The magazine for healthcare administrators and policy makers
Display to 28 February 2017
THE GREAT DIGIHEALTH LEAP WHAT YOU NEED TO KNOW ABOUT DIGITAL CHALLENGES AND ADVANCED HEALTHCARE IN ASIA
BATTLE OF THE HOSPITALSp8 TAIWAN PRESSURED BY GROWING SILVER POPULATIONp10
IS ASIA PACIFIC THE “HOME OFTHE ELDERLY”? p18
UpToDate® — Trusted Worldwide for Clinical Decisions at the Point of Care
Clinicians depend on UpToDate evidence-based clinical decision support for current and accurate treatment recommendations. • Clinicians’ Choice — more than 1.1 million clinicians in 180 countries view over 26 million UpToDate topics each month • Breadth and Depth — comphrehensive coverage of over 10,500 clinical topics in 24 medical specialties • Reliable Content Developers — peer-reviewed content authored and edited by a global staff of more than 6,300 renowned physicians Visit www.uptodate.com for more information.
When surveyed 98% of UpToDate users said they would recommend the program to a colleague*
When surveyed 96% of our users report that UpToDate improves the quality of care they provide* *
UpToDate Subscriber Survey, October 2016 (N=12,102)
Website: www.uptodate.com | Email: firstname.lastname@example.org | Tel: +65 6211-3906 | Fax: +65 6224-2555
FROM THE EDITOR Welcome to the eighth issue of Healthcare Asia! We are about to usher in a new year, and the industry challenges of 2016 will continue to plague Asian countries in 2017. We feature a comprehensive report on the region’s everageing society and how the industry must prepare to tackle issues that it will bring. Are the governments prepared for ballooning costs on elderly care?
Publisher & EDITOR-IN-CHIEF Tim Charlton PRODUCTION Editor Karen Lou Mesina GRAPHIC ARTIST Elizabeth Indoy
ADVERTISING CONTACT Rochelle Romero email@example.com Rizelle Rojo firstname.lastname@example.org
ADMINISTRATION Accounts Department email@example.com Advertising firstname.lastname@example.org Editorial email@example.com
SINGAPORE Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building Singapore 069533
We also feature the top 10 healthcare innovations of the year and how investors must strategise in the coming year. What innovations are most likely to help stakeholders achieve improved care, improved health, reduced spending, and healthcare transformation over the next 10 years? Find out in the featured report from Deloitte. We also give you a glimpse of what transpired in three of the most awaited healthcare events in the region: HIMSS 2016, Medical Fair Asia, and Medtech Forum 2016. As always, we wish you all the very best of health. Start flipping the pages and enjoy!
+65 3158 1386
HONG KONG Charlton Media Group 19/F, Yat Chau Building, 262 Des Voeux Road Central Hong Kong. +852 3972 7166 www.charltonmedia.com Printing Sun Rise Printing & Supplies Pte ltd 10 Admiralty Street #02-20 North Link Building, Singapore - 757695
Can we help? Editorial Enquiries If you have a story idea or just a press release please Email: firstname.lastname@example.org and our news editor will read it. For a personal message to the editor, put the word “Tim” in the subject line.
Healthcare Asia is also the media sponsor for the following events:
Media Partnerships Please Email: email@example.com and put “partnership” on the subject line and it will forward to the right person. Subscriptions Email: firstname.lastname@example.org Healthcare Asia is published by Charlton Media Group. All editorial is copyright and may not be reproduced without consent. Contributions are invited but copies of all work should be kept as Healthcare Asia can accept no responsibility for loss. We will however take the gains.
Distributed to all CxO, board levels, doctors, and healthcare professionals of major private/public hospitals and health ministries in ASEAN and Hong Kong.
HEALTHCARE ASIA 1
18 ANALYSIS Is Asia Pacific the “home of the elderly”?
COVERAGE 22 EVENT Asia’s healthcare industry
Pwc’s digital healthcare report The great digital healthcare leap: Digital health in emerging markets
FIRST 06 Investments in China alive and kicking 07 Attracting medical tourists
players zero in on patientcentred care
10 Taiwan pressured by growing silver population to upgrade elderly care
08 India’s clean bill of health
30 Collaboration is key to the future of medtech 32 Growing interest in SEA healthcare and medtech
HEALTHCARE INSIGHT 14 The top 10 global healthcare innovations
Published Tri-annually on the Second week of the Month by Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building Singapore 069533
2 HEALTHCARE ASIA
To access the stories online, visit the website
Be proactive, not reactive. Avigilon self-learning video analytics evaluates what is happening in real time and alerts security personnel so they can take immediate action – instead of just gathering evidence after-the-fact. The patented technology learns what is most important and keeps a constant watch, so you don’t have to.
INCREASED ALARM ACCURACY
Learn more at avigilon.com/Analytics © 2016, Avigilon Corporation. All rights reserved. ™ indicates a trademark of Avigilon Corporation.Photo is a dramatization, not actual Avigilon camera footage.
co-published corporate profile
ExtraHop takes a leap into Asia Pacific
Healthcare IT may lag behind other forms of information technology, but it’s debatably the most important form of IT there is.
Expanding aggressively into an area thirsty for effective healthcare analytics
ne of ExtraHop’s many strengths is its unique challenges. According to Thomas, approach to measuring clinical data healthcare IT has grown organically over a within a healthcare IT environment. period of time and in its own way. According to Eric Thomas, senior vice president of solutions architecture at ExtraHop Challenges for healthcare IT Networks, ExtraHop is agnostic to specific He says unlike traditional IT architectures vendors and technologies, which means for that are centrally planned with a group the languages that healthcare IT systems of architects designing a specific system, speak (HL7, Legacy TelNet Protocols), the healthcare IT is largely driven by doctors and analytics can patch everything together, medical professionals. “Because if it doesn’t monitor all of them in real time, and pull out work for doctors, it’s not going to be utilised in accurate clinical data. hospitals,” Thomas says. “Things like “TREATMENT IS ACTUALLY “So while these patient admissions, PROCEEDING ACCORDING systems grow discharges, transfers, organically, we’re TO PLAN WITH THE RIGHT able to bring looking at the way DOSAGES.” messages are fulfilled, them together and prescriptions and monitor are fulfilled specifically,” Thomas says. “If and measure them in a unified fashion – all a doctor prescribes some kind of schedule to bring some level of order and control to of treatment, we can verify that treatment a landscape that’s pretty wild in terms of is actually proceeding according to plan technology,” Thomas adds. with the right dosages, the right series of Doctors drive the technology, and they administrations over a period of time.” are generally satisfied once ExtraHop starts Anything speaking HL7, TelNet, web traffic, managing their healthcare IT environment. and other healthcare IT language, ExtraHop According to Thomas, it doesn’t take them can transform and analyse into usable clinical as long to log in to their virtual desktops and data. But healthcare IT isn’t without its own internal portals. Additionally, their interactions
4 HEALTHCARE ASIA
with electronic medical systems are smoother, Thomas says, ultimately helping deliver patient healthcare outcomes. The benefit is then passed directly to the patients. “The feedback we’re hearing is very positive, both from doctors and the technology professionals that support them,” Thomas says. Expansion into Asia Pacific A firm founded in the United States, ExtraHop has also recently expanded aggressively into the Asia Pacific region — a locale thirsty for effective healthcare analytics. Danny Smolders, VP for Asia Pacific at ExtraHop Networks, says the company kicked off its expansion into Asia about a year ago, with an office in Singapore. ExtraHop then expanded rapidly into Korea, Australia, and New Zealand. “That’s primarily the geographies where we feel that healthcare is at the level of sophistication that we require for our product to make sense in,” Smolders says. “We’re also seeing a lot of demands for this type of product in Southeast Asia. It’s fair to say that wherever we see a demand that is growing, and we’re seeing that in Thailand, and Indonesia – those are the areas we’re going to focus on in the future.”
co-published corporate profile
ExtraHop also solidified its presence in Asia as it participated in the annual HIMSS AsiaPac 16 in Bangkok, Thailand. New challenges Of course, a new region would entail different challenges and problems in terms of healthcare IT. According to Smolders, the region’s challenges arise from its diversity. “The way healthcare works in Singapore is very different from how it works in the Philippines, and it’s very different from how it works in Australia,” Smolders explains. “So understanding all of those, and how it works in those particular markets, is our first step and that’s what we’ve achieved so far.” One example of a big distinction, Smolders ExtraHop wins 2016 HIMSS AsiaPac Innovations Challenge Solidifying itself as an up and coming leader for healthcare IT, ExtraHop platform was named the winner of the 2016 HIMSS AsiaPac Innovations Challenge at the HIMSS AsiaPac16 in Bangkok, Thailand. The award gathers academics, researchers, vendors, healthcare providers, and other industry peers to nominate and award the most innovative technology solution in healthcare. “We like to think of ourselves as an innovative company, and to have that validated by the world’s foremost organisation in digital health transformation is fantastic,” says Eric Thomas, senior vice president of solutions architecture at ExtraHop Networks. Thomas says ExtraHop was given the award this for its work in real time clinical data understanding admissions, discharges and transfers, understanding real time monitoring of medical devices, and its ability to detect ransomware in the emerging field of information security in healthcare. “This is fantastic, we thank our judges as well as the HIMSS organisation for inviting us to participate, and very glad to have received this award,” Thomas adds. Meanwhile, Danny Smolders, vice president of sales Asia Pacific at ExtraHop also says the IT transformation occurring in healthcare is unprecedented. “No other industry has had to
recalls, is the difference in terms of patient health records. “The way they are being stored are different in the US than they are here. Also the adoption of those systems has been very different in some of the markets that we have in Southeast Asia,” Smolders says. He adds that Singapore and Australia are the nations ahead of the curve, and therefore, would generate the biggest traction for ExtraHop.
could be seen in imaging, Thomas explains. ExtraHop is the sole company capable of tracking every single type of imaging technology which is being utilised in hospitals. This ensures that radiology images are generated in real-time. “By focusing on technologies that are very specific to healthcare, and given that healthcare is such a large part of our business, not only are we staying ahead, but in most cases we are doing things that no other healthcare IT company is Standing out doing,” Thomas says. While the healthcare IT field is saturated, With these innovations, it’s hard to believe ExtraHop certainly stands out in the crowd. ExtraHop is just getting warmed up. “We’re According to Eric Thomas, one advantage a company that’s swinging for the fences,” of ExtraHop is Thomas says. “NOT ONLY ARE WE STAYING “We’re a its scalability in speed and growth stage AHEAD, BUT WE ARE feeds. “Our company DOING THINGS NO OTHER ability to cover in HEALTHCARE IT COMPANY IS founded next generation 2007, and we’ve DOING.” technologies, been growing hyperconverged technologies, and track the very rapidly ever since.” For ExtraHop, Asia direction that IT is moving,” Thomas says. Pac isn’t the end goal, it’s only the next venue “Even if healthcare IT is lagging behind other and it’s only the next venue and the next stage types of information technology, there are also of its evolution. “We’re looking to bringing a places where that technology leapfrogs.” lot of value to patient care within the Asia Pac An instance of leapfrogging technology region,” Thomas says.
Robust suites of analytics capabilities
integrate such a broad array of technologies in such a short time, under such intense regulatory scrutiny, and with lives on the line,” he says. “To be recognised by a group of respected healthcare professionals as a positive change-agent in this vertical is an honor. We look forward to continuing our work with customers and the healthcare industry on future innovations that keep IT organizations healthy and patients happy.” The award was presented through a judging panel of prestigious industry experts, with representatives from the entire Asia Pacific region. The panel awarded ExtraHop
for helping healthcare organisations gain control of their IT operations to ensure reliability and security of patient-critical applications and improve patient care. “The ExtraHop platform offers a robust suite of analytics capabilities to support healthcare delivery organisations, insurance providers, and others in the healthcare ecosystem,” a release by ExtraHop says. “Automatic discovery and mapping of all applications and infrastructure provide IT teams complete control of critical clinical systems to reduce service disruption and latency.” HEALTHCARE ASIA 5
FIRST the growth of specialised hospitals in 2014. “The upward trend was maintained in 2015. Over the year, a total of 27 deals involving general hospitals were recorded, with a value of CNY3.98b (US$596m). In contrast, the disclosed value for specialised hospitals fell sharply in 2015 compared to 2014,” notes Qian.
