Business Modelling PanelPresentatie 19-3-2010 4. A business model Presentatie 19-3-2010 5...

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Business Modelling Panel

Lisette van Gemert-Pijnen (mod)

Maarten van Limburg

February 12, 2010

eTELEMED 2010, St Maarten

PANEL Digital Society Trends:Business modelling for design & implementation of HealthcareTechnology

Lisette van Gemert-Pijnen

University of Twente The Netherlands

Maarten van Limburg University of Twente The Netherlands

Liezl van Dyk Stellenbosch University South Africa

Marike Hettinga Windesheim The Netherlands

LambertNieuwenhuisHans C. Ossebaard

University of TwenteNational Institute forPublic Health and theEnvironment

The NetherlandsThe Netherlands

Panel procedures

Self-Introduction of panelists

Short propositions

Discussion-statements

Response from the audience

Response from the panel

Interaction between/among panel andaudience

Business models and eHealth (Maarten)

A Business model is ‘the rationale of how anorganization creates, delivers and capturesvalue’.

Going from ‘traditional healthcare services’ toeHealth services requires health organizations toreinvent themselves.

Business modelling facilitates that step!

19-3-2010Presentatie 4

A business model


Infrastructure CustomerValueProposition

Finances

Valueproposition

Customerrelationship

Distributionchannels

Targetcustomers

Partnernetwork

Valueconfiguration

Corecapabilities

Coststructure

Revenuemodel

Osterwalder, Pigneur (2004)

Business modelling is a collaborative process withclients as most relevant stakes (Lisette)

Different from business casus, models

Different from cost benefit analysis

Multi-perspective focus

Service (intangible) oriented

Clients as drivers

Co-creation of values

Consensus-driven

Formative evaluation

Examples business models other industries

3 successful, different business models:

Philips Senseo (co-creation)

Ryan Air (collaboration of stakeholders)

Apple (user-centered innovation)

And in eHealth ???

Statement #1 (Maarten)

The process of business modelling is just asimportant as the business model itself.

High # of stakeholders

Conflicting interests

Complex money flows


Feb 12, 2010Bart Nieuwenhuis - School of Management and Governance 9

Process is equally important as the numbers (Bart)

actor types─ insurance company

─ general practitioner

─ pharmacist

─ home care

─ physiotherapist

─ nursing houses

─ mental health care

─ hospital – specialists

─ hospital – logistics

─ insurer

─ network provider

─ clearing house

aspects─ prevention, diagnostics, therapy, quality, medication,

medical aid, personnel, reimbursement, payment

businessprocesses


Process to analyze impact of a new service

more/less work

more/less failures

more/less quality

…

…

actor

effectactoreffect

process

processeffect

process effectowner

processvolume

process effectvalue

actor effectvalue

period

Statement # 2 Upside down approach (Bart)

approach is important!

Business modelling in an early design phase

Calculation on costs in an early phase, upsidedown approach

Upsidedown

Early stage in a project

Stakeholders participate from start

Formative evaluation of alternative role divisions

(switch presentation)

Statement # 3 Emphasize organisational design(Marike)

Aap

not


Statement # 4 “it’s about economy, stupid” (Bart)

Costs health Care 1998 - 2005

€ 0 M

€ 5.000 M

€ 10.000 M

€ 15.000 M

€ 20.000 M

€ 25.000 M

€ 30.000 M

€ 35.000 M

€ 40.000 M

€ 45.000 M

1998 1999 2000 2001 2002 2003 2004 2005*

Verstrekkers ondersteunende diensten

Verstr. geestelijke gezondheidszorg

Tandartsenpraktijken

Specialistenpraktijken

Paramedische-/verloskundigenpraktijken

Overige verstrekkers gezondheidszorg

Leveranciers therapeutische midd.

Leveranciers geneesmiddelen

Huisartsenpraktijken

Gemeentelijke gezondheidsdiensten

Categorale ziekenhuizen

ARBO-diensten

Algemene ziekenhuizen

Academische ziekenhuizen


Size of population in nl in 2007

Source: Centraal Bureau voor de Statistiek, Voorburg/Heerlen 2007

Size of population in The Netherlands in 2007

K

50 K

100 K

150 K

200 K

250 K

300 K

0 10 20 30 40 50 60 70 80 90

Age

Nu

mb

er

2007


Size of population in nl in 2007 and 2020

Source: Centraal Bureau voor de Statistiek, Voorburg/Heerlen 2007

Size of population in The Netherlands in 2007 and 2020

K

50 K

100 K

150 K

200 K

250 K

300 K

0 10 20 30 40 50 60 70 80 90

Age

Nu

mb

er

2007 2020


Illness related costs/capita in nl - 2003

0

10.000

20.000

30.000

40.000

50.000

60.000

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95+

Niet toew ijsbaar / Niet ziekte gerelateerd

Ongevalsletsel en vergif tigingen

Onvelledig omschreven

Aandoeningen perinatale periode

Congenitale afw ijkingen

Bew egingsstelsel en bindw eefsel

Huid en subcutis

Zw angerschap, bevalling en kraambed

Urogenitaal systeem

Spijsverteringsstelsel

Ademhalingsw egen

Hartvaatstelsel

Zenuw stelsel en zintuigen

Psychische stoornissen

Bloed en bloedvormende organen

Endocriene, voedings en stofw . ziekten

Nieuw vormingen

Infectieziekten en parasitaire ziekten

Copyright RIVM, 2006. Slobbe LCJ, Kommer GJ, Smit JM, Groen J, Meerding WJ,Polder JJ. Kosten van Ziekten in Nederland 2003 (www.kostenvanziekten.nl)


