BHCT CELEBRATES ITS THIRD YEAR
This is a difficult period for all the non-profit organizations and foundations active in public interest fields and, more particularly, for the youngest structures.
But the motivation of the people involved in BHCT remained intact.
The BHCT teams took advantage of the lockdown to update its model of care, carried since its foundation.
Diagnosis initiated – Citizen Driven – Data Supported Care summarizes in three explicit points the basis of a model that involves the citizen, data science and the caregivers, in a dynamic extended to preventive care and new players in healthcare.
WHO WILL TREAT US TOMORROW ?
In March 2018, the ASBL Building Healthcare for Tomorrow (BHCT) was presented during an inaugural session in Solvay’s master auditorium. “One day, your watch will tell you when, where and why to go to your caregiver”, a presentation by Dr Arnaud Bosteels that made people smile.
Indeed in 2018, connected health was in its infancy and industrial players remained discreet about their health strategies.
But, three years later, the world of health can no longer ignore the question: “Who will treat us tomorrow?”
AI FOR THE BENEFIT OF HEALTHCARE
The biggest weakness of artificial intelligence for health is that it suffers from a silo approach.
For the doctor, AI is an indispensable tool to support his clinical practice while the manager will instead see it as the ideal assistant for a more efficient financial dash-boarding, better inventory control, or improved management of spaces and beds.
However, AI in favor of health offers much more than a simple tool to the different stakeholders. It allows a fundamental rethinking of how care is organized by:
- Daring a redistribution of skills,
- Integrating the citizen in the management of his own health,
- Providing doctors and caregivers with the needed time to treat patients while the most simple tasks are shifted to other qualified people or machines.
Isn’t it true that the best treatment is the one that the patient can and wishes to endure medically, financially, and emotionally (comfort)?
The answer seems obvious and yet our health care systems are dangerously moving away from this basic pragmatism, reducing the contribution of AI to a useful tool in which we need to invest without changing any of the global healthcare delivery factors.
BHCT & ARTIFICIAL INTELLIGENCE
BHCT participated to the Belgian AI week, as a member of the health group.
His main input focused on the importance of defining an AI strategy that will benefit the ecosystem more than a particular actor, even if the focus was mainly AI for hospitals
AI in medicine is far from being synonymous with AI in health care. However, it is important that that caregivers and physicians become aware of this nuance, as their vision is most of the time limited to augmented medicine and quality of care measured in a value-based care system.
BHCT committed to the organizers and BOSA in order to share its knowledge on the subject in a report that is partially accessible to its members.
Dr. Sam Ward is today the medical director of the NPO. This young doctor, converted to the idea of new forms of competition, has joined BHCT since its foundation with the hope of exchanging positively with the industrial and financial sectors on the objectives of good medicine.
What attracted you to the BHCT approach?
The international character of our association, which is open to the different philosophies and strategies of the world of health. On a day-to-day, multidisciplinary basis, we bring together the different actors and stakeholders to create value-added partnerships and jointly define sustainability strategies.
Were you aware of the health strategies of industrial and financial companies?
That’s one thing you don’t learn in university. The wall around the world of health care is doing us more harm than good today.
Do you think corporate social responsibility in public health is a reality or just a marketing argument?
The image we have, especially of pharmaceutical companies, today is often biased. The social responsibility of enterprises will be one of the pillars of our welfare state, at least if we want to maintain it.
How do you see your future as a doctor in a society that welcomes these new actors?
The fear of caregivers is that these new players will come in and take market shares which were previously dedicated to caregivers. Thereby, there exists a fear of using medical and social data, as the physician still sees himself as a protector of week persons.
To not cooperate today means to suffer tomorrow.
In your daily practice, have the expectations and aspirations of patients changed?
Absolutely. We live in an instantaneous world. Since the introduction of the mobile phone, the world has changed dramatically. We want an immediate appointment, a diagnosis without any wait, an immediate solution, an intervention without delay. The citizen adopts a consumer behaviour and the world of health does not know how to react.
Hospital doctor, what will be the role of the hospital of tomorrow?
If the hospital wants to survive, it will have to rethink its strategy to integrate itself into the citizen’s driven-care ecosystem. The hospital of tomorrow will be in our pockets, and not around the corner. It will be part of the healthcare chain, as a necessary pit stop for specialized interventions and life threatening & emergency care.
The place of the citizen in tomorrow’s health
Citizen involvement in managing his own health is undoubtedly one of the best sources of savings for any health care system.