No to going gray
Singaporeans are scared to grow old, if NTUC Income and Lien Foundation’s survey is anything to go by. The survey reveals that four in five Singaporeans aged 30 to 75 worry about growing old. Three in four respondents are concerned about ‘ageing in place,’ or living in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. Those aged below 60 years old are the most concerned about ‘ageing in place’ (80% of those aged 30-44 years old, 81% of those aged 45-59 years old), compared to their older (75% of those aged 60-75 years old) counterparts. Almost four in five (78%) prefer to stay in their own home, independently or with their spouses during their silver years. This preference was the strongest amongst the seniors (84%) compared to their younger counterparts (73% of those aged 30-44 years old and 77% of those who are 45-59 years old). Where do they want to stay? Alternative living arrangements such as a retirement village or a senior’s apartment are the preferred choices for the younger set (30-44 years old) whilst those aged 60-75 years old opted for a senior’s apartment (66%) and nursing home (58%). Interestingly, whilst one in two respondents were willing to stay in a nursing home themselves, they were less prepared to send a family member to one. Nearly one in three were strongly against it. Amongst the respondents, two in ten have a relative staying (or stayed in the past) in either an elderly day care centre or a nursing home. The lack of time, space at home, expertise, and social support were key factors that respondents cited for the need of quality aged care services in Singapore.
6 HEALTHCARE ASIA
Public hospitals have become the investors’ darling
Investments in China alive and kicking
ith the robust M&A activities in China’s healthcare industry, it appears that the government is hitting the nail on the head with its healthcare reforms. Healthcare investments in China are very much alive and kicking, with the disclosed number of deals in hospitals increasing steadily from 2012 to 2015. PwC notes that domestic M&A deals are identified as the most active category, with a total of 122 domestic deals in hospitals representing 54.5% of the overall amount whilst the total value reached almost CNY13.79b (US$1.99b). “From 2012 to 2015, domestic M&A in hospitals were concentrated in regions where healthcare reforms were initiated, including Beijing, Jiangsu, and Guangdong. Deals in these four locations accounted for over 50% of the total number and approximately 70% of the combined value,” says PwC analyst Leon Qian. Investments are also pouring into core business areas such as hospitals and clinics, compared to traditional targets like medical examination centres and dental clinics. PwC’s data also show that the increase in investments in general hospitals by both size and volume outpaced
Investments are also pouring into core business areas such as hospitals and clinics.
Scarcity in targets Investors are attracted to specialised hospitals, especially dental, obstetric, and paediatric hospitals, as they are low-risk and profitable investments that can be easily replicated and enlarged, and can so often lead to more profit. However, PwC notes that with more capital flowing in, such targets had become scarce, which led to a dramatic drop in investments in 2015. Also in 2015, level II and III general hospitals became the main focus for investments in domestic hospitals as they yielded stable cash flows and tended to offer the most benefit for new funding. “Our most recent statistics show there has been a rise in the activity of investments in public hospitals, reflected in the total disclosed deal value reaching CNY0.84b (US$121m) in 2015. Investments in private hospitals had also seen a substantial increase in 2014, setting a record high for both the volume and value recorded. However, in 2015, the deal amount plunged to CNY3.94b (US$570m), largely due to fewer deals with specialised hospitals taking place,” adds Qian. But with the government further deepening healthcare reforms in the country and the new technologies transforming the industry, expect M&A activities to continue rising.
Deals in healthcare industry from 2012 to 2015
Source: Zero2IPO Research, Thomson Reuters, and PwC analysis
FIRST Competitively priced treatments
Source: BMI Research, Global Health and Travel
Thailand won’t stop in luring tourists for check ups
Attracting medical tourists
hen Bumrungrad International Hospital saw its Burmese medical tourists grabbing the biggest revenue share earned from international patients, analysts knew then that they were correct in their predictions. Thailand has been aggressive in exerting efforts to boost medical tourism, with the government launching health packages aimed at boosting medical tourist to total arrivals ratio to 9-11%. BMI pharmaceuticals & healthcare analyst Ang Wei Zheng says Thailand will not stop in competitively
Thailand will not stop in competitively pricing its medical treatments and keeping high quality services at low costs.
pricing its medical treatments and keeping high quality services at low costs. While it is clear that prices in Thailand are substantially cheaper than the US — for instance, a valve replacement in Thailand costs only 8% of the amount charged in the US its position in Southeast Asia is more nuanced. “For instance, whilst medical procedures in Thailand are generally priced lower than those in Singapore, the differential varies and is highly dependent on the treatment undertaken — as reflected in hip replacements, for which both
countries charge US$12,000 in 2013. In contrast, treatments in Malaysia are priced consistently lower than Thailand across the treatments surveyed,” Ang says. Looming threats He adds that the country is well placed to attract patients from the frontier markets of Myanmar, Laos, and Vietnam, which have underdeveloped systems. Thailand’s proximity from the Middle East has also allowed it to tap into markets in the Gulf Cooperation Council, accounting for 17.6% of total medical tourism revenue for Bumrungrad. However, he warns that beyond the stiff competition from Singapore and Malaysia, Thailand will also have to contend with the rise of new medical tourism hubs such as South Korea. Private healthcare providers expanding into emerging markets and government policies shaping patient incentives to travel abroad for treatment also pose threats.
The Chartist: The doctor is online now China is on its way to becoming a key telecare market as it widens its technological base. A survey of 10,000 doctors in China by BMI Research reveals that approximately 90% of doctors had medical-related applications installed on their mobile phones. The study found out that physicians spend over 13.7 hours per week online on work-related activities, with 97% subscribed to medical-related WeChat. “Specifically for the Internet-based healthcare market, local industry estimates reveal strong growth over the past few years, with the personal computer-based health services market having risen from a value of CNY4.2b (US$624m) in 2011 to CNY10.8b (US$1.6b) by 2015,” it notes.
Telecare to facilitate sector growth
Sources: China Daily, Analysis International, BMI
Mobile gains dominance in China
Sources: China internet network information center, BMI
HEALTHCARE ASIA 7
India’s clean bill of health
Battle of the hospitals
ndia may be home to 35% of the world’s poorest people, but it is also one of the fastest growing economies in the world. Healthcare spending in the country is expected to grow 16.1% per year, the strongest anticipated growth amongst Asia Pacific countries, according to Deloitte. “The government has set a target of raising public health expenditure — primarily allocated to infrastructure improvements — from its current equivalent of 1.2% of GDP to 2.5% of GDP within five years,” it adds. Although the Asia Pacific region is experiencing an economic slowdown, Deloitte reveals that the rollout of public healthcare programmes combined with increasing private wealth is expected to boost the region’s healthcare spending by an annual average of 6.6% in 20152019.
Purses too tight for healthcare?
remain stable at the equivalent of 4.1% of GDP in 2015-2019. This is below the average of 6.5% expected for the Asia and Australasia region, and is seen by many as inadequate.” Most people in India resort to outof-pocket healthcare spending because of low health insurance coverage in the country. “Successive governments have tightly controlled public health spending — of note, the national Low public spending government reduced its 2014-2015 Deloitte further notes that although healthcare budget and increased India’s healthcare sector is growing the state’s contributions for centrally rapidly — driven mainly by private sponsored schemes, including health.” players — public spending has Deloitte says healthcare organisations remained quite low and has resulted in India will need to innovate to to inadequate infrastructure and improve access, increase quality, and manpower in public health facilities, especially in rural areas. “India’s current simultaneously maximise resource utilisation to ensure growth. spending on healthcare is expected to
Imaging tech to curb rising chronic deaths in Asia ASIA
The World Health Organisation has tagged chronic diseases as the leading cause of mortality, resulting to 60% of deaths worldwide. This has led to a burgeoning demand for diagnostic imaging technology in some parts of the globe. Citing the Global Forecast to 2020, Calgary Scientific Inc. director of product management and healthcare Jonathan Draper says the use of diagnostic imaging is increasing across the globe, with the total market seen to reach US$45b by 2022. The diagnostic imaging market is segmented into X-ray imaging systems, computed tomography scanners, ultrasound, magnetic resonance imaging , and nuclear imaging systems. The study sees the Asia Pacific market having the highest annual growth rate of 7.2% from 2015 to 2020, boosted by the growing medical tourism.
8 HEALTHCARE ASIA
In highly competitive Singapore, private hospitals are contending not only with rivals but with the public sector as well. OCBC Investment Research says the public healthcare landscape in Singapore is undergoing a major facelift with the announced Healthcare Manpower Plan 2020 and the planned overhaul of the Singapore General Hospital Campus. Meanwhile, National Cancer Centre Singapore is investing around US$70m to provide a proton beam therapy system at its new building.
Rising demand for imaging tech
Assistance of diagnostic imaging
Public spending has remained quite low and has resulted to inadequate infrastructure and manpower.
Diversifying for growth OCBC analyst Jodie Foo describes the amount as something not every private player can easily part with for state-of-the-art technology, “hence offering an instance of the public sector’s competence versus the private sector.” She says, “As the sector transforms and strengthens in infrastructure and productivity, we expect to see providers leveraging on technology platforms at a faster pace, and potentially more public-private partnerships among healthcare providers could be set up as well. But this naturally also entails stronger competition for local patients amongst private providers.” Foo believes the private sector can be fragmented to varying extent depending on the specialty. “Amidst a competitive market, growth opportunities for healthcare service providers tend to converge to the following methods — hiring of additional specialists in related or new fields, M&A, and/or collaborations to enter new markets, or even leveraging on new equipment,” she explains. This is especially true for the smaller healthcare service providers.
Taiwan pressured by growing silver population to upgrade elderly care TAIWAN
hen Taiwan released a proposal for the expansion of the nation’s long-term care system, it was a clear sign that the government is serious in escalating efforts to increase the amount and quality of care available to its elderly and disabled population. The new ten-year “Long-term Care Plan 2.0,” which will come into effect in 2017, is an extension of the original plan that was approved by Taiwan’s Executive Yuan (the cabinet) in 2007. Lily Wong, partner at PwC, says the revised iteration is designed to focus more on the local level. According to the Ministry of Health and Welfare, the programme will require an initial funding of around US$640m (NT$20.8b) in 2017, compared with US$160m (NT$5.1b) in 2016 for the current long-term care programme. “The new DPP government had originally proposed to increase inheritance and gift taxes to cover increased expenditure from the programme, but the plan sparked
10 HEALTHCARE ASIA
controversy and so it has set aside the tax hikes for now,” clarifies Wong. Mounting pressure She says with people aged 65 and above representing roughly 12% of Taiwan’s total population in 2014, up from 10.7% in 2010, demographic ageing is increasing pressure on government spending. “Given public budget constraints, we anticipate the planned expansion of Taiwan’s long-term care system will encourage and attract private investment in facilities and services to meet the needs of the growing elderly population,” notes Wong. She explains that four additional recipient eligibility categories will be added to better provide coverage to those in need, namely disabled persons under the age of 49, people with mild dementia over 50, disabled indigenous residents over 55 who live in lowlying areas, and infirm seniors over 65. “The new categories will increase the number of potential beneficiaries from about 511,000 to 738,000.”
