How Much can eHealth Affect the Economic Growth. Valeri L. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Business Models for
eHealth:
Results from an EU Project
Lorenzo Valeri (RAND Europe)
Patrick Jansen (Capgemini Consulting)
Daan Giesen (Capgemini Consulting)

2. Overview of the presentation
• eHealth: understanding business models for
going beyond financial issues
• Sizing the eHealth market
• Applying business models approaches to
eHealth
• Concluding remarks

3. e-healthcare business models: going
beyond financial issues
- Evolution of healthcare delivery- - Challenges for Business Modelling for eHealth
• Financial sustainability
• eHealth systems for efficiency and
effectiveness of pre-existing
services
- Affecting Trends- • Financial (and operational)
Socio-Economic Health Specific Trends
sustainability also via change
Trends management
Aging Funding complexities
Chronic Diseases Patients Mobility • Extended timings for the eHealth
Un-healthy behaviour Standardisation
system development
Healthy and Cultural differences
independent lifestyle

4. EU 27+2 – Total eHealth market 2008
& 2012

5. EU 27+2 – eHealth growth rates per
segment 2008-2012

6. Business models: Identifying the
interactions
Resources Offer Customer
eHealth
Value
Proposition
Interactions
Change
management
Data collection
PROFIT
Financial Performance

7. Mapping eHealth Business Models
KEY KEY VALUE RELATION PATIENT /
PARTNERS ACTIVITIES PROPOSITION USER /
DOCTOR
What kind of relations SEGMENTS
What key activities do does your
you need to perform patient/user/doctor
and how easily can you expect and which kind
What can partners do do this? Which of you clients’ do you maintain? What are your
to leverage your problems do you solve patients’, users’,
business model (better, and which needs are doctors’ needs,
at lower cost)? KEY satisfied? CHANNELS problems, desires, and
RESOURCES ambitions?
What key resources Through which means
does your business do your clients want to
model require? be reached and which
means do you utilize?
COST REVENUE
STRUCTURE STREAMS
What is the cost structure of your business What value are your clients willing to pay
model and is this in line with the core for and what is the preferred payment
values of the business model? mechanism?

8. Centro Unico di Prenotazione-
Umbria
• Booking/cancellation/rescheduling and payment by patient of specialised visit or tests also via
pharmacies
Environment • Integration with Umbria’s local radiology information system, laboratory information system and
hospital information system
• Direct link with Italy’s Ministry of Economic and Finance
• Multichannel access for patients to book/cancell/rescheduling of specialised test or visit
Main drivers to change • Facilitation for rural areas
Business Model • Efficiency in the collection of payments for test (tickets)
• Financial incentives for the involvement of private pharmacies
• Client/Server solution via regional Intranet solution managed by Umbria’s in-house IT company
Webred
• Actors involved: 2 Regional Hospitals (Perugia/Terni), 4 local health authorities (Citta di Castello,
Solution Perugia, Terni, Foligno) and 266 pharmacies (144 in rural areas, 122 in urban areas) and 487
specialist doctor or approved laboratories
• Potential users: over ca. 880.000 citizens, of which 140.000 foreigners (650.000 in the Province of
Perugia and 230.000 in the Province of Terni)
• Direct involvement of all actors in the development of the system
• Financial incentives for private pharmacies to link-up to the system
Key Success Factors • Centralised IT infrastructure
Business Model • ITIL-aligned approach with IT support call centre (especially for private pharmacies) and for specific
operational issues (e.g. suspension of booking by a single laboratory/diagnostic centre due to long waiting
lists)

9. CUP: Changing the Business Model
CUP without pharmacies CUP with pharmacies
Outpatient Outpatient
Outpatient Hospital Outpatient Hospital
Radiology Radiology
Laboratories Radiology/Laboratory Laboratories Radiology/Laboratories
Departments Departments
3 3
Web-Red IT infrastructure Web-Red IT infrastructure
2 2
4 4
4 Local 4 Local
2 Regional 2 Regional A144 Rural A122 Urban
Health Health A15 GPs
Hospitals Hospitals Pharmacies Pharmacies
Authorities Authorities
1 1
Citizen/Patient Citizen/Patient
1: Request of test/specialist by patient/citizens
2: Automatic check on availability and assign date/time for visit
3: Response back on availability/available time
4: Booking/rescheduling complete-Payment for visit by patients