The citizen-driven care, however, casts doubt on the real pursued objective. The fear is a behavioral control aimed at punishing the worst students, either by refusing them reimbursement or by denying them access to care.
This approach is highly questionable, as would also be a value-based care system judging healthcare institutions on the results alone, without taking into account different correction factors, not only related to the patient condition, but also to the environment (SDOH).
In BHCT’s approach, the philosophy of citizen-driven care is based on three essential pillars:
- Provide citizens with the needed education and empowerment for better personal management.
- Ensure equitable access to care for everybody.
- Ensure that the principles of individual freedom are maintained
However, such an approach requires a cultural change that remains difficult to apprehend for the healthcare world. The patient, who was until now defined as a person in a state of weakness to protect, becomes, at his request, a more or less active partner in his care process. Indeed, based on his personal choices, the citizen who wants it, should have the freedom to analyze his genome to identify his risks or opt for connected healthcare solutions, possibly appealing to a commercial partner.
Lucio Scanu is the initiator of Stent.Care, social network that brings together people with diverse pathologies and disabilities to allow them to meet and share around their daily life weighed down by their physical or mental situation. He himself grew up in a situation of disability. He has undergone 46 surgeries and having reached adulthood, Lucio Scanu naturally chose to engage in the associative world of patient federations.
“What are the patient’s expectations about connected healthcare?”
The expectations of patients connected to health tools can be summarized in three words: link, link and again link!
Whether it is his need to join a patient community or to be accompanied (coaching) in his daily treatment and monitoring of his health indicators, the patient waits for connections with his pairs (patients who experience the same pathological situation as him), as with medical teams specialized in the medical situation he is facing, and with social actors (social workers, professional assistants, assistance adapted to the training according to his physical situation) linked to his status as a chronic patient or person with a disability.
The patient no longer has a segmented view when it comes to connected health. His vision has become systemic. In other words, the patient is now taking a 360° look at his situation. He understands that his medical situation will not be solved only in the field of care and treatments but also by including social environment, social position, and socio-professional integration aspects, which have an important impact on its health.
Thus, the patient is waiting for digital tools allowing him to be accompanied on medical, psychological and social issues
“Do you think that the patient’s reflexion goes beyond the caregiver’s thought in the matter?”
The reflections are not on the same levels.
Patients think of multidisciplinary collaboration and partnership while physicians think of professional practice, data collection, and analysis. The medico-centric vision clashes with the multidisciplinary vision expected by patients and people with disabilities.
The Stent.care network is symptomatic of the difficulties that patients experience in being heard in their full reality and in having their own tools designed by operators living with the disease and/or disability. The way patients understand connected health tools is at the opposite of what caregivers think about those tools.
To understand this difference of visions about the changing mentalities and the new needs of patients, we need to go back 40 years.
The beginning of the 1970s with the computerization of management functions and the first projects for a digitized patient record, the use of “new information and communication technologies”, ICT, in the field of health has been undergoing, for 40 years, a sustained interest and repeated failings.
Conceptualized on the needs of hospital physicians in terms of information gathering, the proposed digital tools are still based on on therapeutic education to empower patients to follow the given treatment.
Through this continuous process, integrated into the patient-centered care approach, the hospital world has copied/pasted, on a digital medium, what it has been organizing within their walls since the 2000s: awareness, information, learning activities, screening and accompaniment concerning the disease, the prescribed treatment, and the care. The objective of this digital therapeutic strategy is to help the patient understand the disease and treatment while better cooperating with caregivers and, therefore, maintaining or improving their quality of life.
Unfortunately, the notion of “patient participation” is not understood in the same way by patients and health care professionals. For professionals, patients must describe the symptoms, make available collected data to keep them informed of the progress of the treatment while, at the same time, patients expect explanations about the diagnosis and treatment to make their own choices. Patients feel alienated: they no longer recognize themselves, feel that they no longer belong, and are no longer recognized as persons.
And yet, patients are more digitally educated and increasingly connected and if they are not, their children are for them; connected objects are spreading and more than 3 out of 4 Belgians are ready to communicate about their health on digital channels. The only obstacles to the explosion of digitalization of health that tools are designed by professionals for patients in a top-down approach, leaving little room for the patient experience, and the lack of guarantees of security of medical data and privacy.
Patients thus have a head start on the understanding that the medical profession can have digital health tools. Patients see digital tools as an opportunity to become partners in the health world while the medical world focuses almost exclusively on data analysis.