Gift taxes are being rolled out
The government will begin establishing neighbourhood long-term care stations around Taiwan to ensure the well-being of elderly and disabled residents, with the eventual goal of setting up 2,529 such stations within four years. “There are already around 2,000 of such localised longterm stations, offering non-critical health services such as home-delivered meals and temporary care,” she says.
CO-PUBLISHED CORPORATE PROFILE
Wolters Kluwer delivers precision healthcare for better decision-making At the tap of a finger, clinicians can access the most current clinical content and evidence-based recommendations to improve patient care.
Anytime/anywhere access to clinical decision support
that clinical effectiveness is simply the rom hand-held computers to realapplication of the best knowledge time patient data, technology has available from clinical research and been remarkably transforming experience and patient preferences in the healthcare landscape around the improving the quality of care. According globe. Devices are now becoming more to her, clinicians must be able to use what integrated, making it easier for nurses is known to be effective in the research and doctors to communicate with each setting and apply that into practice. other and access important information within a centralised system. Improving outcomes Wolters Kluwer further redefines With UpToDate, clinicians can have healthcare with fresh and innovative access to Wolters Kluwer’s comprehensive solutions aimed at helping clinicians clinical content make the that highlights best possible “What’s happening decisions for their between what we know the importance of clinical patients. The to what’s happening decision support firm’s UpToDate in clinical practice? in providing Clinical Decision IS THERE A GAP IN THE the best care Support (CDS) possible. Dr System includes KNOWLEDGE OF THE evidence-based HEALTHCARE PROVIDER?” Basow says that in the case clinical topics of atrial fibrillation, clinical research and recommendations, a mobile app, concludes that a blood thinner results in a patient education, graphics search, drug much lower risk of stroke and blood clot interactions, and medical calculators. problems. However, in reality, about 30% Over the years, this platform has helped clinicians improve clinical effectiveness at of patients do not receive these needed medications due to the gap between the point-of-care. research and practice. Dr Denise Basow, MD, President “What’s happening from what we and Chief Executive Officer, Clinical know to what’s happening in clinical Effectiveness, Wolters Kluwer, says
12 HEALTHCARE ASIA
practice? Some of that can be the knowledge of the healthcare provider. Do they actually understand which patients need blood thinners and prescribe them? Do they know which blood thinner to prescribe? Do the patients understand how important it is that they take these medications and take them regularly? Do they know once they take the medication that they need to have follow up blood tests? A lot of things can go wrong when we go from the research to the clinical setting. What clinical effectiveness is all about is trying to develop a process that helps to put the knowledge in the hands of the right people so we can be more effective in care,” Dr Basow adds. Unmatched reputation Wolters Kluwer has gained a prominent reputation in the area of clinical effectiveness, viewing it as their primary job to help, clinicians, and healthcare systems to make the best care decisions. The firm continuously updates the clinical decision support system to include the latest research in over 24 specialties. It features Practice Changing UpDates, a section which highlights selected specific new recommendations and/or updates that may change usual clinical practice.
CO-PUBLISHED CORPORATE PROFILE
decision support, alerts, clinical rules being put into place and that most certainly is an ideal scenario for the application of clinical decision support. Sometimes people dismiss these tools, saying ‘Oh we don’t have the technology, we don’t have the resources’. And I think the point is that it can start very simply and move from there,” says Dr Basow. Bringing clinical effectiveness to Asia Improving clinical effectiveness in Asia Clinicians and hospitals around the means improving the awareness that globe are experiencing the impact of technology can revolutionise healthcare UpToDate in their day-to-day operations. by improving quality and cutting down With UpToDate Anywhere, clinicians on cost. Dr Basow says that is important can access the top-of-the-line research not only to have an awareness of the anywhere that they have an internet existence of these solutions, but also of connection. the benefits that they can provide amidst Wolters Kluwer’s international conventional wisdom. popularity is also due to the fact that In some ASEAN clinicians “Wolters Kluwer countries such can search as Indonesia and for the best can help healthcare information organizations make an Malaysia, Wolters in their own impact with some simple Kluwer helps hospitals by reaching language. first steps.” out to the top Wolters decision makers and allowing them Kluwer plans to expand in Asia further to see the impacts of having clinical in the coming years and hopes to tackle decision support in their institutions. the challenges that Asian countries face Despite the lack of discussion at the in providing healthcare to the rapidly government level in the countries, there growing region. Dr Basow says that in is a lot of room for hospital leadership to Asia, Wolters Kluwer can help healthcare play around with the latest tools that can organizations make an impact with some help them provide better care. simple first steps. “It’s up to local hospitals to implement In other parts of the world, hospitals these types of tools and we’ve seen some often begin with putting decision hospitals where there’s considerable support tools on clinicians’ mobile support for this at the highest levels of devices and then progress to other the hospital. And in those institutions stages of implementation for most where there is a lot of support for these effective care. “We can talk about very tools at the top of the hospital, we see sophisticated types of implementations very good success, so the clinicians will of decision support to improve clinical adopt it and apply it to patient care,” effectiveness, we can talk about HIMSS Basow says. Stage 7 hospitals, fully integrated healthcare practices. Dr Basow says that peer-reviewed literature on UpToDate reveals improved health outcomes such as shorter lengths of stay and reduced adverse events. One of the studies also showed reduced mortality rate when hospitals adopted UpToDate.
Denise S. Basow, MD
“We’ve been working in this area of clinical effectiveness, trying to improve care through clinical decision support for many many years. So we have a lot of experience with how clinicians use medical research and how best to deliver that information. And then we also have research on how that impacts healthcare,” Dr Basow says. For Wolters Kluwer, the measure of the effectiveness of their tools is when clinicians consult them at the point-ofcare. Basow shares that data analytics for UpToDate reveal that clinicians indeed use the solution heavily at the point-of-care, the primary use of which is to answer clinical questions that arise during the normal workflow of seeing patients. She adds that these clinicians have also seen major changes in their decision-making due to their use of UpToDate. “Somewhere between 18 and 37% of the time, when a physician consults UpToDate to answer a clinical question, it actually changes something that they are going to do. These aren’t trivial decisions. These are patient-critical decisions. Changing a diagnostic test, changing a medication, all the way down the chain of decision-making. Somewhere around a third of the time, clinicians are changing decisions when they get the right information at the right time in their hands,” adds Dr Basow. More importantly, as clinicians enhance their decision-making in the process of changing their initial recommendations, they are also moving towards improved outcomes and better
Moving towards improved outcomes
HEALTHCARE ASIA 13
Healthcare insight: top innovations
Pushing the frontiers of what’s possible
The top 10 global healthcare innovations What innovations are most likely to help stakeholders achieve improved care, improved health, reduced spending, and healthcare transformation over the next 10 years?
ealthcare is an industry in need of innovation. Health plans, providers, life sciences companies, and the government are facing rising costs and inconsistent outcomes. They are working to achieve the triple aim — improving care, improving health, and reducing spending. Our current healthcare system’s performance can be defined by its rules, policies, regulations, enabling technologies, operating models, customs, and patient and provider preferences; together, these elements comprise the frontier of what is possible. They also serve as the constraints to what can be achieved. For far too long the healthcare industry’s performance, despite attempts to spur progress, has remained at the edge of this frontier. The industry needs to break current constraints and expand the frontier to achieve true breakthrough performance. Whilst the constraints are many, the traditional, dominant, fee-for-service (FFS) payment model, in particular, does not align provider incentives with the goal of achieving more for less. The 10 innovations we describe in this report have the potential to break the constraints of the FFS-based healthcare system and expand the frontier through new business models that can deliver care in ways previously not thought possible. Early adopters of these innovations are likely to be those already experimenting with business model changes as a result of recent, transformational
14 HEALTHCARE ASIA
Stakeholders should also consider building pilots before investing in scale.
market shifts: value-based care (VBC), consumerism, and the proliferation of new data sources. Incentives for providers VBC creates incentives for providers to experiment with care management and patient engagement approaches that could improve health outcomes and reduce spending. Some stakeholders are recognising the importance of activating patients in their own care and are investing in capabilities to encourage this. Meanwhile, new data sources and tools are informing clinical trial design, treatment decisions, and ongoing patient care. Incorporating these top 10 innovations into business models will require changing how healthcare organisations currently prevent, diagnose, monitor, and treat disease. Leaders should determine which innovations break performance trade-offs, or create “more for less,” in a way that impacts their core business. Healthcare leaders should consider building ecosystems that embrace non-traditional players and sources of knowledge outside their own four walls. Stakeholders should also consider building pilots before investing in scale, learn to embrace change, and evaluate new revenue sources. And organisations should strive to be agile in anticipating and adjusting their strategies as innovations continue to evolve. Advances in genetic sequencing could lead to the development of diagnostic tests that may
Healthcare insight: top innovations identify at-risk populations where early interventions could save downstream healthcare costs. Next-generation sequencing (NGS) Diagnostic tests also may help clinicians target specific medicines to patients who are likely to respond well to them, reducing or eliminating the use of ineffective treatments. Rapid progress in genetic testing is expected to help accelerate scientists’ and clinicians’ understanding of genetic indicators for susceptibility to various diseases, and patients’ likely response to treatment. Researchers working on the Human Genome Project completed sequencing the first human genome in 2001, and it took 15 years and cost US$3b. Since then, advances in sequencing techniques have led to exponential increases in the data output for each sequencing run, from 84 kilobases of data to 1.8 terabases of data. Meanwhile, genome sequencing costs have dropped substantially; current NGS techniques can sequence 45 human genomes in a day for US$1,000. Genetic testing can have broad applications in population health screening and identification of at-risk populations where early intervention would be beneficial. Identifying sub-populations that might be more responsive to treatment could help get the right drug to the right patient at the right time. This, in turn, could reduce inefficiencies and generate more consistent responses for patients receiving treatment.
AM technology provides the ability for mass customization and reduces waste.
3D-printed devices Examples of 3D-printed medical technologies include 3D-printed prosthetics, skin for burn victims, organs, implants (dental and orthopedic), and casts. In some applications, 3D printing offers solutions where none existed; for example, airway splints for babies with tracheobronchomalacia (a rare condition where the tracheal or windpipe cartilage is soft). Other applications, such as 3D-printed prosthetics, offer more customised and lower-cost alternatives than the current standard of care. 3D printing also aids physicians with surgical planning — they can study exact replicas of patients’ organs before going into surgery. Additive manufacturing (AM) techniques are enabling 3D-printed medical devices to enter the market at a reasonable price point. AM technology provides the ability for mass customisation Decreasing genome sequencing costs
Source: National Human Genome Research Institute, “The cost of sequencing a human genome.”
and reduces waste. For example, the airway splints for babies with tracheobronchomalacia can be made in a matter of hours and cost about US$10 per unit. 15 AM works by adding materials layer by layer, rather than producing something and cutting away the excess. This approach could potentially disrupt traditional supply chains in two ways. First, AM requires less capital to achieve scale economies, reducing the minimum efficient scale — the point at which the average cost of each unit of production is minimised. Second, AM decreases the amount of capital needed to achieve scope economies, as its flexibility allows for the same equipment, materials, and processes to be used to produce multiple different products Immunotherapy Immunotherapy refers to classes of drugs that strengthen the body’s ability to generate an immune response. Immunotherapy could be useful in the treatment of cancer, allergies, inflammatory conditions, infectious diseases, and neurodegenerative diseases. Successful applications have been seen in oncology, where therapies can counteract how tumors suppress the immune system and instead help the immune system to effectively attack tumor cells. Researchers are particularly interested in two classes of therapies: checkpoint inhibitors including PD-1 and PDL-1 inhibitors, and adoptive t-cell therapy, including CAR-T. Checkpoint inhibitors: Checkpoints are molecules that help the immune system distinguish normal cells from foreign cells. Cancer cells may express some of these checkpoint molecules to prevent from being recognised and attacked. Checkpoint inhibitors target these checkpoint molecules and essentially turn them off, making the tumor cells more visible to the immune system. The FDA has approved three of these drugs. Adoptive T-cell therapies: Adoptive T-cell therapies involve removing the patient’s T-cells, changing them to better attack cancer cells, and re-injecting them into the patient. Chimeric antigen receptors (or CAR) are added to the T-cells (CAR-T) and injected into the patient, where they replicate and attack the cancer cells. Immunotherapies have already shown early signs of success. Checkpoint inhibitors are increasing progressionfree survival. Using CAR-T to treat blood malignancies has shown response rates as high as 70-90%. Further research is required to see if the technology will have similar success in treating solid tumors. Further progress for immunotherapy may depend on innovators’ ability to invest in additional research to understand what biologic molecules are responsible for triggering tumor susceptibility. Low participation in clinical trials and the need to study individualised responses make further research challenging; develop a scalable manufacturing process. The use of CAR-T is limited to specialised labs where clinicians are trained to handle risks and potentially life-threatening adverse reactions, and; demonstrate evidence of significant improvement over the standard of care, and long-term efficacy to gain reimbursement. Some immunotherapies HEALTHCARE ASIA 15
Healthcare insight: top innovations have shown efficacy in combination with other therapies, with high treatment costs reaching above $250,000.
