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Health Care Business
How to organize and pay for better health outcomes?
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Paying for performance in health care. Implications for health system performance and accountability - WHO/Europe | Publications

Paying for performance in health care. Implications for health system performance and accountability - WHO/Europe | Publications | Health Care Business |
World Health Organization Regional Office for Europe

Health spending continues to outstrip the economic growth of most member countries of the Organisation for Economic Co-operation and Development (OECD). Pay for performance (P4P) has been identified as an innovative tool to improve the efficiency of health systems but evidence that it increases value for money, boosts quality or improves health outcomes is limited.

Using a set of case studies from 12 OECD countries (including Estonia, France, Germany, Turkey and the United Kingdom), this book explores whether the potential power of P4P has been over-sold, or whether the disappointing results to date are more likely to be rooted in problems of design and implementation or inadequate monitoring and evaluation.

Each case study analyses the design and implementation of decisions, including the role of stakeholders; critically assesses objectives versus results; and examines the “net” impacts, including positive spillover effects and unintended consequences.
With experiences from both high and middle-income countries, in primary and acute care settings, and both national and pilot programmes, these studies provide health finance policy-makers in diverse settings with a nuanced assessment of P4P programmes and their potential impact on the performance of health systems.

See the publication by McGrawHill here

rob halkes's insight:

Pay for Performance is a popular thought to found the system of reimbursement to health care. It is good to see reserach evaluating the thought.

I myself have seen  cases in which under the flag of this P4P concept and the idea that within smaller regions things would be easier to control, things did not work out. Performance in health care is not a simple idea to operationalize, without relating to the rich-poor issue, the quality of providers, the local inclination for different epidemeologies, etc. I for one would rather focus on health outcomes to begin with.

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Smart governance for health and well-being: the evidence | WHO/Europe Publications

Smart governance for health and well-being: the evidence | WHO/Europe Publications | Health Care Business |

Governance for health describes the attempts of governments and other actors to steer communities, whole countries or even groups of countries in the pursuit of health as integral to well-being. This study tracks recent innovations to address the priority determinants of health and categorizes them into five strategic approaches to smart governance for health. It relates the emergence of joint action by the health and non-health sectors, public and private actors and citizens, all of which have increasing roles to play in achieving seminal changes in 21st-century societies.

"Built upon an understanding of health and the contexts that drive new governance, it is proposed that smart governance for health is composed of five interrelated aspects:

  • collaboration
  • citizen management
  • a mix of regulation and persuasion
  • independent agencies and expert bodies
  • adaptive policies, resilient structures and foresight

Each of these aspects interacts and manifests differently, depending on the contexts in which they are set." (see page 143 of publication)

The chapters presented here were initially commissioned as papers to provide the evidence base for a study to support the new European policy framework for health and well-being, Health 2020. Calling for a health-in-all-policies, whole-of-government and whole-of-society approach, Health 2020 uses governance as a lens through which to view all technical areas of health. This book provides access to background papers for the study on governance for health in the 21st century, published by the WHO Regional Office for Europe in 2012. Prepared by eminent experts, the chapters provide further detail on the issues raised, and culminate in a comprehensive depiction of what constitutes smart governance for health in the 21st century.

See more information and a free download here

rob halkes's insight:

Great reading about governance to health - specifically in the current times of digital disruption, higher demands, reshuffle of powers, technological development and ever rising costs.

WHO Europe has published an inspiring read!

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Commission on the Future of Health and Social Care in England | The King's Fund

Commission on the Future of Health and Social Care in England | The King's Fund | Health Care Business |

A new settlement for health and social care - Final report

This commission will ask whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose.

Download the final report from the Commission on the Future of Health and Social Care in England. Its 12 recommendations set out a vision for a more integrated health and social care service, simpler pathways through it and more equal treatment for equal needs.

Key findings

  • The commission recommends moving to a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services.
  • A new care and support allowance, suggested by the commission, would offer choice and control to people with low to moderate needs while at the highest levels of need the battlelines between who pays for care – the NHS or the local authority – will be removed.
  • Individuals and their carers would benefit from a much simpler path through the whole system of health and social care that is designed to reflect changing levels of need.
  • The commission also recommends a focus on more equal support for equal need, which in the long term means making much more social care free at the point of use.
  • The commission largely rejects new NHS charges and private insurance options in favour of public funding.

Policy implications

  • Proposals for a single, ring-fenced budget and single local commissioner will have major implications for central and local government and the NHS.
  • Public spending on health and social care is likely to reach between 11 per cent and 12 per cent of GDP by 2025, the next government needs to consider how to respond to these spending pressures.
  • The commission proposes funding changes, including changes to National Insurance contributions, to meet the additional  £5 billion that would be required to improve social care entitlements.
  • A comprehensive review of various forms of wealth taxation needs to be undertaken with a view to generating additional resources that will be needed for health and social care in future years.

