Providing opportunities for

improving healthcare by

connecting technology platforms

Rolan Christian, PhD

AHFOZ Conference 2017

Helios ITS Profile

We are an independent information and

communications technology (ICT)

company.

We specialise within the healthcare

industry by offering technology-based

products and services that deliver

innovative solutions.

Our team has been instrumental in

developing industry-leading medical

scheme administration and health risk

management solutions.

Our systems are equipped to deal with

the large transaction volumes generated

by claims, assessments, electronic funds

transfer, reporting and accounting.

Scalable

healthcare

platforms

Nexus

Schema6

UMS

DMS

Efficiencies

For clients

Mobile apps

Websites

Self service

IVR

BI and DWH

Cutting

edge

technologies

Manages 3.8m lives

Process 6.4m claim lines per month

Full disaster recovery

Cloud base solution

Advanced end-to-end security

Agenda

Changes in the healthcare market

Technology disruptions and their impact

An ICT platform map for healthcare

Example of using technology, for healthcare ecosystems, to improve quality

of life

Opportunities that can contribute to the healthcare ecosystems

Changes in the

healthcare market

Summary of global and local trends

Changes in

member base

• Aging population and increase in chronic conditions

• Increasing life expectancy driving demand for healthcare services

• Younger population using minimal services

• Many still underserviced or not serviced at all in developing economies

Skills and

training

• Healthcare professionals in short supply

• Technical resources in short supply

• Impacts ability to sustain and grow

Cost and

revenue

• Spiraling costs

• Consolidation of schemes

• Failing healthcare systems

• Impact on revenue or reserves to sustain large base

Business

models built on

restriction

• Cost containment as a main business thrust

• Delivery models focused on restriction

• Not addressing healthcare costs

Scheme strategies

Retain members

Options:

Focus on personalised services

Compete on price

Compete on value

Add on additional services

…

Grow member base

Options:

Mergers and acquisitions

Market medical aid but coupled with a

diversified offerings

Appeal to younger and

healthier base

Reduce cost of healthcare

Options:

Develop low cost plans

Negotiate better rates across the healthcare ecosystem

Manage health risks before leading to chronic or hospitalisation

Strategic

focus

areas

Technology disruptions

and their impact

Mobile is a global standard

“Sub-Saharan Africa remains the fastest growing mobile market”

“Less than a fifth of under-16 year-olds (who account for

more than 40% of the population in most countries in the

region) have a mobile subscription, while women were 17%

less likely than men to own a mobile phone in 2016. The

uptake of mobile services by these underserved groups will, in

large part, drive subscriber growth in the future.”

“Mobile broadband and smartphone adoption gain momentum”

The number of mobile

broadband connections will

reach half a billion by

2020, more than double

the number at the end of

2016, and will account for

nearly two thirds of total

connections in the region.

3G will remain the

dominant mobile

broadband technology for

the foreseeable future

Smartphone connections in Sub-Saharan Africa have doubled

over the past two years to nearly 200 million, accounting for

a quarter of mobile connections in 2016. Key factors

supporting the growth of smartphone adoption in the region

include the increasing affordability of new devices and a

growing market for second-hand devices.

Source: The Mobile Economy, Sub-Saharan Africa 2017, GSM Association

Source: The Mobile Economy, Sub-Saharan Africa 2017, GSM Association

Internet access as a proxy for access to innovation

0%

5%

10%

15%

20%

25%

30%

-

10

20

30

40

50

60

SouthAfrica Zambia Zimbabwe

Thousands

Millions

Popula on(2017est.) InternetUsers(31Dec2000) InternetUsers(31March2017)

Penetra on(%Popula on) Facebooksubscribers(30June2016) Growth%

Source: http://www.internetworldstats.com/stats1.htm

Other major technology innovations

Sources:

• Top 10 healthcare innovations: Achieving more for less, Deloitte Centre for health solutions, 2016

• Imagine Africa 2013: Technologies that will shape Africa’s tomorrow, Intellecap, 2017

Next generation sequencing

• Early detection

• Identification for better

fit for trials

Devices

• Diagnostic devices

• 3D printing

• IoT (wearables)

Pharma

• Immunotherapy

• Drug delivery

AI

• Virtual assistant

• Diagnosis support

AR/VR

• Virtual engagement

• Tele-health

• Convenient care

Security & Transactions

• Blockchain

Healthcare and AI

Healthcare has been one of the most active spaces for funding to AI

startups. This could be for a few possible reasons:

1. AI in healthcare promises tangible economic and social benefits. It could extend

the reach of doctors, improve diagnosis, discover and drugs faster, and

significantly cut down on costs.

2. Health data isn't easily accessible, meaning it could be an opportunity for startups

that focus in the area and a harder area for incumbent tech companies to easily

enter.

3. New, massive datasets relevant to healthcare need to be parsed to be useful. This

includes real-time biometric monitoring, troves of genetic data, telemedicine

interactions, and more. AI can play a critical role here.

4. A lot of existing healthcare processes are rooted in pattern matching, a place AI

particularly excels at.

Source: CB Insights, AI Report. Brain signal companies. $90M raise, 2017

#AIHealth

90+ STARTUPS

TRANSFORMING

HEALTHCARE WITH AI

Khosla Ventures is the

most active VC investor,

having backed 5 unique

companies on the map:

Lumiata, Ginger.io, Zebra

Medical Vision, Bay

Labs, and Atomwise.

Imaging & diagnostics is

the most crowded

category.