cost VR systems for consumers (mainly for gaming) could mean increased access for patients in the near future. Currently, academic researchers are helping drive the use of VR in healthcare (with some private industry collaboration) in an attempt to demonstrate clinical effectiveness. VR-related research articles in the Pubmed database have increased over the last decade from 204 in 2004 to 720 in 2014. In the future, VR could be integrated with technology advances such as AI, sophisticated biosensors, and increased computing power. For the innovation to reach its full potential, innovators should: consider VR as an extension of digital strategy, applying new technologies to transform customer engagement and employee empowerment; and demonstrate clinical efficacy for specific conditions to encourage clinician and health plan adoption.
Artificial intelligence (AI) Within healthcare, AI includes clinical tasks such as diagnosing patients and spotting disease outbreaks earlier, accelerating the development of new drugs and devices, and streamlining administrative duties such as approving claims and rooting out fraud. Frost and Sullivan projects that 90% of US hospitals and insurance companies will implement AI systems by 2025. AI has the potential to improve the accuracy, precision, and timeliness of patient diagnoses, which could increase therapeutic success rates and decrease unnecessary medical interventions. Population health would improve with better understanding of behavior patterns that impact chronic disease outcomes. Streamlining administrative duties may improve operational efficiencies. Increased adoption of AI will likely depend on: innovatorsâ€™ ability to decrease cost and improve accuracy of technologies such as natural language processing, big data, and cognitive technologies, and; Healthcare professionalsâ€™ and patientsâ€™ acceptance and trust of AI tools. Point-of-care (POC) diagnostics Patients can use POC diagnostics in the physician office, ambulance, home, or hospital. Current widely available home POC tests include blood glucose, pregnancy, and HIV. Some medical device and diagnostic companies are developing POC tests for cancer, tuberculosis, and stroke markers, amongst others. POC diagnostics could aid in prevention, early diagnosis, and management of chronic conditions. Providing test results when patients are receiving care speeds diagnoses, increases care efficiencies and, potentially, decreases costs associated with delayed treatment. Analysts expect the market for POC diagnostics will total nearly US$3b in 2021, up from US$2.13b in 2015. Further adoption of POC diagnostics will likely require: innovators to improve POC diagnostic technology, through lower cost, less invasive, easy to use, and more accurate tests, and; Healthcare providers to participate in the transition to VBC, which creates opportunities for clinicians to indirectly receive reimbursement for the time and costs of administering these tests. Virtual reality (VR) VR creates multisensory experiences using computergenerated images that appear on a headset. In healthcare, virtual reality has been used to support clinician training via surgery simulation. Research has shown positive impacts from VR in treating alcohol addiction and in changing behaviours to improve wellness, such as weight management and smoking cessation. VR may also aid patients with depression. A 2015 proof-of-concept study on immersive VR demonstrated that it may help people be less critical and more compassionate towards themselves and, ultimately, may help reduce depression. Recent marketing of lower16 HEALTHCARE ASIA
Analysts expect the market for POC diagnostics will total nearly US$3b in 2021, up from US$2.13b in 2015.
Leveraging social media to improve patient experience Just as retailers are using customer data to promote specific products, the healthcare industry is evolving its ability to apply data mining and predictive analytics to help improve population health and the patient experience. Social media can be a rich source of healthcare information that could be valuable to patients, researchers, policymakers, and hospital administrators. Social networks and online communities could play an important role in consumer health management, serving as hubs where patients and caregivers can meet to ask questions, share information, and compare experiences with treatments and medications. The Deloitte Centre for Health Solutions 2015 Survey of US Healthcare Consumers found that 52% of consumers actively search online for health- or carerelated information. Patient-generated content on these digital platforms illustrates the needs, wants, motivations, behaviours, and decision considerations of patients and caregivers. This data can provide a valuable source of insights for providers and pharmaceutical companies seeking to understand how best to reach, engage, and support individuals across the patient journey. Social media also
Consumers actively search online for health-related information
Healthcare insight: top innovations Consumer interest in communicating electronically with doctors is high
Use of social media for health purposes by age cohort
Source: Deloitte Center for Health Solutions 2015 Survey of US Health Care Consumers
Source: Deloitte 2015 Survey of US Health Care Consumers
can be used to track consumers’ experiences with the healthcare system. Research has focussed on leveraging broad population data such as looking for certain terms on Twitter or other platforms, or using focussed disease communities to learn about patient preferences, symptoms, responses to treatment, and other quality-oflife measures. Several well-established surveys capture patient experience with the healthcare system, but it takes several months to publish results, and response rates are typically low.
centres, their impact may increase. According to the Deloitte Centre for Health Solutions 2015 Survey of US Healthcare Consumers, 77% of respondents choose retail clinics for their convenience, 72% for speed of securing an appointment, and 60% for after-hours care. Greater utilisation of these lower-cost care centres would likely require: state regulators’ expansion of the scope of services for non-physician providers, including pharmacists and nurse practitioners; health plan reimbursement for those services, either through traditional FFS or through VBC models in partnership with provider organisations; and retail clinic and urgent care center care coordination and demonstration of equivalent or superior care quality.
Biosensors and trackers Technology-enabled activity trackers, monitors, and sensors incorporated into clothing, accessories, and implantable medical devices are evolving to be able to monitor and sense an increasing number of health indicators. In addition to monitoring exercise, nutrition, and vital signs, these trackers and sensors could track changes inside a patient’s body — medication levels, blood/hormone/protein levels, and device performance. Patients are more likely to accept these devices as they become smaller and less intrusive. Some envision that wearables will shrink to the point where they “disappear” from consumers’ awareness. CCS Insights expects 411 million wearable devices ranging from eyewear to watches to jewelry to be sold in 2020. Increased biosensing could improve patient engagement, medication adherence, disease monitoring, and ultimately, health outcomes. The collected data could be used by clinicians to intervene earlier and more often, and by researchers to better understand treatment effectiveness. Convenient care: Retail clinics and urgent care Retail clinics and urgent care centers are generally lowercost sites of care that focus on a limited number of health issues. Pharmacies or health systems often own or partner to run a retail or urgent care clinic, and they are typically located within shopping centres or other public spaces. These alternative care sites offer extended hours, more locations, and shorter wait times. The use of physician assistants, nurse practitioners, and pharmacists, under the supervision of physicians, lowers costs. As retail clinics expand their services to include areas such as chronic care management, educational and behavioural counseling, care coordination, and infusion
According to the Deloitte Centre for Health Solutions 2015 Survey of US Healthcare Consumers, 77% of respondents choose retail clinics for their convenience.
Telehealth Telehealth is part of connected health (cHealth), technology-enabled integrated care delivery that allows for remote communication, diagnosis, treatment, and monitoring. Specifically, telehealth uses electronic information and telecommunications technologies to support long-distance clinical healthcare and patient and professional health-related education. Telehealth lets healthcare providers connect with patients and consulting practitioners across vast distances. It offers the ability for patients to have more frequent, convenient, and low-cost touchpoints with their physicians. In addition, telehealth may enable closer monitoring, earlier diagnosis and intervention, and better adherence, ultimately resulting in lower cost of care. For healthcare organisations looking to implement or expand telehealth, it is important to note that simply giving consumers more access to care doesn’t automatically translate to improved outcomes. But, organisations have shown that through a targetted approach, especially to certain high-risk populations who are covered under VBC models, telehealth programs can be cost-effective. The US Department of Veterans Affairs (VA) has been using telehealth to enhance veterans’ access to high-quality care for over a decade. VA has published some results of its home telehealth programmes for non-institutionalised care patients with chronic conditions, and the studies show that the programmes have resulted in sizable declines in several healthcare cost drivers (e.g., ER visits and admissions). From Deloitte’s “Top 10 healthcare innovations: Achieving more for less” HEALTHCARE ASIA 17
ANALYSIS: ageing asia
A silver society is awaiting Asia Pacific in the near future
Is Asia Pacific the “home of the elderly”? Driven by improving socio-economic conditions and increasing life expectancy, the speed at which societies in APAC are ageing poses an unprecedented challenge.
sia Pacific (APAC) is the fastest ageing region in the world with more than 200m people expected to move into the ranks of the elderly (aged 65 years and above) between now and 2030. This represents an increase of 71% in the number of elderly people, compared to increases of 55% in North America and 31% in Europe over the same period. For comparison, Singapore’s elderly population will rise from 11 to 20% in the next 15 years, whilst it took France 49 years to do the same. By 2030, Japan will become the world’s first “ultra-aged” nation, with the elderly accounting for more than 28% of the population, whilst Hong Kong, South Korea, and Taiwan will be considered “super-aged”, with more than 21%. Many APAC countries are moving from a period when they reaped a “demographic dividend” to one where they face the prospect of paying a “demographic tax”. Such a significant demographic shift will be accompanied by a host of financial and socio-economic risks affecting multiple stakeholders. Consequently, there is an urgent need to evaluate each country’s readiness to manage increasingly aged societies and to develop solutions that mitigate the associated risks. This report takes a deeper look into the impact of societal ageing on elderly healthcare costs in APAC. The APAC region as a whole faces a common challenge in societal ageing. However due to the
18 HEALTHCARE ASIA
There is an urgent need to evaluate each country’s readiness to manage increasingly aged societies and to develop solutions that mitigate the associated risks.
differences in demographics and epidemiological factors, and the level of healthcare and economic development, the nature and magnitude of the risks will vary. We define three broad groups within APAC, based on the extent of ageing and GDP per capita. As discussed in the full report, these three groups also show distinct patterns in the profile of healthcare cost drivers, infrastructure, and human capital. In turn, this allows the identification of key group-specific imperatives to manage the impact of societal ageing on elderly healthcare expenditure. Spiralling cost of elderly healthcare Societal ageing and the greater need for elderly healthcare poses significant risks to APAC countries for the following reasons. Elderly healthcare represents an immense financial burden and a risk to the fiscal health of countries. We estimate the cumulative elderly healthcare expenditure from 2015 to 2030 at over US$20t in APAC. Elderly healthcare expenditure is determined by multiple, interconnected supply- and demand-side cost drivers. We estimate that the cumulative elderly healthcare expenditure from 2015 to 2030 will reach US$20t, which represents approximately half of the region’s healthcare expenditure during that period. To put this into perspective, this amount is equivalent to the combined GDP of the 14 markets in 2015. The annual cost by 2030 is US$2.5t, five times the annual expenditure
ANALYSIS: ageing asia of US$500b in 2015, representing a compound annual growth rate (CAGR) of 7-21% across the respective markets. We believe these estimates are still conservative, as indirect costs (e.g., productivity loss by family carers) and capital costs (e.g., infrastructure construction) have not been included. The key driver in the growth of elderly healthcare expenditure is the medical cost trend, accounting for more than half of the incremental growth.
