Kick off Meeting

Technological Innovations and Drivers of the Future of Health CareBack to the FutureTCI-NHIP/HEU 10th Caribbean Conference on National Health Financing InitiativesTurks & Caicos Islands, 30 October 2015

1NON DISCLOSURE STATEMENTThe information in this document may not to be copied, stored in an electronic database, made publicly available in any way or form, either electronically, mechanically, by means of photocopying, recording or any other way without the prior written consent of ACSION and SZVFOR FURTHER INFORMATIONACSIONSZVAddressVan Engelenweg 21AWillemstadCuraao,Sparrow Road 4PhilipsburgSt. MaartenPhone+(599-9) 737-3595: +1-721-546-6782Websitewwwacsiongroup.comwww.szv.sxeMailJavier.asin@acsiongroup.com#2AgendaBack to the futureWhat do we expect from technologyWhat do we want technology to bring us?

State of the Art 2015Budget & Cost MonitorCosts per patientIntegral CaremHealth Apps

The bridge to the futureData warehousingClose the Knowing-Doing Gap

#Back to the FutureWhat do we want technology to bring us?

#Predictions Back to the Future got rightFlat Screen TVsWatching multiple channels simultaneouslyVideo conference technologyVideo games without handsBiometric identification3D and TV glassesHolographic displaysDronesSlamballBaseball team in MiamiCubs in World SeriesCameras everywhereAsian InvasionPlastic surgery maniaSelf-lacing shoes

#If I had to choose Lets change sad surprises

# for anticipated risks or loss

#Nice picture, but this is actually our picture at the moment

#AgendaBack to the futureWhat do we expect from technologyWhat do we want technology to bring us?

State of the Art 2015Budget & Cost MonitorCosts per patientIntegral CaremHealth Apps

The bridge to the futureData warehousingClose the Knowing-Doing Gap

#Budget & Cost Monitor

#Important information to manage our budget, but the patients at risk are not in view

#Support multidisciplinary cooperation and continuity of registration Link with the health insurer systems

Claims administrationGPPharmacyLaboratoryOther care providersSpecialist /HospitalReferralsReferralsLab forms and resultsElectronic prescribingElectronic claims#Reporting on the main care episodesExample: Uncomplicated hypertensie (K86)Prescribed medicationActivitiesmarfebjanDuration of the episode64% > 1 year50% > 2 years?Care contacts~6 times a yearMedian: 1 per 55 daysAverage: 1 per 65 days4 yr or more1 yrCum % of episodes / duration6 months0Interval of encounters%NdurationSource: international data on episodes in family practice, Transitieproject#13Managing costs per patient#14Average costs per patient

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Only 1/3 of the most expensive patients in 2014 (31.000 patients) were the most expensive in 2013 (10.000). Only 50% of the most expensive patients in 2014 are still alive in 2015. And they will not be the most expensive#We still have to identify the ones that need special attention

#Data warehousing and predictive modelingData sources:ClaimsEligibilityLab resultsDatacleanupData split:Two 12-month filesDiagnoses variablesPharmacy variablesAssign clinical groupsEvaluate complianceGenerate measuresAIEnginePredictionsTotal costsIP daysER visitsRx Costs#How does this work?Start with universal model

Optimize universal modelIdentify best clustersSelect best drivers for each clusterSelect best models for training each clusterCombine models and apply current data to predict future-year risk

Applied analytical techniquesSpline transformationsNearest neighborsFractional polynomial regressionNonlinear regression treesNeural netsLocal discriminant classifiersetcPredictions based on data 2013

Compare predictions with actual 2014Optimize model and predictions 2015

The more data sources on (health) behaviors, the more accurate predictions#

#Now we can anticipate risks or loss much better

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#AgendaBack to the futureWhat do we expect from technologyWhat do we want technology to bring us?

