tokyo, japan, 4-5 february 2013 abu dhabi weqaya programme tackling ncds: application to low and...
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Tokyo, Japan, 4-5 February 2013
Abu Dhabi Weqaya Programme Tackling NCDs: Application to Low and Middle Income Health Markets
Reehan SheikhTechnology Strategist
Platform [email protected]
m
ITU Workshop on “E-health services in low-resource settings:
Requirements and ITU role”
(Tokyo, Japan, 4-5 February 2013)
Tokyo, Japan, 4-5 February 2013 2
Abu Dhabi has been ideal market for innovation in health data
2.1m lives: “Big enough to matter, small enough to manage…”2.1m lives: “Big enough to matter, small enough to manage…”
Highly strategic government with broad-based popular trustHighly strategic government with broad-based popular trust
Extreme pace and depth of socio-economic development – very high burden of NCDs
Extreme pace and depth of socio-economic development – very high burden of NCDs
Plural and diverse payers and providersPlural and diverse payers and providers
Relatively well-resourced health system enabling innovationRelatively well-resourced health system enabling innovation
Abu Dhabi’s greatest health challenge
Tokyo, Japan, 4-5 February 2013 3
Implementing the Dubai declarationGCC Council of Ministers
Addresses at least six of the eight objectives
# Objective Relevance
1 National pol icies , prevention and treatment Yes , di rect
2 Health awareness Yes , di rect
3 Promoting a heal thy l i festyle Yes , di rect
4 Women, pregnant women and chi ldren Pending
5Empowering patients and promoting dia logue with care providers
Yes , di rect
6 Stopping discrimination Indirect
7 Research and studies Yes , di rect
8Monitoring systems and monitoring health and economic burden
Yes , di rect
UAE: World’s 2nd highest prevalence
of diabetes
Modeling suggests rapid cost increase
Predicted costs of UAE National diabetes treatment, AED
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Direct healthcare cost
Societal cost
Delivering model at scale: Overview of Weqaya
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Interventions
Population•Standard clinical care•Nutrition (trans-fats, food labeling)•Physical activity (gyms, AD UPC)•Tobacco control
Group•Workplaces and schools•Local communities, families•Segments: Disease groups e.g. diabetics
Individual•Clinical care•Encourage: Weqaya reports•Enable: Website/call centre
Interventions
Population•Standard clinical care•Nutrition (trans-fats, food labeling)•Physical activity (gyms, AD UPC)•Tobacco control
Group•Workplaces and schools•Local communities, families•Segments: Disease groups e.g. diabetics
Individual•Clinical care•Encourage: Weqaya reports•Enable: Website/call centre
Population
Group
Individual
Approach
Screen Screen individuals iteratively97% adult Emiratis screened (>190,000)
Plan Clinical Standards, website/call centre
Act Clinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco)
Approach
Screen Screen individuals iteratively97% adult Emiratis screened (>190,000)
Plan Clinical Standards, website/call centre
Act Clinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco)
1
2
PLAN
SCREEN
ACT
An individual score and customized call to action
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Principles of data feedback
Patients should have access to their own health data:
- Personal Health Record (secure paper mail-out)
- Electronic Health Record (www.weqaya.ae)
- Smart Portable Health Record (Weqaya Data Architecture)
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Pay for Quality and Pay for Health
• Based on compliance with evidence-based care pathways and clinical quality indicators
• Mechanism set-out in Standard Contract (between Healthcare Facilities and Health Insurers)
• Expectation it will affect base payment by <10%• “Compliance with high quality care receives a bonus”
Pay for QualityPay for Quality
Pay for HealthPay for Health
• Based on individual health status • Health initially defined as 10-year risk of cardiovascular event (heart
attack or stroke)• Contract between individual and Disease Management Programme• AED1,000 per 1% reduction in risk to maximum of AED5,000 (5%)• “No health improvement – no money”
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In AD eHealth systems are a platform for health
Everyone can know their numbers…
2008 2009 2010
… and the numbers can change health outcomes
Control
Weqaya
% engaged with care*
% with HbA1c <7.5%
% with LDL:HDL ratio <3.5
Control
Weqaya
Control
Weqaya
Two domains of Weqaya action
Healthcare Sector• Clinical care standards• Patient empowerment• Customer-centred services• Research and Innovation
Health Guardians• Nutrition• Physical activity• Tobacco control• Alcohol control• Employers and schools• Urban Planning
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We set clear targets based on global evidence
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Type Objective Baseline 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2030
Input Screening 94% 50% 90% 100% 50% 90% 100% 50% 90% 100% 100% 100%
Programme engagement* 6% 30% 50% 60% 75% 75% 75% 75% 75% 75% 75% 75%
% obesity 35% 35% 36% 36% 35% 34% 33% 33% 32% 31% 28% 26%
% Weqaya population with pre-diabetes 26% 26% 26% 26% 26% 26% 25% 25% 25% 24% 24% 23%
% Weqaya population with diabetes 18% 19% 20% 20% 21% 21% 20% 19% 19% 18% 18% 15%
% diabetes with HbA1c <7% 15% 25% 40% 50% 60% 70% 75% 75% 75% 75% 75% 75%
% smoking 11% 12% 12% 11% 11% 10% 10% 9% 9% 9% 8% 6%
OutputReduction in predicted incident cardiovascular mortality
0% 1% 2% 5% 8% 12% 15% 18% 20% 24% 30% 80%
* Weqaya account activation and/or % eligible population engaged with DMP
Process
Target risk reductionTarget risk reduction
Annual Weqaya targets
Annual Weqaya targets
Screening: Adaptations for medium and low income countries
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$1
$2
$15
• Non-clinical staff• Train the trainer• SMS-based reporting
• Clinical/para-clinical staff• Train the trainer• SMS-based reporting
• Personal Health Record
Per person cost Adaptation
Data Exchange in low and medium income countries
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Data capture (mobile device)
•Unique identifier (patient, clinician, etc.)•(Simplified) diagnosis, treatment provided, outcome, etc.
Standardised data
•Kilobyte range (works with 2G mobile phone)
Data store
•Donors•Clinicians•Programme managers•Academia•WHO•UN – Development Goals (MDGs)
AA BB CC
Option to create “central health philanthropy bank” to administrate
Option to create “central health philanthropy bank” to administrate
Range of data systems enable secure ubiquity
Measuring healthMeasuring health
• Opt-out screening• Opt-in data sharing
Taking health promoting action
Taking health promoting action
• Ubiquitous Weqaya Programme
• Point of decision prompts (e.g. Weqaya label on healthy food)
• At home monitoring• Secure data
sharing
Standardized and Centralized Health Data
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Health & Wellness data can be capture in the field using basic mobile technologies
1
All Health & Wellness information is saved centrally for population and individual level analysis
2Healthcare workers can immediately access data captured in the field and begin a two-way dialog
3
In healthcare facilities, providers can get a full view of the patient
5
Personal health/wellness tracking and intervention can be tied to clinical information allowing a view into effectiveness of intervention and patient behaviour change
4