Governments may be forced to increase access to healthcare, while relying on a shrinking workforce.
Critical challenges As a result of the rising demand and cost of elderly healthcare, societal ageing poses three critical challenges that will significantly impact multiple stakeholders in the health ecosystem. The combination of increasing life expectancies, a sustained low-interest-rate environment, and growth in medical costs that exceeds growth in GDP present challenges to the following. First is the lack of government healthcare funds. Escalating elderly healthcare costs may force governments to reduce non-healthcare expenditure, increase taxation, expand borrowing and fiscal deficits, and/or shift the burden of financial support for the elderly more to the private sector and individuals. Second is the unviable medical insurance products for the elderly. The difficulty in accurately forecasting longevity risk and future medical costs results in premiums that are prohibitively expensive for most (if coverage is offered at all), who will also face steep increases in premiums as they grow older. Last is the inadequacy of personal retirement income. Elderly healthcare costs will place a strain on retirement savings due to the inadequacy of social security and pension systems, the decline in intra-family support, and the high out-of-pocket payments for healthcare in many APAC countries. This could force elderly individuals to choose between spending on health and other living expenses. Our analysis shows there is a significant gap in healthcare capacity in most APAC countries and that significant investment in both infrastructure and human capital will be required to meet future demand. Long-term care is of particular importance to an ageing population. Our projections show that APAC will face a deficit of 18.2m LTC workers, with China alone requiring 9.3m more professional caregivers, by 2030. The shortfall Ageing group in APAC according to elderly proportion and GDP per capita
Source: APRC analysis of data from Oxford Economics, World Bank, UN Population Division
in LTC workers is mirrored by a lack of LTC facilities. For example, we estimate that Japan and South Korea each require 100,000 or more LTC beds by 2030. In many developing countries, the poor “bankability” of healthcare infrastructure projects, due to the legal and financial uncertainty faced by foreign investors, results in an infrastructure gap. Whilst healthcare capacity building is normally a natural consequence of economic development, due to the speed of ageing in APAC, many young and developing countries may not have sufficient time to achieve a high level of economic development before the detrimental effect of societal ageing occurs. Governments may be forced to increase access to healthcare, whilst relying on a shrinking workforce (and reduced income tax revenue). This could lead to increased fiscal deficits, which may trigger a rise in government borrowing and the diversion of funds from areas that can fuel economic growth, such as education, infrastructure, and R&D. The increase in debt might also necessitate an increase in taxes and interest rates, which could place further downward pressure on economic growth. The above challenges highlight the need for radical changes to present public policy and business models of healthcare delivery and financing. However solutions to tackle these issues are complex and need time to evolve. Consequently, there is an urgent need for countries to prioritise these issues and start to implement reforms now. Many stakeholders, complex solutions The unsustainable increase of elderly healthcare costs highlights the urgent need for solutions. However the healthcare ecosystem is complex, with multiple stakeholders, who often have conflicting priorities. The elderly individual (patient) at the heart of the ecosystem bears a particular responsibility, since his/her physical and financial health ultimately drives the demand for healthcare services. Consequently, solutions that align the objectives of multiple stakeholders (e.g., value-based healthcare) will be the most successful in effecting change. Complexity in the healthcare ecosystem also extends across countries. Differences in the type and immediacy of ageingrelated challenges mean that each country will need customised solutions to address its unique set of issues and constraints. These differences in demographics, epidemiology, and economic development also present opportunities for arbitrage in the form of cross-border solutions, including healthcare tourism and the migration of workers from Asia and beyond, such as Africa where half of the global population growth will occur through to 2050. Taking into consideration the cost drivers and stakeholders of elderly healthcare, we have identified four aspects of the ecosystem that most urgently require improvements. In this report, instead of discussing “traditional” strategies to combat societal ageing and healthcare costs, we discuss several “green shoots” — innovative solutions and concepts that could be HEALTHCARE ASIA 19
ANALYSIS: ageing asia cultivated to improve the sustainability of healthcare provision for the elderly in APAC. The “Internet of Things” and use of Big Data analysis (e.g., through telematics, wearable technologies, and online behaviour tracking) have the potential to improve the measurement of risk. This could allow more accurate insurance pricing that reflects the individual’s risk and the distribution of healthcare costs during a person’s later years. Together with innovative approaches to structuring premium payments (e.g., front loading of premiums during working years), this may enable insurers to offer insurance at lower premiums. Equity reverse mortgages are challenging for insurers due to the longevity risk, interest rate risk, and asset price risk that they have to assume. As a consequence, their products may not be financially attractive for consumers. In addition, there are cultural and social barriers to selling of family assets, particularly in Asia. Accordingly, innovative products are needed to improve the take-up rate. For example, hybrid products combining reverse mortgages with life- and non-life insurance products, minimising the inherent risks, and providing an option for the asset to be retained by the borrower’s spouse (or heirs) at the termination of the loan period. Innovative digihealth tech The introduction of integrated value-based health delivery models enabled by digital health technologies (e.g., electronic health records and remote patient monitoring) have shown promising initial results in bending the cost curve through lower utilisation of services and better clinical outcomes. These are achieved by improving the coordination of the care process, including both the prevention and the management of health conditions. The development of innovative digital healthcare technologies, such as wearable health trackers, have the potential to improve patient outcomes through greater adherence to treatments and timely access to care. With rapid advancements in this technology, an ever larger set of disruptors in the healthcare ecosystem will transform the management of elderly healthcare. The current period of low interest rates presents opportunities for more affordably tapping international funds and well organised public-private partnerships. Consequently, it is imperative for governments in developing APAC countries to address the main obstacles impeding foreign investments, such as uncertainty in the legal and financial systems. This will mitigate the risks and uncertainty for private foreign investors, whilst upgrading and commoditising infrastructure investment as a viable alternative asset class. In addition, the continued growth of crowdfunding opens its potential use in healthcare infrastructure projects (e.g., a multi-purpose community centre was successfully crowdfunded through Spacehive.com). However the ability to scale up this approach to fund billion-dollar infrastructure projects will require further developments in regulation, technology, and financing 20 HEALTHCARE ASIA
options. Many APAC countries are transitting from a period when they reaped a “demographic dividend” to one when they are concerned about the prospect of paying a “demographic tax”. It’s clear that there is an urgent need to understand each country’s readiness to manage the increasingly aged societies and mitigate the associated risks. Many opportunities to capitalise on an ageing society depend on obtaining net positive economic contributions from elderly populations, or at least minimising the negative impacts. “Demographic dividend” Given the complex nature, there are many systemic risks associated with societal ageing that affect multiple stakeholders. Corporates need to consider whether there are potential business models that can benefit from both the growing elderly workforce and the growing demand for products marketted to the elderly. Governments need to manage labour market risks, and consider whether they need to incentivise citizens to work beyond standard retirement ages, or to encourage migrant workers. Furthermore, the adequacy of pensions (or retirement income more broadly) is a key consideration for governments, corporates, and individuals alike. Another key consideration is the need to maintain a level of healthcare for the elderly population. Current data shows that increased longevity correlates directly with an increased prevalence of non-communicable diseases (NCDs) such as cancer and diabetes, and greater care dependency. The higher funding required to satisfy this rising need for social support comes simultaneously as more people leave the workforce and stop contributing to the economy. This creates a positive feedback loop that amplifies the pressures on elderly healthcare management. The problem is exacerbated if traditional familial care is eroded, alongside with its financing sources. In a perfect world, elderly healthcare — in fact healthcare for everyone — would be available and affordable to all who required it. From Marsh & McLenann Companies’ “Advancing into the Golden Years: Cost of healthcare for Asia Pacific’s Elderly“ Elderly population by region in millions
Source: APRC analysis on data from Worldbank and UN Population Division
ISSUE NO. 7
ISSUE NO. 6
The magazine for healthcare administrators and policy makers
Display to 30 June 2016
The magazine for healthcare administrators and policy makers
HOW WILL THE AEC BOOST ASEAN HEALTHCARE?
Find out how healthcare proFessionals are dealing with inFormation asymmetry
Dr. LUk ChE-ChUNg CEO, QUEEN Mary hOSpItaL p16
HONG KONG REVAMPS ELDER CARE
taE yOU kIM, Dr. MINErva CaLIMag, ChaIrMaN, SNU CaNCEr prESIDENt, phILIppINE hOSpItaL p5 MEDICaL aSSOCIatION p18
CASE STUDY: PHILIPPINE HEART CENTER’S EXPANSION
philippine MediCal assoCiation spearheads healthCare data optiMisation p18
Display to 31 October 2016
Dr GooGle Healthcare Asia
Dr. Nila Moeloek, Indonesia’s minister of health, speaks about the progress of the country’s universal healthcare plan
INDONESIA’S DIFFICULT UHC PLAN
INSTITUT JANTUNG NEGARA’S
CHIEF EXECUTIVE OFFICER
sinGapore’s private hospitals ClaMour for Greater support p22 Case study: Gat andres BonifaCio MeMorial MediCal Centre’s free dialysis Centre p24 Malaysian hospitals find trouBle inteGratinG new teChnoloGyp10 teChnoloGyp10 trouBle inteGratinG new Malaysian hospitals find
Complete a survey, win an iPad Mini Complete a survey,
free dialysis Centre p24 MeMorial MediCal Centre’s Gat andres BonifaCio Case study:
ClaMour for Greater support p22 sinGapore’s private hospitals CHIEF EXECUTIVE OFFICER
data optiMisation p18 spearheads healthCare philippine MediCal assoCiation
INSTITUT JANTUNG NEGARA’S
CENTER’S EXPANSION PHILIPPINE HEART CASE STUDY: ELDER CARE HONG KONG REVAMPS
universal healthcare plan the progress of the country’s minister of health, speaks about Dr. Nila Moeloek, Indonesia’s
UHC PLAN DIFFICULT INDONESIA’S
hOSpItaL p16 CEO, QUEEN Mary Dr. LUk ChE-ChUNg
ASEAN HEALTHCARE? HOW WILL THE AEC BOOST
p18 hOSpItaL p5 MEDICaL aSSOCIatION ChaIrMaN, SNU CaNCEr prESIDENt, phILIppINE taE yOU kIM, Dr. MINErva CaLIMag,
Dr GooGle vs Dr Watson are dealing with inFormation asymmetry Find out how healthcare proFessionals
EXCLUSIVE The magazine for healthcare administrators and policy makers
The magazine for healthcare administrators and policy makers
Display to 30 June 2016
Display to 31 October 2016
7 .ON EUSSI
6 .ON EUSSI
+65 3158 1386
For inquiries, contact Julie Anne Nuñez
event coverage: HIMSS 2016
Big data and healthcare analytics will play a critical role
Asia’s healthcare industry players zero in on patient-centred care
Healthcare Information and Management Systems Society (HIMSS) Asia Pacific emphasised the sector’s need to re-engineer current healthcare models to combat chronic diseases.
he 2016 HIMSS AsiaPac16 Conference and Exhibition’s sessions emphasised patientcentred care. Healthcare Information and Management Systems Society (HIMSS) Asia Pacific recently welcomed over 1,500 delegates to its annual conference, which was convened this year under the theme Advancing Digital and PatientCentred Care. The main conference education program had four tracks: Creating SMART Hospitals, Applying Better Data for Better Health, Transforming Care Models, and Moving Closer to Your Patient. The first day of the event which discussed the tracks Moving Closer to Your Patient and Creating SMART Hospitals, began with a plenary session by Dr. Richard Milani, chief clinical transformation Officer at Ochsner Health System, where he emphasised the need to re-engineer 22 HEALTHCARE ASIA
Mobile health apps can play a big role in improving patient’s health.
current healthcare models to combat chronic disease. His presentation revealed that 62% of deaths in Southeast Asia are from chronic disease and mobile health apps can play a big role in improving patient’s health. A new delivery model suggested for chronic disease patients include frequent data points, social support, analytics engine, and specialised and integrated tools tailored for each patient including health apps, medication adjustment, diet planning and exercise regimes. Patient focus Under the Moving Closer to Your Patient track, Dr. Chong Yoke Sin, CEO, IHiS, delivered a presentation that showcased the story of Singapore as a Smart Nation. Her presentation noted that the Internet of Things is the leading trend in healthcare, — home as well as community —
with wireless sensor-based systems gathering patient medical data available for analytics, removing the limitations of human-entered data, and ultimately improving treatment. Big data and healthcare analytics will also play an increasingly critical role in eliminating risks and providing operations and decision support. Dr. Jonathan Schaffer, MD, Cleveland Clinic, presented on webbased portals for oncology patients. The buzzword social media came up in his session as a critical tool that patients use to communicate with family and friends, get support and reduce feelings of isolation and associated stresses. Thus by developing appropriate digital applications, it is possible to reduce stressors that can influence the care of cancer patients, and in turn improving and enhancing their quality of life. Another highlight
event coverage: HIMSS 2016 There is a growing cadre of clinicians who need to become leaders in clinical informatics and advance the path forward.
