Esteban Manuel Keenoy

Director Kronikgune

CHALLENGES IN SCALING UP SOLUTIONS: THE BASQUE

COUNTRY EXPERIENCE

Promoting innovation by scaling up: myth or fact?

AAL Forum 2014

Palace of the Parliament

Bucharest, Romania

Demographic and epidemiological context

2

Basque Health System

Life expectancy

85,7 years

women

79 years

men Source: Eustat –Basque Institute of Statistics 2012

Population (2011): 2.183.615

≥65 years: 19%39% in 2050

BIZKAIA

GIPUZKOA

ARABA

Chronic diseases 80% of medical consultations

75% of the Health Budget

8.760 HOURS/YEAR

HEALTHCARE

HOME

1-2% contact with Healthcare System

In a system designed to treat acute problems:

episodic care

4

" More at home and PHC and less in hospitals“

• Technology key driver in Health Care change.

• Productivity gains for Health Care Systems

• Have to be aligned with complex Health System

STRATIFICATION: 100% population stratified

Population without chronic conditions 1.394.539

636.000

173.000

43.000

• General

population

• Chronic

patients

• High risk

patients

• Highly complex

multimorbidity

Prevention and

Promotion

Self management

support

Disease

management

Case management

Telehealth Pilots

BIZKAIA

GIPUZKOA

ARABA

1

Telbil A

Telbil T FRAIL

2

U4H CHF

3

Telepoc COPD

4

Respirratory

rehabilitation

5

Teki COPD 6

Tele diabetes

7

Frail Patients

CHF

COPD

FRAIL MM

DIABETES

SYSTEMS

Weight

Oxigen

saturation

Questio

nnaire

Devices and

services

Hardware

Software

Reception Base

HOME

EHR Osabide

Telecare

Blood

pressure

Manual

EXTERNAL

WEB

PLATFORM

Main findings

• Facilitates clinical decision making.

• Better relationship with professionals

• Sense of security and easeness, patients and

caregivers

• Patients greater role in self-care.

• Greater adherence to treatment.

• Increased satisfaction

• Avoid admissions and increases patients quality of life.

BUT EXTENSION AND SCALING UP?

CHF Management Protocol

HOME Telecare call centre

BetiOn

24X7 Health Counseling

call centre HACC

Emergencies

Specialist Consultant

Primary Care

Technical

Social alarm

Validated

Health related alarm

HACC Resolution

Referral to

Primary Care

(apppointment)

PC Resolution Resolution

With Specialist consultant

(teleconsultation)

Referral to Specialist Consultant

Activation alarm

2 1 5

4 3

4

5

Weight

Oxigen

saturation

Question

naire

Devices and

services

Hardware

Software

Reception Base

HOME+ BETI ON

HEALTH SERVICE

CRM

Process

management

Platform

Telecare

Blood

pressure

Manual Server EHR Osabide

Scaling up telehealth projects

Scaling up telehealth projects

Decision makers

involvement

Analisys telemedicine & telecare

pilots

Team: PC + Hospital, Call

Centers+ Managers Design the

clinical pathway

(who, when, where)

Logistics, funding and

ICT infraestructure

Dissemination Plan

Lessons learnt • Fragmented care delivery inertia protected by laws,

norms and interest groups

• Health care practices highly stable: network of

influences and constraints (knowledge, beliefs, attitudes,

habits, systems, incentives, …)

• No substitution effect in Service: new models require

extra resources and additional health workers, the former

practice remains!

• Integration telehealth and process management & EHR

platforms takes time

• Commitment and active role of politicians

• Involve managers and clinicians

• Integrate in clinical practice and information systems

• Combined top-down and bottom-up actions

Two points of view:

Pre- start:

• Solve most problems

• Matches Health System needs

• Promises a short development and deployment process

Pre- start:

• Single Payer Healthcare systems predicts Economies of scale.

• Historic Business Models based on individual projects

• Fidelization gives market advantage

Health System View Provider’s View

In the long term…

• It requires larger funding and time for adapting and updating

• Significant Transactional costs development and deployment

In the long term:

• Each Health system has different strategies, systems and processes

• Higher Transactional costs

• Budget shortages reduced margins

Crisis is an opportunity

Need to reallocate funding

PPIs : co-create global products and services

Redefine targets and timelines

It is not easy, ¡Keep going!

Thank you!