Chris Ham blog

"One of the great merits of the commission’s report is that it rises above the immediate pressures facing public finances to show that additional public funding is affordable."

Read Chris's blog about the commission's final report 

See the summary on slideshare here

rob halkes's insight:

Great challenges ahead for the Ministry of Health in the UK: A commission on the future of health and social care published its report. New structuring, new relations between national and local authorities, and what's more new sources to be found for missing funds for public health. Change ahead!

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Healthcare IT: Top Five Digital Trends Fueling Disruption in Healthcare - Accenture

Healthcare IT: Top Five Digital Trends Fueling Disruption in Healthcare - Accenture | Health Care Business |

Explore the five health technology trends that healthcare leaders should pay attention to as they shape the future of healthcare.

Healthcare IT is changing every day, and digital is driving the evolution. Accenture has identified five health technology trends that healthcare leaders should pay attention to as they shape the future of healthcare.

Digital-physical blur: Enabling location-independent care

The digital-physical blur enables location-independent care through healthcare IT. In fact, one Spanish hospital’s telehealth platform is reducing the cost per patient by 7 percent.

From workforce to crowdsource: Enabling new data sources for population management

Moving from workforce to crowdsource opens up a new world of data sources. One group of individuals self-organised a clinical trial to reveal that a relatively dangerous off-label drug did not deliver expected benefits.

Data supply chain: Putting information into circulation

The data supply chain puts information into circulation for powerful analysis. Texas Medical Center empowers its people to analyse complex big data sets through data visualisation and built-in statistical tools.

Harnessing hyperscale: Hardware is back (and never really went away)

Harnessing hyperscale means that hardware never really went away. Healthcare is data-intensive, and providers and payers need lower cost, higher speed healthcare IT solutions to store and share data.

Business of applications: Software as a core competency in the digital world

The business of applications will grow as software becomes a core competency in healthcare IT. Consumers increasingly want access to electronic health records and other shared platforms for decision making among patients and clinicians.

View the infographic to learn more about the technology trends that are disrupting healthcare.

rob halkes's insight:

Of course, there's some promotional intention behind this all. But still, Accenture points at 5 inspiring IT-trends relevant to the development of health care. Do reflect upon them regarding HealthIT. Read them!

Art Jones's curator insight, August 30, 6:30 PM

Healthcare IT: Top Five Digital Trends Fueling Disruption in Healthcare - Accenture 

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Almost one in six doctor visits will be virtual this year

Almost one in six doctor visits will be virtual this year | Health Care Business |
As the Baby Boomer generation ages, and rural population grows, telemedicine is expected to take off this year as an alternative to traditional in-person physician visits.

This year in the U.S. and Canada, 75 million of 600 million appointments with general practitioners will involve electronic visits, or eVisits, according to new research from Deloitte.

The overall cost of in-person primary physician visits worldwide is $175 billion, according to Deloitte. Globally, the number of eVisits will climb to 100 million this year, potentially saving over $5 billion when compared to the cost of in-person doctor visits. The eVisit projection represents growth of 400% from 2012 levels, Deloitte's study showed. [...]

UPMC, an $11 billion health care provider and insurer, with 21 hospitals, and more than 400 outpatient sites, said its AnywhereCare service has an 80% satisfaction rating. Patients love the convenience and speed of remote care, according to Natasa Sokolovich, executive director of telemedicine at UPMC.

"The new model provides a faster turnaround. Within 30 minutes ... they have the ability to get access to a healthcare provider," Sokolovich said.

eVisits reduce time to patient care and costs. Through electronic record portals, they can also offer physician and patient a view of the same health information, such as appointments, prescriptions, test results and complete medical histories.

Electronic visits or telemedicine is comprised of electronic document exchanges, telephone consultations, email or texting, and videoconferencing between physicians and patients.

The vast majority of eVisits, according to Deloitte, are likely to focus on capturing patient information through electronic forms, questionnaires and photos, rather than through direct interaction with a physician using Skype or some other real-time tool.

"For example, patients with symptoms of certain illnesses such as sinusitis, strep throat, allergies, bladder infection or acne would complete an online form and then receive a diagnosis and, if required, a prescription," Deloitte stated in a recent report.

While not all in-person primary physician consults can be handled by eVisits, even only 30% to 40% implies a $50 to $60 billion total addressable market, according to Deloitte. [...]