“What does the interactive patient mean to you?”
This question alone explains the gulf between patients’ perception of the digital world (and what can be done with it) and that of the medical world.
For patients, to be interactive is simply to participate online in exchanges (questions/answers/testimonies/aids). For the professional world these are interactive computer tools intended for the education and evaluation of professionals in their practice.
To use a marketing terminology, “persona”, this fictional person who would have all the social/psychological attributes and characteristics of the target group, does not exist for patients. Patients feel unique and are, as a whole, unable (with exceptions) to view the interactive patient as a virtual duplicate of who they are and what they experience as part of their health journey.
Hospital funding, model coherence first
On 30th March, ABDH organized a debate with Antares Consulting on the financing of hospitals in Belgium (1).
Addressing hospital funding is a particularly sensitive issue in this time of COVID.
A first mistake, fortunately avoided, would be to use the argument of the pandemic seeking to demonstrate the underfunding of hospitals, firstly because the exception cannot justify the rule, and then because the problem of the sustainability of health care coverage is real and its funding must be rethought in a comprehensive and integrated way.
A funding model depends on the desired and agreed healthcare delivery model and not viceversa, as Dr Edouardo Portella, author of the report, rightly pointed out.
While inspiration may come from elsewhere, it has its limits and, in Belgium, the particularities of an excessively decentralized care system, the fear of optimal use of data and the resistance of the medical profession to give up on fee-for-service payments, undoubtedly complicate the reform of the system.
So a key question remains.
Where do we start when hospitals are in the red and the hospital medical staff has reached its tolerance threshold concerning additional contributions that it is willing to grant to finance a sinking boat?
The answer will in any case not come from a rejection of one another’s responsibilities – recalled Paul d’Otreppe – but from a better collaboration between doctors and management.
More generally, it will be necessary to reposition the hospital in the care chain whose value and, consequently, the payment must be established.
Bundled payments, lump payment or per capita are part of this logic, but life threatening care and emergency care should be excluded, as demonstrated by the pandemic.
Those require a fully-fledged funding model that would particularly benefit the hospitals in charge of this costly and heavy medicine.
For all other pathologies, the integrated approach leads to move away from hospitalo-centric models and to focus on the patient and his therapeutic needs, starting from his diagnosis.
It is on this basis that third-party payers, insurers or States, rely to determine the budget required for the takeover. The budget thus established will then be distributed among the various actors whose performances will be measured at the same time.
In short, nothing new in this philosophy which continues its implementation in several countries, with more or less success.
But achieving an integrated approach, by pathology, will take time and, in the meantime, hospitals survive by savings on overheads and increased contributions from the medical profession, with no real solution other than to wait.
Nevertheless, five important elements contributing to funding of hospitals were only briefly addressed at this seminar, which, it is true, was focused more particularly on a comparative approach of the existing funding models and their progress.
These complementary elements should be debated:
- The role of data in optimizing financial, patient and logistical flows.
- The fight against medical overconsumption and waste in hospitals.
- Empowering the patient in their own management.
- The network impact.
- The direct and indirect contribution of new players, here included those who are actually not part of the healthcare world.
THE SOCIAL RESPONSIBILITY OF ENTERPRISES
Over the past three years, BHCT has largely become known through social media, hampered by the advent of COVID.
Supported by several volunteers converted to the idea that the public health of tomorrow will be preventive, interactive and multidisciplinary, BHCT has been able to position itself on the national as well as international level.
For the financial and the business world, BHCT offers the opportunity to discuss more informally about the expectations, needs and wishes, with patient associations, caregivers and doctors.
For caregivers and healthcare institutions, BHCT brings a vision of corporate social responsibility, as enterprises are submitted to citizen and political pressure in order to contribute more actively to public interest issues, including healthcare.
Beyond these concepts, the change is real and accelerated by Covid. The sharing of values thus becomes a condition of positioning for the company, if not a condition of survival.
Here again, BHCT was right in presenting, in March 2018, a radical shift of the cursor positioning, from a customer-king towards a responsible consumer who expects the same from the commercial sector.
Moving the cursor towards values of public interest, to obtain the support of citizens and the political world is a goal sought by the world of business. Over the past three years, BHCT has been able to see, over the course of its meetings and conferences, how many companies were thus anxious to reconnect with the health of citizens, without depriving themselves of their core business or profit margins. A win-win situation against which the healthcare sector remains skeptical.
The BHCT teams wish you a happy easter weekend
#BHCT20 devient #BHCT22
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