Health costs during the last years of life

€ -

€ 5.000

€ 10.000

€ 15.000

€ 20.000

€ 25.000

€ 30.000

€ 35.000

€ 40.000

€ 45.000

€ 50.000

9-14 15-24 25-44 45-64 65-74 75-84 85+

x

x - 1

x - 2

x - 3

x - 4

x - 5

x - 6

x - 7

x - 8


PUBLIC AND MARKET SERVICESLabor productivity developments

Publieke prestaties in perspectief, SCP, Jan 2007, page 46

cost reduction due to re-use of medicalinformation

cost reduction due to decrease of medicationerrors

reduction of costs required for additional healthcare

cost reduction due to improved labour productivity

increased cost/benefit ratio due to increasedquality


Well-known effects of ict in health care

Statement #5 Patients complicate business modelling(Maarten en Marike)

Patients have a delicate role in healthcare

Patients are no real customers

Patients are not the deciding or payingstakeholder

Asymmetric relationships, heavily dependanton trust

‘What do patients want’ vs. ‘We know what’sbest’


Statement #6 Business modelling implies a holisticapproach (Maarten, Hans)

Collaborating health organizations

Collaborating with patients

Empowering patients

Iterative process stimulating reconsideration ofdeep-rooted assumptions


•Telemedicine is a multidisciplinary effort

(Switch presentation)

Statement # 7 Cooperation a multidisciplinary effort,but… (Liezl)

Statement #8 Business modeling is overlookedor poorly understood in health care (Maarten)

Existing business models are “simple sums”-models

Based on fuzzy assumptions

Skewed Critical Design Issues

Borrowed Business models


Thank youMerci beaucoup

Baaie dankieBedankt

Why to use Business Modeling forDesign and Implementation ofHealthcare Technology

Telemedicine:

A multidisciplinary effort

Liezl van Dyk(Stellenbosch University)•“Bedryfsingenieur”

•Operations Research (MathematicalModeling for Decision Making)•Systems/ Business/ EnterprizeEngineering

•2005-2008 – E-learning Advisor

•From 2009: Engineering Management

•Engineering Faculty Telemedicineproject

S

Business (Process) Modeling ≠ Business Model

Managementbusinessprocesses

Operationalprocesses

Supportingprocesses

Telemedicine:


Technology push Needs pull

Bottom-up

Top-down

Telemedicine:


Regional Systems of Innovation

External Influences

Knowledge generation and diffusion subsystemKnowledge generation and diffusion subsystem

Knowledge application and exploitation subsystem

Customer

Collaborators

Contractors

Competitors

IndustrialCompaniesIndustrial

Companies

Workforce mediatingorganizations

Workforce mediatingorganizations

EducationalorganizationsEducational

organizations

Technology mediatingorganizations

Technology mediatingorganizations

Public researchorganizations

Public researchorganizations

Knowledge, resource andcapital flows and interactions

Regional socio-economic and cultural setting

• Individual patient? Family of individual patient?• Doctor? / Nurse? / Doctor-in-training• Hospital (hospital group)? / Pharmacy? / Drug developer?• Government (public health)? Private Healthcare provider?• Medical School? / Medical Student? / Government?

Who isthe

customer?

Who isthe

customer?

Open Business Models as answer toeTELEMED initiatives?

Telemedicine:


“How to” Open Innovation

Telemedicine:


• Is Open Innovation and Open Business Modelsthe answer to getting things work in a multi-disciplinary environment?

• Is Web 2.0 an answer to the need for KnowledgeNetworks within context of eTELEMED?

Telemedicine:


Organisational design asrequirement for sustainableembedding of telemedicine

Panel contribution e-Telemed, February 12, 2010

Marike Hettinga, Timber Haaker, Sikke VisserWindesheim University of Applied Sciences, Zwolle, the Netherlands

& Novay, Enschede, the Netherlands

[email protected]

gap between project and practice is too deep:• too often: end-of-project equals end-of-telemed-innovation

• too late during project: anticipation on sustainable embedding ofinnovation in regular care practice

opportunity using business model method:• perspective switch: telemed-innovation as a service instead of a

solely technological innovation

• development of a viable business model for this service

Viable Telemedicine!

Business model

Servicese.g., Value proposition,Target group

Organisationse.g., Division roles,Network strategy

Technologye.g., Service deliverysystem

Financiale.g., Revenue model

Value forcustomers

Value forproviders

Creating successful ICT-services, practical guidelines based on the STOF method, Edward Faber en Henny de Vos (2008)See also: www.stofmethod.com

An example:

Organizational arrangements for aPersonalized Dementia Directory

(PDD)

in an early stage of the project:

- draw an inventory of all activitiesneeded to offer this service

- cluster these activities in roles

Advertisers Sponsors

UsersPDD-service

provider

Care or wellfareservice providers

Informationservice providers

General role modelfor PDD

Alternative organizationalarrangements

Commercialmodel

Govermentmodel

Insurermodel

Patientcommunity

model

Care providermodel

discuss alternative models withstakeholders

graphical presentation makes it concreteand serves as a vehicle for discussion

Think of your own telemedicineprojects…

How and when did you anticipate on theorganizational role division for thesustainable offering of the service?

Please share your best practices!

Business Modelling PanelPresentatie 19-3-2010 4. A business model Presentatie 19-3-2010 5...

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