6 out of 9 startups using

AI in drug discovery have

VC backing.

www.cbinsights.com 10source: https:/ /www.cbinsights.com/blog/ artificial-intelligence-startups-healthcare/

VIRTUAL ASSISTANTS

DRUG DISCOVERY

WEARABLES

EMERGENCY ROOM & HOSPITAL MANAGEMENT

MEDICAL IMAGING & DIAGNOSTICSINSIGHTS & RISK MANAGEMENT

LIFESTYLE MANAGEMENT & MONITORING

HEALTHCARE RESEARCH

MENTAL HEALTH

NUTRITION

MISCELLANEOUS

istock.com/hilch

Source: Artificial Intelligence In Healthcare, Emerging trends, investments, AI in oncology, CB Insights 2017

An ICT platform mapComponents available to assist healthcare products and services

SecurityRegulatory …Legal

• Starts with basic business intelligence around reporting and dashboards using integrated data sets

• Decision platforms that allow for deeper reactive analysis and insights

• AI as the next progression on data analysis (predicative or near predictive capabilities)Intelligence

• A diverse set of application ecosystems are provided to connect to the devices and channels

• Includes personal health apps, provider apps, practise mngt. and Internet enables applications

• Also manages all required data to provide healthcare services

Platforms

of data

• Represents a plethora of cloud ecosystems currently available to extend offerings

• Provides components of infrastructure required to scale

• Allows secure storage and sharing of data between remote sites and dispersed customers

On-demand

infrastructure

• World wide connectivity provided by the telecommunication network providers (closed ecosystem)

• Required to connect individuals to each other, providers, schemes and administratorsAccess &

connectivity

• Speech, messaging and App ecosystems driving rich channels for healthcare products and services

• Devices extract value for channels by sharing health and location data, even across platforms

• These technology components allow “personalised” solutions to gain maximum reach

Devices

& Channels

• Basic services that allow use of connectivity, such as call centre and disaster recovery

• Includes voice, SMS, networking, interconnection, billing, …

• Includes the infrastructure required to process and share large datasets Base services

• Integration with disparate data and platforms is a key requirement to gain overall insight across data

• Platforms become data and feature hubs for ecosystems

• Integrated is key in trying to manage and consolidate different standards across the value chainIntegration

ExampleIntegrated Chronic Care Model (ICCM)

Background to ICCM

0.0

1.0

2.0

3.0

4.0

5.0

6.0

9.0

8.0

7.0

ERM ERM ERM ERM ERM HRM HRM HRM HRM HRM

Ra

te o

f c

ha

ng

e

HYPERTENSION

(t=0) (t=1) (t=2) (t=3)

Prevalence

(t=4) (t= -4) (t= -3) (t= -2) (t= -1) (t=0)

Complications

• 100% increase in

hypertension prevalence

• 680% increase in cost of

complications assoc.

with hypertension

• 110% increase in diabetes

prevalence

• 1718% increase in cost of

complications assoc.

with diabetes

20.0 19.0 18.0 17.0 16.0 15.0 14.0 13.0 12.0 11.0 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0

ERM (t=0) (t=4)

ERM HRM HRM HRM HRM HRM (t= -4) (t= -3) (t= -2) (t= -1) (t=0)

Ra

te o

f c

han

ge

DIABETES

ERM ERM ERM (t=1) (t=2) (t=3)

Prevalence Complications

ICCM objectives

Identify• Members that are high risk

• Use and reward doctor ecosystem for diagnosis and management of member

• Enrol members onto the programme

• Get member consent to share information across the care ecosystem

Treat• Assign a treatment plan based on severity of disease

• Link treatment to claims analysis

• Manage via analysis of combined data sets

Manage• Manage communication and

feedback via channels

• Long term: foster a member

ecosystem via an app platform

• Leveraged the app and device ecosystem to

ensure reach and scale

• Maximized use of channels via the various

devices and data from devices

• Already in use connectivity from South African

telecommunications operators

• Not much innovation but the ecosystem exists

for use to reuse this capability at a cost

• Voice and messaging services already in use

via call centers

• Data stored and processed on commodity

database infrastructure

• The solution crossed multiple ecosystems

• Helios and Amazon infrastructure used

• Security is essential to this as well as

adherence to appropriate laws and regulations

• Multiple platforms exist (Nexus, UMS, DWH,

EHR, SOA gateway, app environments, …

• Data is heterogeneous and structured

differently

• Integration between platforms, data, channels

• Claims assessing, managed care, warehouse,

health records (pathology data sources, …)

• Electronic Health Record (EHR) provided the

central integration point

• Large data processed that are available in

claims assessing system (Nexus) and managed

care systems (UMS)

• Based on analytics data provides insight into

high risk and emerging risk members

ICCM enabling technology platforms

Intelligence

Platforms

of data

On-demand

infrastructure

Access &

connectivity

Devices

& Channels

Base services

Integration

Results of the ICCM programme

Consented Beneficiaries with

a Care Plan*

Adherence to Care Plan FP visit

Prior Pilot % Change

Prolonged Consultation with FP 122 34% 47% 12%

No Prolonged Consultation with FP 231 34% 34% -1%

Overall 353 34% 38% 4%

Care Plan Adherence by FP Prolonged Consultation

*Beneficiaries who have been enrolled for a minimum of 12 months

Hospital Outcomes

Consented Beneficiaries*

All Admission Rate per 1 000 FP Visit (Prolonged)

Prior Pilot % Difference

Prolonged consultation with FP 152 70 58 -17%

No Prolonged consultation with FP 335 69 66 -5%

Overall 487 69 63 -9%

Other opportunities that exist

Richer EMR/PHR channels and data

Standardised exchange data between central hubs, e.g HIE

End-user rating of providers (DocAdvisor)

Integrate channels deeper into mobile device

Health Insurance as a means to supplement members leaving the

ecosystem