TELUS Talks Health

In November 2015, the annual TELUS Talks Health event

welcomed 250 leaders from across Canada’s healthcare

ecosystem to attend a compelling keynote from our

internationally esteemed guest, Dr. Mark Britnell, Chairman

and Partner of KPMG’s Global Health Practice. He is an

advocate of patient engagement and author of In Search of

the Perfect Health System, in which he shares first-hand,

compelling observations of health systems in 25 countries.

Of Canada, he notes: “Canada’s health system, or rather its 13 provincial and territorial health systems, needs to find more urgency

and resolve for solutions to its healthcare sustainability challenge. A measure of tough love will be needed not only to maintain

enduring values, but also to change outdated delivery models. Canada stands at the crossroads and needs to find the political will

and managerial and clinical skill to establish a progressive coalition of the willing.”

In my own experience speaking with health leaders across the country, there is no dispute that the sustainability of our health

system is the primary concern keeping people up at night. As governments, health authorities, care providers and vendors traverse

these crossroads, patient engagement is as top of mind for leaders in Canada, as it is globally.

This TELUS Health position paper leverages insights shared by Dr. Britnell, among others and discusses the advantages of patient

engagement in two ways: the management of chronic conditions – an area well-known to deliver return on investment; and prevention

to reverse or head-off preventable health issues and avert further undue strain on the health system.

Canadian healthcare 3.0Traversing the crossroads with patient engagement

December 2015 Edition

Paul Lepage

President, TELUS Health

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The third wave: digital health, disruptive innovation

Canada is poised to embark on its third wave of healthcare delivery. The first wave, at the turn of the 20th century, was focused on

addressing infectious disease. The second wave in the 50’s and 60’s was centred on establishing a system to deliver more effective

acute care. This is the foundation of our current healthcare system; one that is now overburdened by the demands of today’s larger

and aging population. The third wave – Canadian healthcare 3.0 – is fuelled by technology, focused on patient engagement and

harnesses digital information to involve people in managing their own health and wellness.

Disruptive innovation in healthcare

Lifestyle Behaviors

Chronic Diseases

Over 50% of Deaths

low costlow tech

low access

high costhigh tech

low access

digital carelow costhigh tech

high access

Past Present Future

Physical inactivityPoor nutritionSmoking

DiabetesHeart diseaseLung diseaseCancer

Source: Goldman Sachs Global Investment Research

In Goldman Sachs’ 2015 analysis of the Internet of Things (IoT),

the firm notes that digital health is the disruptive innovation that

will lead to a future of lower cost, higher access care. This

means that technologies like remote patient monitoring and

telehealth that bridge digital and physical worlds to change

physician and patient behavior will define the future of primary

healthcare delivery. In addition, digital health tools and apps

are becoming paramount in supporting new, healthier and

preventative behaviors for citizens at large.

Goldman Sachs calculates potential savings in the US by

adopting IoT for remote patient monitoring, telehealth, and

behavior modification to be approximately US$305 billion,

two-thirds of which come from improvements to chronic

disease managementi.

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What engaging patients (aka ‘people’) looks like

Engaging patients and citizens is at the heart of digital health

and is fast becoming an integral component in designing

this brave new world – not only in Canada, but around

the world. However, there is no single model for patient

engagement. Rather, the idea reaches across a spectrum of

care: from disease management for those living with chronic

conditions, all the way to wellness and prevention to help

anyone lead an active and healthy lifestyle.

Disease management and prevention each targets a different

segment of Canadian health consumers. Each employs

different tools and technologies. However, both agendas

are aimed squarely at equipping Canadians themselves

to proactively participate in making our health system

more sustainable.

In a recent poll, KPMG found that 72% of global leaders believe

empowered patients create better value care. This has certainly

proven to be the case with chronic disease management in

Canada, as elsewhere. In Ontario for example, pilots show that

the use of telemedicine has reduced emergency room visits and

hospital visits by 50 percentii. Similarly in BC pilots, the use of

home health monitoring has decreased health system utilization

by 76% and resulted in cost savings associated with inpatient,

emergency and physician services.iii

But we’re not there yet. Eighty-nine percent of health leaders

globally believe their health systems are designed around

organizations’ – not patients’ – priorities and they are not very

satisfied they are meeting patients’ needs.iv

Patient engagement becomes more than a buzzword when

the people-factor is front and centre. This sentiment was

echoed by a KPMG-commissioned global survey of patient

representative and advocacy groups. To them, patient

engagement means “people engagement,” i.e:

Being seen as a person, not a condition or intervention site

Being an informed and empowered partner in care

Not feeling abandoned due to fragmented care

(especially after discharge)

This is an important reminder that patient engagement does

not mean technology engagement. Rather, technology is for

enhancing collaborative care between a patient and their health

providers; not transferring the onus of care to the patient alone.

Easing the high cost of chronic conditions

Chronic conditions come with a very high emotional cost to

individuals and their families and their crippling financial impact

to the health system is well known. Forty percent of Canada’s

overall population – and 80 percent of those over the age of

65 – live with chronic disease and caring for this population

accounts for close to half of our provincial budgets. As the aging

population increases from 16 percent today to 25 percent within

the next 15 years, the impact on health system sustainability

will be untenable.

