Business Models for

eHealth: Results from an EU Project

Lorenzo Valeri (RAND Europe)

Patrick Jansen (Capgemini Consulting)

Daan Giesen (Capgemini Consulting)

Overview of the presentation

• eHealth: understanding business models for

going beyond financial issues

• Sizing the eHealth market

• Applying business models approaches to

eHealth

• Concluding remarks

e-healthcare business models: going

beyond financial issues

- Evolution of healthcare delivery-

• Financial sustainability

• eHealth systems for efficiency and

effectiveness of pre-existing

services

• Financial (and operational)

sustainability also via change

management

• Extended timings for the eHealth

system development

- Challenges for Business Modelling for eHealth

Socio-Economic

Trends

Health Specific Trends

Aging Funding complexities

Chronic Diseases Patients Mobility

Un-healthy behaviour Standardisation

Healthy and

independent lifestyle

Cultural differences

- Affecting Trends-

EU 27+2 – Total eHealth market 2008

& 2012

EU 27+2 – eHealth growth rates per

segment 2008-2012

Business models: Identifying the

interactions

Resources

PROFIT

CustomerOffer

Financial Performance

eHealth

Value

Proposition

Interactions

Change

management

Data collection

KEY

PARTNERS

KEY

ACTIVITIES

VALUE

PROPOSITION

RELATION PATIENT /

USER /

DOCTOR

SEGMENTS

CHANNELSKEY

RESOURCES

COST

STRUCTURE

REVENUE

STREAMS

What can partners do

to leverage your

business model (better,

at lower cost)?

What key activities do

you need to perform

and how easily can you

do this?

What key resources

does your business

model require?

Which of you clients’

problems do you solve

and which needs are

satisfied?

What kind of relations

does your

patient/user/doctor

expect and which kind

do you maintain?

Through which means

do your clients want to

be reached and which

means do you utilize?

What are your

patients’, users’,

doctors’ needs,

problems, desires, and

ambitions?

What is the cost structure of your business

model and is this in line with the core

values of the business model?

What value are your clients willing to pay

for and what is the preferred payment

mechanism?

Mapping eHealth Business Models

• Booking/cancellation/rescheduling and payment by patient of specialised visit or tests also via

pharmacies

• Integration with Umbria’s local radiology information system, laboratory information system and

hospital information system

• Direct link with Italy’s Ministry of Economic and Finance

• Multichannel access for patients to book/cancell/rescheduling of specialised test or visit

• Facilitation for rural areas

• Efficiency in the collection of payments for test (tickets)

• Financial incentives for the involvement of private pharmacies

• Client/Server solution via regional Intranet solution managed by Umbria’s in-house IT company

Webred

• Actors involved: 2 Regional Hospitals (Perugia/Terni), 4 local health authorities (Citta di Castello,

Perugia, Terni, Foligno) and 266 pharmacies (144 in rural areas, 122 in urban areas) and 487

specialist doctor or approved laboratories

• Potential users: over ca. 880.000 citizens, of which 140.000 foreigners (650.000 in the Province of

Perugia and 230.000 in the Province of Terni)

Solution

Environment

Main drivers to change Business Model

• Direct involvement of all actors in the development of the system

• Financial incentives for private pharmacies to link-up to the system

• Centralised IT infrastructure

• ITIL-aligned approach with IT support call centre (especially for private pharmacies) and for specific

operational issues (e.g. suspension of booking by a single laboratory/diagnostic centre due to long waiting

lists)

Key Success Factors Business Model

Centro Unico di Prenotazione-

Umbria

CUP: Changing the Business Model

CUP without pharmacies CUP with pharmacies

2 Regional

Hospitals

4 Local

Health

Authorities

Outpatient

Radiology

Departments

Outpatient

Laboratories

Hospital

Radiology/Laboratory

2 Regional

Hospitals

4 Local

Health

Authorities

Outpatient

Radiology

Departments

Outpatient

Laboratories

Hospital

Radiology/Laboratories

A144 Rural

Pharmacies

Citizen/Patient Citizen/Patient

1: Request of test/specialist by patient/citizens

2: Automatic check on availability and assign date/time for visit

3: Response back on availability/available time

4: Booking/rescheduling complete-Payment for visit by patients

A122 Urban

Pharmacies

Web-Red IT infrastructure Web-Red IT infrastructure

A15 GPs

4

1

3

2

3

1

2

4

CUP: Changing the Value Proposition

KEY

PARTNERS

KEY

ACTIVITIES

VALUE

PROPOSITION

CLIENT

RELATION

PATIENT /

USER /

DOCTOR

SEGMENTS

CHANNELS

KEY

RESOURCES

COST

STRUCTURE

REVENUE

STREAMS

Hospital wards

Diagnostic Tests

144 Rural Pharmacies

122 Urban Pharmacies

15 GPS

Web (TBD)

6 locations for

booking/payment/reschedule

/cancellation of

lab.test/specialised visit/ 281

locations

High quality service

Efficiency and

effectiveness

Multiple access points

especially for rural

areas

Customer

retention/additional

revenues for

pharmacies

Management of the

results of health

awareness campaigns.

