors. Rudy is currently Chairman of the Voka Health community, General Manager at ISS Belgium and sits on the board of several companies active in the healthcare sector, as well as on the board of hospitals and elderly homes. He is member of the Institute of Care Technologies at the Univ. of Antwerp and during his six years as Chair of the European Standardization Institute “Medical informatics, medical imaging and multimedia”, he played a pivotal role in developing the world standards for the international medical community know as the DICOM standard.
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