Another reason for the enormous increase in the adoption of telehealthcare is the Affordable Care Act (ACA). The act places an emphasis on decreasing healthcare costs while increasing quality through standardized methods of care.

"Technology is going to be the game changer there," Collins said.

rob halkes's insight:

"eVisits" have got a broad definition here, more extended than "econsult" for instance. Than the expectation is right that it will have a large growth the coming year. Still, parties involved have to accommodate. It is precisely this accommodation process that is struggling. Patients will overcome the burden of knowing whether they send too little or too much documentation, must adjust to not seeing immediate feedback from their physician etc. Physicians need to organize fragmented actions normally covered in one face-to-face consult, and the organization needs logistics to enable and facilitate all this. Technology is just one aspect.. ;-)

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Eleven truths of digital health -

Eleven truths of digital health - | Health Care Business |

Here are the first five:


“The single most broken thing in healthcare is communication.

Vocera CMO Dr. Bridget Duffy, MD on The Future of Delivery

“The healthcare industry missed the PC revolution, it missed the internet revolution, and it can’t afford to miss the mobility and cloud revolution.

Former Apple CEO John Sculley at HISUM 2013 Keynote

“As healthcare innovators in this room, we know that changing the system is a slog. We’re fighting an uphill battle sometimes. But we will all face healthcare crises in our lives. And when we do, I would encourage everyone to harness those opportunities to remind us why we’re in healthcare innovationto begin with.”

Wildflower Co-founder and CEO Leah Sparks on How My Healthcare Experience Inspired My Company


“Machine learning makes a much better doctor than Dr. House.”

Khosla Ventures founder Vinod Khosla at HISUM 2012 Keynote


“Healthcare’s a fascinating market. It’s the only area where you wake up every day and you feel like you’re doing something for millions of people.”

Castlight Health Founder & CEO Giovanni Colella on Beyond the First Adopters: Digital Health at Scale

Via Andrew Spong
rob halkes's insight:

In line with  Andrew Spong's  note: some great statements that bring a smile to health innovators.

But why the is the sloggy health system still the one industry that is so reluctant to their own need for change ..?

Andrew Spong's curator insight, July 24, 5:21 AM

I normally spare you thinly-veiled advertorials by default, but will make an exception for this well-chosen batch of provocative one-liners.


OK, one and two-liners ;)

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Healthcare’s digital future | McKinsey & Company

Healthcare’s digital future | McKinsey & Company | Health Care Business |

by McKinsey; See also Insights by Gary Monk at MobiHealth here

A McKinsey & Company article: Insights from our international survey can help healthcare organizations plan their next moves in the journey toward full digitization. 

The adoption of IT in HealthCare systems has, in general followed the same pattern as other industries. [ ..]
As for its effects on the healthcare sector, this second wave of IT adoption helped bring about, for example, the electronic health card in Germany. It was also a catalyst for the Health Information Technology for Economic and Clinical Health Act in the United States—an effort to promote the adoption of health-information technology—and the National Programme for IT in the National Health Service in the United Kingdom. Regardless of their immediate impact, these programs helped create an important and powerful infrastructure that certainly will be useful in the future.

Many institutions in the private and public sector have already moved to the third wave of IT adoption—full digitization of their entire enterprise, including digital products, channels, and processes, as well as advanced analytics that enable entirely new operating models. No longer limited to helping organizations do a certain task better or more efficiently, digital technology has the potential to affect every aspect of business and private life, enabling smarter choices, allowing people to spend more time on tasks they deem valuable, and often fundamentally transforming the way value is created. What will this third wave of IT adoption look like for healthcare?

Players in the healthcare industry were relatively successful at—and benefited from—the first and second waves of IT adoption. But they struggled to successfully manage the myriad stakeholders, regulations, and privacy concerns required to build a fully integrated healthcare IT system. This is partly because the first and second wave of IT adoption focused more on processes and less on patient needs. Still, programs like the N3 communication network in the United Kingdom and the secure telematics platform in Germany have created powerful infrastructures that have the potential to support the third wave of digital services in healthcare—but only if stakeholders take the appropriate next steps.

Now that patients around the world have grown more comfortable using digital networks and services, even for complex and sensitive issues such as healthcare (successful websites DrEd, PatientsLikeMe, and ZocDoc are just three examples of this trend), we believe the time has come for healthcare systems, payors, and providers to go “all in” on their digital strategies. The question is, where should they start?

