developing a business model and it foundation for digital healthcare version 3

8/18/2019 Developing a Business Model and IT Foundation for Digital Healthcare Version 3

1/9

Developing A Business Model and IT Foundation for Digital

HealthcareMichael Ali and Eric Plummer

April 2016

I. Introduction The business case for digital healthcare derives from the need to continually deliver

better value at lower cost The healthcare industry is migrating toward measuring

value by using ob!ective measures of bene"cial results for the patient# which $%&

calls 'competing on outcomes( )$%&a* There are a number of case studies

demonstrating that outcomes+based healthcare wor,s for the patient# the provider#

and the payer )$%&b* The &artner &roup )&artnera* states 'The successful

transformation of the industry to a consumer+centric# value+based delivery model

depends upon healthcare digitali-ation#.and the means to leverage /T to achieve

uality outcomes at lower cost( This paper proposes an approach to creating the

business model and enabling /T infrastructure that can serve as a foundation for

achieving digitali-ed healthcare

II. Business Case for Digital Healthcare The business case for digital healthcare derives from the need to continually deliver

better value at lower cost The healthcare industry is migrating toward measuring

value by using ob!ective measures of bene"cial results for the patient# which $%&calls 'competing on outcomes( )$%&a* %ompeting on outcomes reuires the

following business capabilities

a 360 vie of the patient! ideally# every interaction with a patient is

captured# from prevention and wellness# to diagnosis# to intervention and

therapy# to treatment and monitoring /nteractions include the various

channels such as the pharmacy# in+ and out+patient care# emergency room#

self+service perhaps via mobile3# etcb Anal"tics identi"cation of patterns and trends# modeling and decision+

support# ideally with the option of leveraging machine learning

c #o$friction interface %eteen partners! patient data needs to beaccessible across 1st# 2nd# and 4rd level service providers# payers# suppliers#

etc

There are a number of case studies demonstrating that outcomes+based healthcare

wor,s for the patient# the provider# and the payer )$%&b* 5owever# achieving the

enabling capabilities reuires that each of the players in the value chain have a

vision# strategy# and plan for creating a digital business model and the aligned


2/9

/nformation Technology /T3 infrastructure enabling that model /n many cases#

developing a business model and enabling /T is a transformational eercise /n any

transformation# the "rst step is to determine the end+state vision ie# 'if you don7t

,now where you7re going# you will probably end up someplace else(3 /n 8ections ///

and /9 we present an approach and an eample for creating this vision /n 8ection

///# we layout a digital business model and in section /9 we layout the enabling /Tfrom a logical architecture# process# organi-ation# and governance standpoint :e

are leveraging an approach developed over the past 20 years at M/T7s %enter for

/nformation 8ystems ;esearch %/8;3 )M/Ta* and used by one of the authors Ali3 at

large multi+national enterprises such as and ;over# 5arman

/nternational# ?8


3/9


4/9


5/9


6/9


7/9

that wor, within one layer of the architecture e with one or two applications3 but

also teams that can wor, across multiple layersapplications to create complete

solutions

Infrastructure / (perations! responsible for the day+to+day running of

applications# des,topslaptops# mobile# servers# storage# and the networ,

-rogra) Manage)ent! processes for program management Programs consist

of multiple pro!ects that need to be coordinated to achieve an outcome Programs

reuire a process distinct from pro!ect management# with emphasis on ris,

management and governance to ensure success

Agile! %reating applications across the typical multi+tier architecture shown earlierreuires software development techniues that can handle compleity# incomplete

andor evolving reuirements# fast chec, and ad!ust cycles Agile software

development# which has been in eistence almost 20 years# is the preferred

approach to meet these needs

ITI#! The /T /nfrastructure >ibrary is a set of processes for maintaining and

upgrading systems and software %hief among these are the 8ervice5elp Des,#

which handles end+user reuests and incidents# /ncident Management for handling

systems failures and root cause analysis# and change management for ma,ing

system changes in a safe and structured manner

D. IT -roect Invest)ent 1overnance

Maimi-ing the value of investments reuires governance to align business needs

against pro!ect investments This group must a3 set the appropriate budget for /T

pro!ects# b3 select a portfolio of pro!ects from a list of proposals# c3 trac, pro!ect

eecution against budget and deliverables# and d3 con"rm the reali-ation of

bene"ts on pro!ect completion


8/9

*. 'u))ar"/n 8ection //# we listed three capabilities that need to be provided in digitali-ed

healthcare model Then in 8ections /// and /9# we laid out an approach and eample

to creating this model The approach is based on research from the M/T %enter for

/nformation 8ystems ;esearch and eperiences of the authors The table below

lin,s the model features to the desired capabilities

Capa%ilit" Ho achieved1

460 view of the patient The model captures interactions with the

patient via the various channels in+person and

digital3 The data is captured in the underlying

applications as shown in the application

architecture# and shared via a master data

construct2

Analytics Analytics capability is speci"cally called out in

both the %ore Diagram and the application

architecture4

>ow+friction interface with

partners

There is a portal channel provided as well as a

partner AP/ for sharing medical records

2eferences)$%&a* %ompeting on Cutcomes :inning 8trategies for 9alue+$ased 5ealth %are#

$oston %onsulting &roup# =anuary 201F

)$%&b* Alternative Payer Models 8how /mproved 5ealth+%are 9alue# $oston

%onsulting &roup# May 2014

)&artnera* $usiness Drivers for 5ealthcare Provider /nformation Technology

Decisions# 2016 &artner# =anuary 2016

)&artnerb* Match ?se %ases and %apabilites for Cperational D$M8s# &artner# August

201H

)&artnerc* A Tour of @o8> in Eight ?se %ases# &artner#


9/9

)Plummer* Episode Analytics A 5ealthcare /nformation /ntegration Platform# March

2016 ?npublished presentation by Eric Plummer

Appendi&! (perating Model Denitions 4MITa5

Diversication lo process co))onalit"7 lo data co))onalit"8! business

units have limited commonality across customers# suppliers# andor products There

may be some shared services e human resources# and /T infrastructure such as

email and scheduling

2eplication high process co))onalit"7 lo data co))onalit"8! operations

are standardi-ed# but business units are autonomous %ompetitive advantage is

repeatable processes vs shared information

Coordination lo process co))onalit"7 high data co))onalit"8! business

units must share customer# supplier# andor product data# but eecute diBerent

processes with that data

9nied high process co))onalit"7 high data co))onalit"8! business units

are interdependent# so are organi-ed around standard and shared processes and

data

developing a business model and it foundation for digital healthcare version 3

Documents