Healthcare is behind in technology use
of this track was the session by Dr. Sean Frederick, chief medical officer, Allscripts. He touched upon a topic close to every healthcare worker’s heart: moving back to the heart of healthcare and getting closer to the patient. His presentation poignantly pointed out that healthcare is behind the times in its use of technology. Strategic collaborations Rounding up the first day were discussions under the Creating SMART Hospitals track, which started with a panel discussion examining the strategic framework to creating SMART hospitals moderated by John Daniels, global vice president, HIMSS Analytics. Further, Ms. Renea Collins, clinical director eHealth from Metro South Health in Australia spoke on the strategic partnerships that led to improved adoption and safety during the clinical transformation implemented for Princess Alexandra Hospital (PAH). There was a need to transform because of increasing expectations from clinicians and community, need for continuous improvement, changing practice model, service complexity and so on. Mr. Eric Woo from ECRI Institute Asia Pacific shared in his presentation the top 10 healthcare IT hazards and provided risks, evidence, and solutions. Hazards included poor data integrity, poor usability, missing safeguards (leading factor in CDS events), mishandling of timed medication orders, and truncation of information on display. The last track speaker was Mr. Andy Tan, principal medical
informatics at JurongHealth Services, Singapore. He shared about pathways to improve care coordination. At Ng Teng Fong General Hospital (NTFGH), there were 348 pathways used over the last 12 months, out of which 203 were hip fracture pathways and 145 were heart failure pathways. The hospital created savings using the pathways and the pathways also showed promise in reducing patient length of stay. Using data effectively The second day conference began with Dr. William Hersh, professor and chair, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University’s presentation. Dr. Hersh talked about how advancing digital and patient-centred care requires competent clinicians and informatics professionals. He said that there is a growing cadre of clinicians who need to become leaders in clinical informatics and advance the path forward. He highlighted that in order to achieve and demonstrate competence, education and training is necessary for informatics professionals, clinicians, and even patients and consumers. He introduced the audience to the 10x10 program. This course provided an entry point for those who wished to further their studies or develop their careers in the biomedical and health informatics field. The course was called as such because when launched in 2005, the aim was to educate 10,000
healthcare and related professionals in biomedical and health informatics by 2010. The first of the second day’s tracks, Applying Better Data for Better Health, started with Mr. John Daniels, global vice president, Healthcare Advisory Services Group, HIMSS Analytics, USA. He talked about the formula to successful data analytics. Public-private ICT interoperability Another highlight was Mr. Bret Watson’s (Enterprise Architect, The Health Architects, Australia) presentation, focused on publicprivate ICT interoperability. He shared that due to the dispersed population and need to support all patients and multiple treatment pathways, Western Australia Health (WA Health) consumes a large proportion of the State’s operating budget. Thus, there is a strong drive to reduce the price per treatment and one avenue to do so is to create public-private partnerships with private hospital operators operating various hospitals, particularly in the metropolitan area. Dr. Dinesh Jain, vice president – Clinical Data Analytics from Max Healthcare Institute, India, presented on the Experience with Analyzing Health Data for Patient Care and Safety – Linking Risk with Action for Better Patient Outcome. Dr. Jain explained that while healthcare has data, it needs solutions. Solutions include analytic tools, comprehensive data warehousing and data marts, as well as clinical decision support systems. Under the fourth track, Transforming Care Models, Mr. Peter Morgan, senior consultant, Singapore and SEA Branch, Gevity Consulting, spoke out on the increasingly crucial role of information systems amidst public health crises. Dr. Stephen Chu, co-chair, HL7 Patient Care Workgroup and Principal Clinical Informacist then discussed about transforming care through care management, using standard care plan model and care coordination services. Currently, chronic condition management is facing multiple challenges resulting in poor outcomes. HEALTHCARE ASIA 23
ANALYSIS: DIGITAL HEALTHCARE
Digital health can dramatically improve an organisation’s productivity
The great digital healthcare leap: Digital health in emerging markets Today the health sector faces a daunting new digital challenge: unleashing the power of technology to fundamentally reinvent how care is delivered to consumers.
hether we like it or not, technology has become part of our lives. It has arguably helped us as individuals become more informed and more connected. The use of technology is embedded in the industries of banking, automotive, insurance, and retail. Today the health sector faces a daunting new digital challenge: unleashing the power of technology to fundamentally reinvent how care is delivered. On top of their existing technology needs and priorities, today’s healthcare providers need to address the digital requirements demanded by health policy or by consumers and other stakeholders. Digital health initiatives rely heavily on having the right information in the right place at the right time for use by the right clinician. To really use technology effectively in health, we need systems to interact with one another to provide the data required to make informed decisions about the delivery of care. Digital healthcare is not about the technologies, it’s about new ways of solving healthcare problems, creating unique experiences for patients, and accelerating healthcare providers’ growth. Over the longer term, digital healthcare will help system-wide operations and organisations to deliver more powerful healthcare. Yet these challenging financial times discourage all but 24 HEALTHCARE ASIA
Traditional digital healthcare models often come with high costs.
the most prudent, high-return investments. Advanced, enterprise-wide digital health solutions should head many emerging healthcare providers’ lists of must-have capabilities. However traditional digital healthcare models often come with high costs. Burgeoning healthcare demand Our experience is that digital health can dramatically improve an organisation’s productivity and, in turn, provide benefits in both patient outcomes and the bottom line. This means that if the costs of digital healthcare solutions can be made affordable, digital health could be an answer to the emerging markets’ challenge to achieve sustainable growth and leapfrog the developed nations to provide quality, affordable, universal, and patient-centric care. Healthcare demand in emerging markets is growing, driven by a number of factors such as a growing population as well as an ageing population. With the growing middle class and rising incomes, people are spending more on healthcare. Non-communicablediseases such as diabetes are no longer rich country diseases and their prevalence is increasing in emerging markets. In these countries most of the healthcare infrastructure is
ANALYSIS: DIGITAL HEALTHCARE concentrated in urban areas, whilst more than 50% of the population lives in rural areas. Emerging markets will account for 80% of the world’s elderly by 2050. Some emerging markets should expect a significant increase in the portion of their population aged 65+ between 2015 and 2050. Many emerging markets in the Asia Pacific region are yet to reach their peak population. More than two-thirds of total deaths globally occur due to non-communicable diseases (NCDs); emerging markets account for 75% of these deaths. Almost 200m of the world’s 370m people diagnosed with diabetes live in Asia. Sarah Butler, PwC Australia national healthcare leader, says, “There is a clear burning platform and opportunity to address the growing burden of healthcare costs and corresponding impact on economic productivity due to ill health (the impact of non-communicable diseases like cardiovascular, cancer, and diabetes is estimated at 4-6% of GDP across the APAC region). Solutions will require robust analysis and foresight, leadership, and multistakeholder public-private partnerships.” The healthcare gap Expenditure on healthcare is increasing exponentially in emerging markets. As incomes are rising and the middle class is growing in emerging markets, people are spending more on healthcare and demanding better healthcare services. With changing lifestyles and people living longer, there is a tectonic epidemiological shift from communicable to chronic disease such as diabetes, cardiovascular and cancer. Whilst developed economies Projected population growth (2015-2050)
Sources: PwC “The Digital Healthcare Leap”
Prevalence of diabetes as % of population
Sources: PwC | The Digital Healthcare Leap
also have their challenges with affordability of care, their fundamental infrastructure is in place, for the most part, and their population growth remains relatively steady. Improving healthcare access and quality is becoming a priority in emerging markets. However these countries have significant strain on their health systems. Digitisation of health services, if done in a different model, can help to improve the quality of and access to care whilst reducing costs. On the demand side, the patients/consumers in emerging markets are becoming more discerning around their own health, and customer experience has become a key motivator for providers. Healthcare providers that fail to adapt to this consumer shift will risk consumers turning elsewhere to have their health needs met. For example, in Indonesia, patients are increasingly travelling to neighbouring countries such as Malaysia and Thailand to access better healthcare services. Digitisation of health services, if done in a different model, can help to improve the quality of and access to care whilst reducing costs.
Healthcare in emerging markets On the supply side, the healthcare system in the emerging markets is characterised by underdeveloped infrastructure and faces an acute shortage of resources. Governments are looking to improve healthcare access and affordability. They are implementing universal healthcare coverage and increasing national budget allocated to healthcare to upgrade the existing facilities as well as to add new facilities. However considering the gap and what is needed to bridge it, the traditional model for growth would not be sustainable. For example, Indonesia is looking to expand its national insurance programme to all its citizens by 2019. In 2015, it allocated 5% of its national budget to healthcare. However it is already facing a funding gap and has an acute shortage of healthcare resources. It would need an additional ~900,000 hospital beds and ~700,000 physicians to provide healthcare services comparable to those available in OECD (Organisation for Economic Cooperation and Development) nations. To ensure the long-term sustainability of its national healthcare programme, Indonesia needs to look at innovative technology and disruptive business models. Vaughn Kauffman, PwC global healthcare new entrants leader, says, “Over the next decade, developing countries will need to spend billions on healthcare infrastructure and services. Advancements in technology must be considered with these investments. Where urgent needs prevail in emerging markets with limited access to healthcare, the learnings from costly Electronic Health Records (EHR) implementations in developed markets must be considered to determine a more affordable path forward. Similarly to how wireless solutions have allowed developing countries to leapfrog fixed line infrastructure investments for broadband access, emerging markets need to consider innovative EHR solutions that will allow them to leap towards improved healthcare that is more affordable.” Adoption of traditional EHR is still low in emerging markets. These markets mostly use paper-based solutions and outdated IT equipment. The traditional HEALTHCARE ASIA 25
ANALYSIS: DIGITAL HEALTHCARE EHR solutions have mostly been implemented in developed markets and represent a monumental change transformation which can be measured in decades, rather than months or years. There is a significant upfront cost required to purchase and install EHR as well as training costs and ongoing maintenance costs. The USA Congressional Budget Office (CBO) reported that, on average, EHR implementation costs for hospitals amount to approximately US$14,500 per bed with annual operating costs of US$2,700 per bed per year. For example, US-based healthcare provider Lifespan announced plans to implement Epic’s EHR in March 2013, and the health system went live in April 2015. The implementation is estimated to have cost US$100m. Innovative and cost-effective solutions Healthcare providers in emerging markets are unlikely to be in a position to afford such prohibitively expensive operating costs from major EHR vendors. However, the adoption of digital healthcare solutions including EHRs in emerging markets could change dramatically in the next few years. With the internet and smartphone penetration growing and the technology infrastructure moving to cloud-based services, this presents the opportunity to develop innovative and cost-effective solutions to deliver healthcare services. These new digital healthcare models involve rapid prototyping, design, and implementation which presents a great opportunity for emerging markets to leapfrog the developed markets. Also it will be easier to implement innovative solutions in emerging markets because of fewer sunk costs, given existing infrastructure and equipment, lower fixed costs from building overcapacity, weaker vested interests, and less divided public opinion than is typical in established markets. Do traditional digital health business models have a role in emerging markets? John Forsythe, PwC Australia, Southeast Asia, New Zealand digital healthcare leader, says, “Emerging markets will reset the delivery model for EMRs and EHRs in the next few years. The lack of legacy infrastructure can liberate health systems (both public and private) from the financially daunting capital
Emerging economies will leapfrog developed markets and adopt the new digital health model
Sources: PwC | The Digital Healthcare Leap
Emerging markets will reset the delivery model for EMRs and EHRs in the next few years.