[...] Success in the third wave of digital depends very much on first understanding patients’ digital preferences in both channel and service. But many digital healthcare strategies are still driven by myths or information that is no longer true. We interviewed thousands of patients from different age groups, countries, genders, and incomes; respondents had varying levels of digital savvy. Our research revealed surprising and actionable insights about what patients really want, which can in turn inform how healthcare organizations begin their digital patient-enablement journey. Here, we present five of those insights.

Myth 1: People don’t want to use digital services for healthcare

Many healthcare executives believe that, due to the sensitive nature of medical care, patients don’t want to use digital services except in a few specific situations; [..] . In fact, the results of our survey reveal something quite different. The reason patients are slow to adopt digital healthcare is primarily because existing services don’t meet their needs or because they are of poor quality. [..] 1 more than 75 percent of respondents would like to use digital healthcare services, as long as those services meet their needs and provide the level of quality they expect (Exhibit 1).[..] Of course, nondigital channels will continue to be relevant and important, so digital channels will have to be embedded in a well-thought-through multichannel concept.

Myth 2: Only young people want to use digital services

[..] however, that patients from all age groups are more than willing to use digital services for healthcare (Exhibit 2). In fact, older patients (those over 50) want digital healthcare services nearly as much as their younger counterparts. More than 70 percent of all older patients [..] A recent report from the European Union2 suggests that service type—not just channel—should be segmented by age; [..]

Myth 3: Mobile health is the game changer

[..] our survey shows that demand for mobile healthcare is not universal. It is therefore not the single critical factor in the future of healthcare digitization [..]

Myth 4: Patients want innovative features and apps

[..] But the core features patients expect from their health system are surprisingly mundane: efficiency, better access to information, integration with other channels, and the availability of a real person if the digital service doesn’t give them what they need. [..]

Myth 5: A comprehensive platform of service offerings is a prerequisite for creating value

When going digital, many institutions—not only those in healthcare—think it is necessary to “go big” before they can achieve anything; they believe they must build a comprehensive platform with offerings along the entire spectrum of customer services. But our survey finds that it can be smarter to start small and act fast (Exhibit 4). [..] Surprisingly, across the globe, most people want the same thing: assistance with routine tasks and navigating the often-complex healthcare system.[..]patients most often cite “finding and scheduling physician appointments"[..] selecting the right specialist and support for repetitive administrative tasks such as prescription refills. What most of these services have in common is that they do not require massive IT investments to get started.

The third wave of digitization in healthcare: Getting started

Three steps can help healthcare companies begin their journey toward the third wave of digitization.
The first step is to understand what it is that patients really want and the best way to give it to them. [..]
Next, organizations should segment their services according to basic criteria such as the amount of investment required, estimated patient demand, and value created through the service.[..]
And finally, just like organizations in other industries, healthcare companies should continually add new services to keep patient attention and build value. Once patients are familiar with the general idea of digital-service provision, organizations can begin offering more complex, high-value services, such as integrated-care companion apps or mobile health records....

rob halkes's insight:

Great Survey results, aligning with what experts already thought. Results generated by Germany, Singapore and the UK, but believed to be representative of patients in these advanced markets (!).

Results tell us this:

  • Age of patients does not influence the desire to find health services on line - the differences between age groups regard preferences for channels and for content: in any case directly related with the very health condition of the patient;
  • Current, initial expectations of patients regard convenience services first, like ability to make appointments on line and service with prescription refills - but there's indication that expectations will rise with accustomed use of available offerings;
  • This means that a developmental process of creating and rendering services allows for both the health care organization and its patients to grow into more complicated patterns of digital services. It also makes way for gradual implementation of the very development. So each organization may create its own path in digital development, internally and with external digital service delivery;
  • It implies that there is no dominance as in "need-to-have" of specific digital services  - no organization needs to jump to hypes, as they perceive them, but the very need is to do and take your own roadmap with digital;
  • Even stronger, the roadmap to digital is better guided with the concept of eHealth, that in fact entails every aspect of digital service provision in health care, from a facilitative level of making appointments, through information support, health records, wearables and monitoring, up to interaction, data exchange and communication. The authors acknowledge that there is no one concept needed of a one comprehensive platform (myth 5);
  • So one's development into one's own configuration is the best way to move forward. But, indeed there are two conditions:
    - it better be well thought off: early steps may generate but also limit consecutive steps, so a general design of one's view on eHealth will be helpful, and
    - each patients does prefer his or her own selection and (developmental) way into further uses. This implies that the very digital platform needs to allow for such. That strengthens the need to apply experience-co-creation methods of development.   