10. CUP: Changing the Value Proposition
KEY KEY VALUE CLIENT PATIENT /
PARTNERS ACTIVITIES PROPOSITION RELATION USER /
DOCTOR
6 locations for SEGMENTS
booking/payment/reschedule High quality service Distant relation
/cancellation of Efficiency and Closer to needs of
lab.test/specialised visit/ 281 effectiveness patients
locations Multiple access points
Hospital wards especially for rural Doctors
Diagnostic Tests areas GPs
144 Rural Pharmacies Customer Patients
122 Urban Pharmacies CHANNELS Pharmacies
retention/additional
15 GPS KEY revenues for
Web (TBD) RESOURCES pharmacies Hospital structures
Diagnostic centres Management of the Local Healthcare
Hospital/Local Health results of health authorities
Authorities awareness campaigns. Pharmacies
Patients GPs
Pharmacies
COST REVENUE
STRUCTURE STREAMS
Personnel
Direct cost (printing, etc…) Pharmacies:
Education & Training for pharmacies 2 EURO per booking
IT Call centre Better cash flow for pharmacies
IT system integration
IT support for pharmacies

11. Tactus: Serving Alcoholics online
• Tactus delivers care and treatment to addicts with alcohol, drugs, medicine, gambling, and eating
problems
Environment • Especially alcoholic abuse has a stigma: people are ashamed; it is a taboo
• Tactus performs 5,500 units of care per year and the 2007 result was €1,605,000 (budget of €57
mio)
• 10% of all Alcoholics ever got help
Main drivers to change • Research pointed out that preventive actions should indicate better results
Business Model
• The behavioral change side of the treatment needs to be easily accessible
• Structured asynchronous Internet treatment program (Tactive) with a focus on cognitive
behavioral therapy through one-to-one counseling of a professional assistant:
• Two-sided treatment (diagnostics & behavioral change)
• Informative website
Solution
• Forum for online contact with fellow-sufferers
• Internet-based treatment (on a secured platform)
• Aftercare chat module
• Three executing organisations: Tactus, Mondriaan, and Symphora Group
• Research that underpins the benefits of the service, and gives opportunities to adjust
Key Success Factors • Personal counseling relation between professional assistant and alcoholic is key
Business Model • Price from M&ICT of €650K
• No transportation needed, freedom in time and place

12. Tactive: Changing the Business Model
Alcoholic treatment before Alcoholic treatment after
Feedback
Internet-based Informative Aftercare chat
Forum
treatment website module
Local, regional, Quality & Control; Subsidy
Treatment
national
government
Provide treatment & Tactive
care to clients (Alchoholdebaas.nl)
Professional
Tactus
Assistants
Knowledge
Local, regional,
Healthcare
national Tactus
Insurer
government
Healthcare
Insurer
Orders & Leads; Money
Professional
Assistants
Source: Interview Hans Keizer, Tactive / Tactive Documentation

13. Tactive: Changing the Value Proposition
KEY KEY VALUE RELATION PATIENT /
PARTNERS ACTIVITIES PROPOSITION USER /
DOCTOR
Need-oriented relationship SEGMENTS
Give care & treatment Personal & Anonymous
Supervise assistants Patient has the control over
Provide addict care his/her own treatment
Local, regional and Develop internet-based Tactive online treatments People with addicts
national government platform E.g. Alcoholdebaas.nl Desired knowledge and
Tactus Provide information, experience around
TheFactor.e KEY fellow-sufferer contact, CHANNELS addictions
Health insurer RESOURCES treatment and aftercare Other target groups:
Mondriaan assistance Anonymous patients
Symphora Group 680 Prof. assistants Roll-out to other areas: Policyholders
20-25 Prof. assistants Front-end IT system
Gambling Professional assistants Companies
Knowledge on diagnostics Drugs Self-payers
& behavioral change Health insurer
Eating Roll-out to other
IT knowledge Medicine countries
COST REVENUE
STRUCTURE STREAMS
Personnel – Professional assistants Client fee: fixed fee + fee per hour for
Education & Training delivered treatment/care
Coaching on digital treatment Franchise fee
IT application: development and Resell of application to other countries
maintenance
Source: Interview Hans Keizer, Tactive / Tactive Documentation

14. Conclusions
• Mapping business model
• Long term commitment of senior management
• Not about new service but about news ways of delivering a specific
healthcare care specific service
• Financial commitment
• Stable financial support throughout project life line
• Final support for supporting staff commitment
• Patient’s needs
• Patients viewed as “clients” or “customers”
• Healthcare services aimed at providing more efficient services
• Open standards
• Explicit use of technical open standards to foster integration and follow-
up extension of functionalities
• Evaluation
• Senior management commitment to a-priori and ex-post evaluation of the
effects of IT-enhanced healthcare service

15. For more information
Prof. Jo Chataway
Director
RAND Europe
Westbrook Centre
Milton Road
CB4 1YG Cambridge
Tel:00441223353329
Email: chataway@rand.org