State of the Art 2015AdministrationRegistrationConnectivitymHealth Apps

The bridge to the futureData warehousingClose the knowing-doing gap

#National Health BudgetPopulationCare productsCare providersBalance between affordability of care and funding for exploitation of care practices and institutesBalance between care needs and quantity and quality of careBalance between what care providers are paid and the care products they deliverWe have to make sure that the health budget is well spentAnd is considered an investment rather than cost to societyCOSTS TO SOCIETYVALUE FORSOCIETYPOPULATION:WHY DO WEHAVE TO PAYTHAT MUCH?POPULATION:BURDEN AND COSTSOF DISEASE AVOIDED

PROVIDERS:WE NEED MORECAPACITY AND DESERVE MORECOMPENSATION FORTHE VALUE CREATEDPROVIDERS:WE NEED MORE MONEY24REGISTERMEASUREKNOWLEDGEMANAGEHISAISLISZISQuality systemRationalizePharmaceut.careCVRMCaredemandImprovefinancialperformanceClaims administration systemEpisode registrationDISAnnual reportsCensusRegistrationLevyHealth issues / DiagnosesCare activitiesCostsCare product definitionsValue basedReimbursement and tariff systemHIVOncologyMonitorcompliancemandatoryinsuranceCustomersatisfactionNationalHealthAccountsAnalyzenon-complianceBench-marksMorbidityHealth risksCare qualitySafetyCost-efficiencyImprove participationof companies and individualsPatientsatisfactionEnforceprimary careWorkforceplanningIntramuralCarepoliciesProfessional satisfactionQuality ofcareRegistration of membersLevy PremiumsTariff discusionsClaims administration

Target DeceasedTarget costs

Target The right#ChallengesPrivacy of patient and the doctorThis is already an issue, not caused by Automization and dataminingAs a matter of fact Automization can offer solutions to protect privacy

Technology, knowledge and skillsIt is available

CostsWe are already spending the money, it is a way of shifting it to the stages where you should spend it

Wllingness to change#Visualize risk profileScores from 1 to 10 for each relevant health problem

LIFESTYLEPSYCHOLOGICAL COMPLAINTSVASCULAR RISKCOPDDIABETES MELLITUS#27Make an individual care plan based on assessmentUnhealthylifestyleGeneralwellbeingDiabetesmellitusCardiovascularrisk-managementSmokingPhysical activityAlcoholNutritionDepressionStressParticipationObesityHypertensionDyslipidemiaNephropathyGlucoseRetinopathyNeuropathyFeetSc module 1Sc module 1Sc module 1Health issuesStepped-care modulesDisease specificDisease specificDisease specificDisease specificSc module 1Sc module 1Sc module 1Sc module 1Sc module 2Sc module 2Sc module 2Sc module 2Sc module 3Sc module 3Sc module 3Sc module 3Sc module 4Sc module 4Sc module 4Sc module 4Sc module 2Sc module 2Sc module 2Sc module 3Sc module 3Sc module 3Sc module 4Sc module 4Sc module 4Sc module 1Sc module 1Sc module 1Sc module 1Sc module 2Sc module 2Sc module 2Sc module 2Sc module 3Sc module 3Sc module 3Sc module 3Sc module 4Sc module 4Sc module 4Sc module 4Sc module 1Sc module 1Sc module 1Sc module 1Sc module 2Sc module 2Sc module 2Sc module 2Sc module 3Sc module 3Sc module 3Sc module 3Sc module 4Sc module 4Sc module 4Sc module 4#28Individual Care Plan based on chosen SCMs

Leef- en behandeldoelenRoken 2R2.A LeefstijladviezenR2.F FarmacotherapieR2.V VerwijzingR2.M Monitoring & ControleOvergewicht 3O3.A LeefstijladviezenO3.F FarmacotherapieO3.V VerwijzingO3.M Monitoring & ControleHypertensie 3H3.A LeefstijladviezenH3.F FarmacotherapieH3.V VerwijzingH3.M Monitoring & Controle#Grafiek1106868486648664427464641164111111646411

T0T1

Blad1T0T1Smoking106Overweight86Physical (in)activity84Nutrition86Alcohol64Stress86Depression64Anxiety42Somatisation74Cholesterol64Blood pressure64Nefropathy11Glucose64Diabetic foot11Neuropathy11Retinopathy11Pulmonary function / dyspnea64Exercise tolerance64COPD exacerbations11Als u de afmetingen van het gegevensbereik van de grafiek wilt wijzigen, versleept u de rechterbenedenhoek van het bereik.