Healthcare expenditure developed vs. emerging markets (%)
Sources: PwC | The Digital Healthcare Leap
26 HEALTHCARE ASIA
costs which have led to government-sponsored initiatives such as Meaningful Use in the United States. Cloud-based technology, mobile enablement, and fees for service models will lead to faster deployment and increased benefits for patients. Perhaps then the emerging markets will instead become the leaders, with the followers quickly shedding their ‘on premises’ technology.” Traditional digital health models Most developed countries have moved away from paperbased healthcare solutions and have adopted or are in the process of adopting “traditional” digital healthcare models. These traditional models require the purchase or lease of hardware and software as well as dedicated space to house servers/data centres. These systems are coded, siloed, fully customised and require highly skilled programmers and IT professionals to develop and manage solutions. The developed markets are now moving to a new digital health model with increasing adoption of cloud and mobilebased technology in the healthcare system. But integration and interoperability challenges of existing traditional models will make this progress slower. For example, in Singapore, the National Electronic Health Record (NEHR) system was rolled out in 2011. It allows patient healthcare records to be shared across the entire healthcare system. Currently, all community hospitals, community healthcare providers, and close to 40% of GP clinics have access to NEHR. The Singaporean government aims to get the remaining private players on board as well. It invested US$128m to develop Phase 1 of the NEHR, and is paying about US$15m each year in maintenance costs.Singapore is now transitioning to a new digital health model. It is looking to move health information to the cloud. Named as hCloud, the project will cost US$37m for the first ten years. However it will help to bring down the cost of running the Healthcare IT system. Future developments will also include the use of data analytics to support both decision making at the point of care and national planning for the Ministry of Health (MOH). Emerging economies are unlikely to adopt the traditional digital health models. There is a significant
ANALYSIS: DIGITAL HEALTHCARE gap in most of the parameters required for successful adoption of the traditional digital healthcare model, including affordability. Figure 5 compares emerging economies in Southeast Asia to Singapore on the ten parameters required to leverage information and communications technologies (ICTs) for social and economic impact. An emerging market such as Indonesia lags behind Singapore in terms of the political and business environment, infrastructure, affordability, skills, and stakeholder readiness required to adopt the traditional digital health model. New digital health models In emerging markets the new digital health model will play a pivotal role in overcoming many of the challenges impeding healthcare delivery. It will help improve healthcare access, affordability, quality, and safety. Emerging markets will leapfrog developed markets to move to the new digital health model. Emerging markets are increasingly digitising health information. Affordable EHR solutions are coming to market, such as cloud-based EHR or open-source EHR, which can help emerging markets digitise at a fraction of the cost and in a fraction of the time. The Philippines has implemented an open source electronic medical record system for government health facilities called CHITS (the Community Health Information Tracking system). CHITS is managed by the UP Manila – National Telehealth Centre. The program has been able to improve healthcare delivery in government health centres. Nurses and midwives who usually record health data on paper were trained to use the system to generate timely reports for the Department of Health national vertical health programs. Through the programmes implementation, delays in accessing health data were minimised, giving more time for health workers to give care to patients at the health centre. Many private sector providers in emerging markets have also opted for cloud-based solutions. There is strong support for healthcare cloud systems from both public and private hospitals in Malaysia and the Philippines. Mary Johnston Hospital in Manila, in the Philippines, implemented a cloud-based EHR solution called HarmoniMD. This solution is built from the ground up using the latest cloud technologies and helps Percentage of population in rural areas (2015)
Sources: PwC | The Digital Healthcare Leap
Digital adoption is still low in emerging markets
Sources: PwC | The Digital Healthcare Leap
leapfrog over legacy server-based applications. Similarly, the Philippines-based company Lifedata offers a webbased electronic medical records system. It has also signed an agreement with the Philippine Medical Association (PMA) for the “standardisation and computerisation of clinical practices in the Philippines.” Digitising the health information lays the foundation of the digital health model in emerging markets. For best outcomes, other healthcare innovations such as telemedicine, mHealth applications, and e-prescriptions will be built around the digitised health information.
In emerging markets the new digital health model will play a pivotal role in overcoming many of the challenges impeding healthcare delivery.
Making the transition to the new digital health model The new digital health model is focussed on four key elements — disruption, engagement, integration, and trust. Disruption refers to transforming businesses through innovative models that don’t exist in the market today. Engagement is enabling digital interactions between clients and customers in a more engaging and patient-centred way. Integration is providing seamless access to health information across systems and devices. Lastly, trust is ensuring secure information in a digital age to inspire trust in the providers by the customers. From digitisation to disruption New entrants are disrupting the traditional health model by offering digital healthcare services in new and unique ways. They are exploiting the cost-quality curve to deliver healthcare services in an alternative setting. The new care delivery models introduced by these new stakeholders will partially fill the healthcare gap. The new entrants are increasingly collaborating with healthcare providers and combining the use of EHRs and mHealth applications. There will be an increasing influx of wearable solutions in emerging markets that will support consumer and healthcare desire for monitoring and tracking to be integrated into daily life. With fewer sunk costs and regulatory hurdles, emerging markets will be able to transition quickly to these disruptive solutions. A small start-up founded in 2009 in Myanmar offers web-based and mobile application (app) solutions related HEALTHCARE ASIA 27
ANALYSIS: DIGITAL HEALTHCARE to healthcare. Its main solution is offered in conjunction with the leading telecom provider. The mobile application helps users schedule telemedicine consultation or appointments with doctors. Users can also order medicine and seek health-related information through the app. The app had a user base of around 7,000 in 2015, and the telecom partner has agreed to pre-load the app in 600,000 mobile phones in 2016 and 1m phones the year after. The startup is further seeking partnerships with hospitals to give the app to their patients. It has also developed a health information system aimed at helping healthcare providers to track patient data. It is also currently creating a human resource information system to help healthcare providers keep track of doctor entry and retirement. From physician-centric to patient-centric Consumers are demanding better quality and customer service through social, mobile analytics, and cloud technologies. With democratisation of data and increased usage of social media and mobile, patients will play a more active role in clinical decision making. The new digital model will focus on customer experience and understanding patients in their everyday lives. The solution will use customer relationship management technology to deliver patient-centric care. The digital solution will also act as a hub by sharing information across a broad community to provide support, coaching, recommendations, and other forms of assistance. It will enable patient involvement and the provision of ubiquitous and instant feedback in order to realise new behaviours and/or sustain desired performance.
Fundamental gaps in every aspect of Information Communication Technology
Sources: PwC | The Digital Healthcare Leap
The new digital healthcare model will transition towards an inherent capability.
From independent to integrated Consumers increasingly expect seamless management of their information across their healthcare providers. Currently, traditional healthcare models rely on disparate systems, multiple sources of truth, and silos of solutions that don’t support the provider. The new digital healthcare New digital health model is focused on four key elements – disruption, engagement, integration and trust
Sources: PwC | The Digital Healthcare Leap
28 HEALTHCARE ASIA
model will transition towards an inherent capability to ensure seamless information exchange across system(s) of record. Leading products must integrate data collected from disparate devices and apps into external health ecosystems. It should be integrated into existing activities and workflows of providers and patients to provide the support needed for new behaviours. As health data becomes more integrated and analytics and Big Data becomes more prevalent, healthcare providers will increasingly gain insight into real-time customer needs and pain points. Analytics will help in early diagnosis, better treatment, and improved clinical decision making. From security to trust Cybersecurity is a growing concern in healthcare, especially given recent disruptive ransomware incidents, and the increasing cost of breaches. Data breaches happen for both malicious and benign reasons, enabled by greater digital adoption. Health records are an attractive target for criminals due to the breadth and depth of their data, and healthcare organisations’ relatively low degree of focus on security issues. Ensuring secure information in a digital age to inspire trust in consumers by their providers is critical. Security in the traditional sense rested on a patient’s level of comfort about the protection of the privacy of health-related information and threats of cybersecurity breaches. In the new digital health model where measures have been established to ensure the security of this type of information, the patient’s focus has shifted to how to establish a trust-based relationship with their healthcare provider who may or may not be physically present. Healthcare providers and governments are rethinking strategies for avoiding these attacks. Employee education is a key tactic for avoiding attacks. The players are also looking at innovative solutions such as cloud-based initiatives, Big Data analytics, and advanced authentication to improve security and build trust. David Wijeratne, PwC growth markets centre leader, says, “The
ANALYSIS: DIGITAL HEALTHCARE benefits of digital healthcare can be felt beyond patients. By assisting the prevention of illness and supporting the provision of care through alternative locations such as clinics, fewer new doctors and nurses will need to be trained and fewer additional beds and hospitals created, which can help to reduce the overall financial healthcare burden on governments in emerging markets, enabling them to fund other key areas of the economy. A whole nation benefits from digital healthcare.” Benefits of moving to the new digital health model There are substantial potential benefits of digital healthcare solutions in addressing business challenges caused by the current systems and processes associated with paper medical records. The benefits are not unlike those that could be achieved in a developed market; however with a much lower cost base, and much broader diversity of solutions that cross the continuum of care, they could be significantly enhanced. It is well documented that 80% of large organisational change initiatives fail to achieve their intended objectives, particularly in technology-related programmes. Regardless of the quality of technology developed prior to rollout, implementations often encounter change resistance and can fail — primarily due to an inability to manage the people, process, and organisational issues effectively. Digital health initiatives offer the opportunity to have a fundamental impact on the business model of the implementing organisation. With the introduction of new ways of solving business problems, creating unique experiences for the customer, and engaging people through digital mechanisms, many tasks may also become automated or be eliminated, and result in new workflows to complement digital solutions. As a result, any company looking at digital healthcare needs to provide substantial support to the business in order to manage people through this change process. Attempting to implement a digital change in a healthcare environment requires the active involvement of clinical leaders and sponsors who are committed to the change process and can help lead the organisation through the change. These individuals or groups are sponsors and champions who play a key role in driving the change. Healthcare providers and administrators need to set strategies that harness technology for mutual interests and mutual gain as they build care delivery models with patients — not patient encounters — at their centre. The companies that will emerge as winners in this new marketplace will be those that can articulate how technology can add value, align incentives, strategically share and analyse data, and redeploy, extend, and expand their workforce to embrace digital enablers. The following elements are key: understanding which digital health technologies healthcare providers and consumers value should shape digital strategies; generating meaningful, actionable insights through analytics will focus investments and yield better, faster results; understanding what motivates both caregivers and consumers to adopt and continue to use digital
Emerging markets will account for 80% of the world’s elderly by 2050
Sources: PwC | The Digital Healthcare Leap
technology will be critical for sustainability, and; rethinking the workforce and informing workflows will fuel the digital health return on investment.
Healthcare providers and administrators need to set strategies that harness technology.