Hospital structures

Local Healthcare

authorities

Pharmacies

GPs

Doctors

GPs

Patients

Pharmacies

Personnel

Direct cost (printing, etc…)

Education & Training for pharmacies

IT Call centre

IT system integration

IT support for pharmacies

Pharmacies:

2 EURO per booking

Better cash flow for pharmacies

Distant relation

Closer to needs of

patients

Diagnostic centres

Hospital/Local Health

Authorities

Patients

Pharmacies

Tactus: Serving Alcoholics online

• Tactus delivers care and treatment to addicts with alcohol, drugs, medicine, gambling, and eating

problems

• Especially alcoholic abuse has a stigma: people are ashamed; it is a taboo

• Tactus performs 5,500 units of care per year and the 2007 result was €1,605,000 (budget of €57

mio)

• 10% of all Alcoholics ever got help

• Research pointed out that preventive actions should indicate better results

• The behavioral change side of the treatment needs to be easily accessible

• Structured asynchronous Internet treatment program (Tactive) with a focus on cognitive

behavioral therapy through one-to-one counseling of a professional assistant:

• Two-sided treatment (diagnostics & behavioral change)

• Informative website

• Forum for online contact with fellow-sufferers

• Internet-based treatment (on a secured platform)

• Aftercare chat module

• Three executing organisations: Tactus, Mondriaan, and Symphora Group

Solution

Environment

Main drivers to change Business Model

• Research that underpins the benefits of the service, and gives opportunities to adjust

• Personal counseling relation between professional assistant and alcoholic is key

• Price from M&ICT of €650K

• No transportation needed, freedom in time and place

Key Success Factors Business Model

Tactus

Local, regional,

national

government

Healthcare

Insurer

Provide treatment &

care to clients

Professional

Assistants

Quality & Control; Subsidy

Knowledge

Orders & Leads; Money

Treatment

Feedback

Tactive

(Alchoholdebaas.nl)

Local, regional,

national

government

Healthcare

Insurer

Internet-based

treatment

Professional

Assistants

Tactus

ForumInformative

website

Aftercare chat

module

Source: Interview Hans Keizer, Tactive / Tactive Documentation

Tactive: Changing the Business Model

Alcoholic treatment before Alcoholic treatment after

KEY

PARTNERS

KEY

ACTIVITIES

VALUE

PROPOSITION

RELATION PATIENT /

USER /

DOCTOR

SEGMENTS

CHANNELSKEY

RESOURCES

COST

STRUCTURE

REVENUE

STREAMS

Local, regional and

national government

Tactus

TheFactor.e

Health insurer

Mondriaan

Symphora Group

Give care & treatment

Supervise assistants

Provide addict care

Develop internet-based

platform

680 Prof. assistants

20-25 Prof. assistants

Knowledge on diagnostics

& behavioral change

IT knowledge

Tactive online treatments

E.g. Alcoholdebaas.nl

Provide information,

fellow-sufferer contact,

treatment and aftercare

assistance

Roll-out to other areas:

Gambling

Drugs

Eating

Medicine

Need-oriented relationship

Personal & Anonymous

Patient has the control over

his/her own treatment

Front-end IT system

Professional assistants

Health insurer

People with addicts

Desired knowledge and

experience around

addictions

Other target groups:

Anonymous patients

Policyholders

Companies

Self-payers

Roll-out to other

countries

Personnel – Professional assistants

Education & Training

Coaching on digital treatment

IT application: development and

maintenance

Client fee: fixed fee + fee per hour for

delivered treatment/care

Franchise fee

Resell of application to other countries

Source: Interview Hans Keizer, Tactive / Tactive Documentation

Tactive: Changing the Value Proposition

Conclusions

• Mapping business model

• Long term commitment of senior management

• Not about new service but about news ways of delivering a specific

healthcare care specific service

• Financial commitment

• Stable financial support throughout project life line

• Final support for supporting staff commitment

• Patient’s needs

• Patients viewed as “clients” or “customers”

• Healthcare services aimed at providing more efficient services

• Open standards

• Explicit use of technical open standards to foster integration and follow-

up extension of functionalities

• Evaluation

• Senior management commitment to a-priori and ex-post evaluation of the

effects of IT-enhanced healthcare service

For more information

Prof. Jo Chataway

Director

RAND Europe

Westbrook Centre

Milton Road

CB4 1YG Cambridge

Tel:00441223353329

Email: chataway@rand.org