The care model we have for healthcare today has changed very little in hundreds of years. Put simply, doctors and other providers are paid to treat a patient with a specific complaint or condition. If the treatment does not work, the patient returns for more treatment and the health provider is again reimbursed. And so on.
An unsustainable model
But there is a growing realisation that this pay-for-service model is not sustainable. In Singapore, like many other countries around the world, we have an ageing population that will inevitably place a heavier burden on the healthcare system and, of course, the funds required to support it. Focusing on treatment for those who become unwell has to be replaced by an approach that prioritises maintaining their health and preventing them – as much as possible - from becoming unwell. Focusing on educating people about healthy behaviour and empowering them with the right tools and resources could both reduce the strain on health systems and drive better overall health outcomes.
The outcome (good health) becomes the aim of healthcare. That’s easy to say. But putting it into practice runs into a number of significant challenges.
Incentivising prevention, not cure
First is the need to have a primary care physician who is responsible for an individual patient’s overall health and coordinates the activities and treatments for them. In a value-based health system, the outcome that this physician is aiming to achieve is an individual’s health and wellness. The problem with that? The financial incentives model that has traditionally guided healthcare activities is not built to focus on keeping patients well and needing less medical care.
The model, therefore, has to change. Today, that model is made up of three parts: payers (government and insurance companies), providers (doctors and hospitals) and citizens. Ensuring people remain as healthy as possible has obvious benefits for payers and for citizens too. But those providing care are not currently incentivised to achieve that goal. That needs to change so that prevention, wellness and health become their main focus too.
Targeting individual health
Few would argue with the dictum that prevention is better than cure. But while it seems obvious, it’s far less often seen in practice. The Health Promotion Board of Singapore is making strides to persuade citizens to become more active, for example by launching the National Steps Challenge, providing fitness tracker and encouraging citizens to walk 10,000 steps a day. Citizens are rewarded for achieving milestones as they build positive and healthy behaviours. The shortcoming of broad preventative programs is that they lack the personalisation that can target specific individuals or groups with the more precise programs that will achieve the greatest benefits for them.
Here’s where data and technologies such as AI and machine learning could come into their own. By combining health information with demographic and socio-economic data it should be possible to identify at-risk groups and target specific recommendations to them that will have the greatest impact on their health. For example, that could be those at risk of developing diabetes, or suffering from hypertension. The increasing sophistication of wearable sensors (used by 28% of Singaporeans) can provide data on a whole range of indicators. And by using these in combination with apps to generate specific and tailored nudges to change an individual’s behaviour, and specific teams able to contact individuals and give them advice directly, it’s possible to start helping them to adopt healthier lifestyles and driving behavioural changes.
Accenture research shows that while uptake of digital health technology is currently low in Singapore compared to other countries, there’s real scope for dramatic improvement. The key? Combining tech with the human touch. That means addressing people's misgivings about security and confidentiality (over 70% of people raise these as concerns) as well as helping them to integrate digital technology conveniently and cost-effectively into their everyday lives.
Personalised medicine- the next wave of wellness
When genomic data is added to this mix, the possibilities for preventative care become even more far-reaching, leading to a shift in care delivery from protocol-based to true personalization. More precisely targeted interventions based on known propensities mean people are healthier for longer. That has clear benefits to patients and to payers, too, who will see the costs for acute and chronic care decrease. And with Singapore now ramping up the collection of genomic data, it could provide a step-change for the nation’s health.
Combining Virtual with in-person care – the hospital of the future
Of course, even with a highly effective and appropriately incentivised preventative health program, people will still fall ill and require hospital treatment. But the experience of hospital treatment is also set to change. Advances in remote monitoring and the advent of 5G technology that can keep help keep people out of the hospital could also help them stay there for less time when they do have to have treatment. And people say that they are willing to use digital technology to interact with their medical providers for disease prevention or to treat and manage chronic conditions. The combination of virtual and in-person care could see the hospital of the future operate in a very different way from today, leading to a transition from hospital-centric to more patient-centric care. That’s a subject I will explore in greater depth in my next blog.
I’d love to hear your views on value-based healthcare. Please get in touch.
Disclaimer: This content is provided for general information purposes and is not intended to be used in place of consultation with our professional advisors.
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