Global research shows that patients who are less engaged cost

the health system from 8 to 21 percent more than those who are

engaged.v Furthermore, patients managing chronic conditions

do so for about 5,800 waking hours each year while typically

spending fewer than 10 hours with a healthcare professional.vi

Imagine the potential value that can be delivered when we

bolster patients’ ability to engage and collaborate with their

circle of care during those 5,800 hours. The technology exists,

the demand is there and the opportunity to impact system

sustainability is staggering.

Behavior is another key pillar. It plays a major role in deaths

associated with chronic disease. According to the Oxford Health

Alliance 3-4-50 initiative, three lifestyle behaviors lead to four

chronic conditions that account for over half of deaths worldwide.vii

Lifestyle Behaviors

Chronic Diseases

Over 50% of Deaths

low costlow tech

low access

high costhigh tech

low access

digital carelow costhigh tech

high access

Past Present Future

Physical inactivityPoor nutritionSmoking

DiabetesHeart diseaseLung diseaseCancer

Complications associated with chronic disease are largely due to addressable lifestyle behaviors.

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This is why prevention should be an important thrust in recasting

our health system. When we are able to support people in making

life-saving lifestyle changes, we will be able to ease the burden

of chronic disease on individuals and system sustainability.

Prevention mindset – the missing link

Prevention and individual accountability for maintaining healthy

behaviors is often overlooked in the conversation around health

system sustainability. This may be because prevention is not

associated with primary or acute clinical care. Or it may be

because, culturally-speaking, prevention is an individual versus

a systemic pursuit. Whatever the case, research suggests that

adopting healthy behaviors – proper nutrition, adequate sleep,

and regular exercise – are the primary levers that enable

individuals to re-set their health trajectory.

The prevention mindset is alive and well in other jurisdictions,

most notably the Nordic countries (Denmark, Finland,

Iceland, Norway and Sweden) that share well-developed public

health and illness prevention strategies that are connected

not only between national bodies and local municipalities but,

increasingly, between the public and private sectors, tooviii.

Taking this a step further, Sweden recently embarked on

implementing an electronic personal health record for its citizens.

The Swedish government’s goal is to contribute to improved

healthcare by providing a secure personal health record with

tools to increase engagement and empower people to take

greater control of their own health. Swedes can use the

interactive platform to gather their health information from multiple

parties and even connect wearable devices. Overall, the intent

is to support greater engagement by individuals in their own

personal health development.

Here at home, Alberta is set to launch a similar program,

making tracking tools and access to healthcare data available

to its citizens; a bold step toward facilitating wellness and

prevention for its population.

We can all learn from these examples as individual accountability

for maintaining healthy behaviors will become more and more

important as the nation works to improve its health system.

Innovating with courageous patience

Leadership guru, Warren Bennis, describes successful innovation

as requiring ‘courageous patience.’ And, as Canada traverses

the crossroads of health system sustainability and patient-

people-engagement, it will take the courageous patience of an

entire digital health ecosystem comprised of entrepreneurs and

established vendors alike to bring about a new standard of care.

After all, healthcare is a team sport and digital consumer

technology is driving expectations for the same level of service

in healthcare. With access to online banking and travel booking,

why not have access to lab results, medication information, a

record of visits with care providers and care plans?

Seventy six percent of Canadians say digital health can make

accessing health care services easier and more convenient.ix

More than 80 percent of Canadians would take advantage

of digital health solutions, if available, by viewing their own

information (laboratory tests, immunization records,

prescriptions and medication history) and accessing services

(making appointments, requesting prescription renewals,

seeking more information about their care).x

According to a new report published by MarketsandMarkets, it

seems the market is poised to deliver on these expectations.

The global forecast for mobile health solutions is anticipated to

reach US $59.15 billion by 2020. This includes:

Connected devices, such as blood pressure monitors,

glucose meters, pulse oximeters

Apps, including those for weight loss, women’s health,

Personal Health Record, and medication

Services, including remote monitoring, consultation,

and prevention

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i The Digital Revolution comes to US Healthcare, Goldman Sachs, July 2015ii Remarks to the Canadian Club of Toronto By Dr. Ed Brown, OTN CEO, November 6, 2014iii Impact of Home Health Monitoring on Clients with Heart Failure. Cheryl Beach, BSc(PT), MSc, PhD; Oluseyi Oyedele, BSc, MSc, PhD, MPH; Dion Bedard, BSc; Mark Lazurko, BSc(Pharm),

MBA, 2014iv KPMG Global Healthcare Conference 2014, pre-conference survey v Hibbard J H, Greene J, Overton V (2013) ‘Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”.’ Health Affairs, 32, no (2013): 216-22.

(Quoted in KPMG, ‘Creating new value with patients, carers and communities’)vi Department of Health, Research evidence on the effectiveness of self-care support (DH, 2007), as cited in In Search of the Perfect Health System, Britnell, 2015vii As aboveviii In Search of the Perfect Health System, Britnell, 2015ix Harris/Decima Annual Survey for Canada Health Infoway, March 2014x Ipsos Reid Omnibus Survey for Canada Health Infoway, May 2015

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Patients at the heart of care

In closing, it is important to underscore that

delivering patient-centred care has always been at

the heart of what healthcare providers do. What has

changed is the level of proactivity that patients and

individuals expect to have.

As Canada takes further strides to enable patients

to self-serve, this will not only address expectations;

it will take significant burden off of the health system

and promote a culture of prevention and individual

accountability at the same time.