Conclusion After decades of slow progress, it’s time for healthcare to take the leap into the new digitally enabled healthcare era. The magnitude of the challenge facing the health sector is considerable. Its implications are far-reaching for all aspects of society and the economy. It is clear that the challenge of affordable and sustainable healthcare is common across both emerging and developed economies. Finding a sustainable solution to enable better healthcare delivery is no longer the responsibility of the public sector. There is a collective responsibility across both the public sector and private sector to redefine traditional healthcare business models to find new pathways to sustainability. Innovative companies are empowering healthcare customers with new solutions and forcing the entire industry to rethink the way it does business. With the patient/customer becoming more discerning around their own health, customer experience has become a key motivator for providers. Consumers are no longer passive patients, but have become more engaged and more discerning, wielding new tools and better information to compare providers. The near future will be marked by how well the industry responds to this consumer shift. Hospitals and healthcare providers that fail to adapt will risk declining revenues as consumers turn elsewhere to have their health needs met. The message is clear for healthcare delivery: digital is here and if as a provider you are not prepared, you may be left behind. Healthcare companies should look to how they will integrate and connect their existing systems with new digital technologies and merge the data locked inside them to generate meaningful, actionable insights for caregivers. In the new digital health era, digitally enabled care is no longer going to be a nice-to-have, but rather a fundamental business imperative. From PwC’s “The digital healthcare leap: Digital health in emerging markets” HEALTHCARE ASIA 29
event coverage: ASIA PACIFIC MEDTECH FORUM 2016 life as a teenager. I faced judgements and criticism from others who did not know the disease well,” she said. “My aim as a medical student and a future doctor is to bring awareness to this invisible disease as well as to prove to patients with type 1 diabetes that living a normal life is possible with balance.” After Jayabalan, the following led the discussion on Asia Pacific’s role on the global stage: Koji Nakao, corporate adviser and former chairman, Terumo Corporation; Gary Pruden, worldwide chairman of medical devices and executive vice president, Johnson & Johnson; and Anna Braun, president, Asia Pacific, B. Braun Medical Industries.
Medical advancements have helped extend life expectancies across the globe
Collaboration is key to the future of medtech
The preeminent gathering of medtech professionals highlighted the importance of cooperation and collaboration amongst industry players.
he Asia Pacific MedTech Forum, the leading gathering of medical technology professionals, government leaders, regulatory experts, healthcare practitioners, and researchers in Asia Pacific, was recently held in Singapore with the theme “Creating New Partnerships in Healthcare.” Hosted by the Asia Pacific Medical Technology Association (APACMed), the two-day conference explored how multi-stakeholder collaboration across the healthcare sector can address challenges in upgrading the region’s regulatory systems, accelerating the pace of medical education, and ensuring patient access to new lifesaving and life-changing innovations. Medical devices and diagnostics allow people to live longer, healthier, and more productive lives. “Over the past 30 years, medical advancements have helped extend life expectancies in both developed and developing countries across the globe. These innovations also yield savings across the healthcare system by replacing 30 HEALTHCARE ASIA
An overwhelming 5b people across the world lack access to surgery and anaesthesia care.
more expensive procedures, reducing hospital stays, and allowing people to return to work more quickly,” said Fredrik Nyberg, chief executive officer, APACMed. Sustainability through cooperation “Beyond innovation, meaningful and inclusive collaboration is key to creating sustainable partnerships. Although great progress has been made in global health over the last three decades, progress is not uniform. According to the Lancet Commission on Global Surgery 2030 Report, an overwhelming 5b people across the world lack access to surgery and anaesthesia care,” Nyberg added. Twenty-six-year-old Yoshitaa Jayabalan, a diabetes patient and in her final year as a medical student in Malaysia, kicked off the Asia Pacific MedTech Forum’s numerous plenary sessions by talking about life with the disease. “Due to the lack of awareness on Type 1 diabetes, I was very much restricted from having a “normal”
Diverse gathering Other plenary and breakout sessions during the forum addressed topics around regulatory harmonisation and convergence, digital and mobile health, medical education, universal healthcare, and a series of patient testimonials. For instance, there was a breakout session entitled, “The Road to Regulatory Harmonisation & Convergence - Progress, Impact, and Next Steps.” It was moderated by Dr. John Lim, whose credentials include being deputy director of medical services (industry & research matters), Ministry of Health, Singapore; executive director, Centre of Regulatory Excellence, Duke-NUS Graduate Medical School, Singapore; and chairman, Singapore Clinical Research Institute. This session brought together representatives from regulatory authorities across the region who shared their perspectives on initiatives to promote greater regulatory harmonisation and convergence. The panel gave their assessments of what has been accomplished over the past 20 years by various regional groupings, and also spoke on issues that still need to be addressed and the way ahead to further promote harmonisation and convergence of regional medical device regulatory systems in the next five to ten years. Global insights and case studies were presented in concert with a focus on the needs, solutions, and ongoing work in Asia Pacific.
AWARDS 2017 For inquiries, contact Julie Anne NuĂąez +65 3158 1386 ext 221 email@example.com
event coverage: MEDICAL FAIR ASIA 2016 strongly represented. “The event has been extremely interesting and we have had some incredible meetings. The business matching service has been able to match us up with various organisations to have some discovery meetings about ways we can work together. At the same time, it has exposed us to a lot of the technology in Southeast Asia that we would not have been aware of otherwise,” noted Darryl Culley, president of Emergency Management Inc.
Visitor numbers increased to 12,000
Growing interest in SEA healthcare and medtech
A record-breaking number of attendees flocked to Medical Fair Asia 2016.
he 2016 edition of Medical Fair Asia, the region’s leading exhibition for the medical and healthcare sector, was a major success, packing its new and larger venue, the Sands Expo and Convention Centre in Singapore, with the highest ever number of exhibitors and visitors.This year’s exhibition was 30% larger than in 2014, and was entirely filled to host 830 international companies from 40 countries. Recent editions of Medical Fair Asia have seen growing exhibitor interest from North America and the Middle East, due to the attractive burgeoning growth in Southeast Asia. The co-location of Medical Fair Asia with Medical Manufacturing Asia, the region’s leading event for the manufacturing processes for the medtech sector, was another big draw as, between them, the two exhibitions provided the ideal platform for all those involved in the medical and healthcare sector. Attendees were delighted in the deluge of information that the event presented. It was a point highlighted in the 32 HEALTHCARE ASIA
Southeast Asia is an emerging market and one that everyone should target.
opening speech by Mr S. Iswaran, Singapore’s Minister for Trade and Industry. He stressed Singapore’s strong position as a gateway for medtech companies, both local and foreign, to access growing markets in the region. Record-breaking attendance Visitor numbers increased this year to a record-breaking attendance of 12,000, with 40% of visitors, hailing from countries such as India, Japan, South Korea, China, Hong Kong, Taiwan, and Australia. The organiser also facilitated, during the exhibition’s three days, a personal best of 1,100 pre-scheduled meetings via the synergistic business matching service with many formal business dealings coming to fruition during the exhibition. The exhibition featured international brand names such as Perry Baromedical, SwannMorton, and Hitachi, and national pavilions and country groups. Local companies like RAS Pharma and Yeap Medical Supplies were also
Additional players Honed as an international marketplace in the healthcare and medical sector, Medical Fair Asia 2016 was attended by returning national pavilions and country groups from North America, Europe, and Asia, whilst also welcoming two new first-time national pavilion participants, Turkey and Saudi Arabia. “Southeast Asia is an emerging market and one that everyone should target, which is why we have decided to participate at Medical Fair Asia. We have come here with high expectations and our experience has been entirely positive. This exhibition has been a gateway for our companies to enter these markets,” said Nasser M. Alrashed of Saudi Export Development Authority. Manager of RS Awal Bros, Batam Hospital, Dr Retno Kusumo has attended every edition since 2010 to see the latest products and to keep up with new technologies and innovation. She said, “The show has grown significantly over the last couple of years. This year we were especially looking forward to the new Saudi Arabia and Turkey pavilions. We typically attend Medical Fair Asia to procure medical consumables and devices and gain new perspectives and information, which we acquired.” Making their debut alongside the exhibition were a series of wellattended expert conferences and seminars, technical presentations and product demonstrations that represented a significant milestone for Medical Fair Asia 2016, which has a well-established history of over two decades.
MNL | BKK | SG MNL || BKK || SG MNL BKK MNL | BKK | SG SG Healthcare Asia Magazine is proud event to welcome you to the Healthcare Asia Magazine is proud for the healthcare arena. Healthcare Asia Magazine is proud Healthcare Asia Magazine is proud event to welcome you to the to welcome you to event the The Healthcare Asiafor Forum is happening to Aprilevent 2017. The trailblazing to welcome you to thefrom March the healthcare arena. event will gather over 200 healthcare leaders across Southeast Asia to discuss for the healthcare arena. for the healthcare arena. pertinent issues and what’s hot in the healthcare scene. The event will take place in Manila February Asia 16, Bangkok March 16, Singapore April 27. The trailblazing Theon Healthcare Forum is on happening from March toonApril 2017. The Healthcare Asia Forum is happening from March to April 2017. The . eventThe willHealthcare gather over healthcare leaders Asia to trailblazing discuss Asia200 Forum is happening fromacross MarchSoutheast to April 2017. The trailblazing event will gather over 200 healthcare leaders across Southeast Asia to discuss pertinent what’s in the healthcare event willAsia taketoplace in event will issues gatherand over 200 hot healthcare leaders scene. acrossThe Southeast discuss pertinent issues and what’s hot in the healthcare scene. The event will take place Manila onissues February Bangkok 16, Singapore Aprilwill 27.take place in pertinent and 16, what’s hot in on theMarch healthcare scene. Theon event in Manila on February 16, Bangkok on. March 16, Singapore on April 27. Manila on February 16, Bangkok on March 16, Singapore on April 27. . .
For speaking opportunities: If you are interested in participating either as a delegate or panelist, do contact our event organiser For speaking opportunities: Nikki at firstname.lastname@example.org
For speaking opportunities:
For sponsorship opportunities: If you are a vendor or partner to the healthcare industry and wish to sponsor/speak, please contact For sponsorship opportunities: Rochelle at email@example.com
For sponsorship opportunities:
For sponsorship For in speaking opportunities: If you are a vendoropportunities: or partner to the healthcare If you are interested participating either as a If you you are areand vendor orsponsor/speak, partner to to the the healthcare healthcare If you you arehttp://healthcareasiamagazine.com/event/2017-healthcare-asia-forum interested in participating participating either as as aa If aa vendor or partner If are interested in either industry wish to please contact To learndelegate more, visit or contact us at +65 3518 1386. or panelist, do contact our event organiser If you areand aatvendor orsponsor/speak, partner to the healthcare If you are interested in participating either as a industry and wish to sponsor/speak, please contact contact delegate orNikki panelist, do contact contact our event event organiser organiser industry wish to please delegate or panelist, do our Rochelle firstname.lastname@example.org at email@example.com industry to sponsor/speak, please contact delegate orNikki panelist, do contact our event organiser Rochelle and at wish firstname.lastname@example.org Nikki at email@example.com firstname.lastname@example.org Rochelle at email@example.com at
3-5 April 2017
Suntec Exhibition & Convention Centre, Singapore
ASIAâ€™S LARGEST MEETING FOR THE MEDICAL LABORATORY INDUSTRY WHY EXHIBIT? NETWORK with medical laboratory industry professionals to build productive business contacts. DISPLAY YOUR LATEST PRODUCTS to buyers, distributors, dealers and suppliers across the pan-Asia region GAIN COMPETITIVE-EDGE in an ever expanding medical laboratory market PUT YOUR BRAND IN THE SPOTLIGHT by exposing it to a targeted audience of laboratory professionals.
BOOK NOW firstname.lastname@example.org +971 (0) 4 336 5161 www.medlabasia.com