In short: we know where to move, we know how to create it, let's go for it.
Get in contact here

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Corporate reputation of the medical device industry - the patient perspective

Corporate reputation of the medical device industry - the patient perspective | Health Care Business |


Report published by PatientView, June 4th 2014

London, June 4, 2014. This report is based on the findings of a PatientView March-April 2014 global survey exploring the views of 408 international, national, regional, and local patient groups from 54 countries (86% from Europe), and with a wide range of differing medical specialties. The report provides feedback on the corporate reputation of the medical device industry during 2013-2014, as well as the performance of 28 leading medical device companies for six key indicators that influence corporate reputation: patient-centredness; patient information; patient safety; useful products; transparency; and integrity. Results are compared with industry and corporate performance in the previous two years.

For the purposes of this report, the phrase ‘corporate reputation’ is defined as the extent to which medical device companies are meeting the expectations of patients and patient groups. 28 companies are examined in the report.

See the complete press release !!

Key Findings:

The 2014 survey is an exact repeat of studies carried out in2012 and 2013, allowing the progress of the medical device industry (and individual companies) to be tracked over the three-year period.

- 2013-2014 results put the medical device industry first among all healthcare industries (but by default). 60% of the patient groups responding to the 2013-2014 survey state that multinational medical device companies had an “Excellent” or “Good” reputation that year, the same percentage as in 2012-2013, and higher than in 2011-2012 (when only 53% stated as such). [..]
- In fact, the overall reputation of the medical device industry has slipped, in the perception of patients. When respondent patient groups were asked whether the corporate reputation of medical device companies in their own right had improved, declined, or remained unchanged over the past year (2013-2014), just 34% felt able to state that the industry’s reputation had improved (compared with 40% in 2012-2013). And 26% of the 2013-2014 respondents say that the reputation of the medical device industry declined (the figure was 24% in 2012-2013).[...]- The medical device industry’s performance at various activities of importance to patient groups is stable. On the whole, the performance of the medical device industry at activities of importance to patient groups has remained remarkably similar over the past two years (between 2013-2014 and 2012-2013). [...]


Ranking              2013-2014

Coloplast A/S   

St.Jude Mecial
Novo Nordisk A/S
Roche Diagnostics


Abbott Labaratories

Fresenius Medical Care

Medtronic, Inc.

Philips Healthcare

rob halkes's insight:

Congrats to those in the top 10. What are you doing when you're organization is less than good in this perspective?

rob halkes's curator insight, June 4, 4:40 AM

Great Insights into the corporate reputations from the best performing Medical  Device Industry in patients' perspectives!

Kudos to Coloplast, ConvaTec and St.Jude Medical.

Sorry to see Philips healthcare just at the 10th place. 

Sweden seems to be the best country for Medical devices Industry..;-)

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Statistics Netherlands - CBS: growth care expenditure at lowest level in 15 years.

Statistics Netherlands - CBS: growth care expenditure at lowest level in 15 years. | Health Care Business |

From the Dutch Statistics Office:

  • Last year, spending on care totalled 94.2 billion euros, 1.6 percent up from 2012
  • Hospital care expenditure up by nearly 5 percent
  • Spending on care for elderly and disabled people grows marginally
  • Less spent on medicines and childcare

Last year, total spending on care rose by 1.6 percent, i.e. less than in prior years. This is partly due to the fact that the growth in medicine consumption slowed down and the average price level of medicines fell further. Rates and compensations for health care and welfare services also declined, in particular for care and nursing services. According to the Central Bureau of Statistics (CBS), overall expenditure on health care and welfare was in excess of 94.2 billion euros.

Spending on hospital care rose most rapidly

Spending on hospitals and medical specialist practices, which account for more than a quarter of total care spending, increased by 4.9 percent in 2013. One of the reasons for the increase is that since 2013, hospitals have taken up the supply of a category of expensive medicines (oncolytics and growth hormones, with an approximate value of 200 million euros).

Marginal growth spending on care for elderly and disabled persons

Spending on care for elderly and disabled persons grew by 2.4 and 0.7 percent respectively in 2013 relative to 2012. These percentages are below the level recorded in prior years. Regulations have become stricter: rates were lowered, the room for expenditure growth is limited and the compensation for transport costs was lowered. Together, care for elderly and disabled persons account for 29 percent of total care expenditure.

Spending on medicines and childcare down

Medicine sales through dispensing pharmacies and chemist shops were nearly 5 percent down, not only because hospitals have taken up the supply of a category of expensive medicines, but also because the consumption of medicines grew less rapidly. The average price level of medicines also declined further.
Spending on childcare decreased further. The number of children using childcare facilities declined and the number of hours in childcare per child was also reduced  further as parents and guardians received lower childcare allowances.

Ratio care expenditure to GDP marginally up

The ratio of care expenditure to the gross domestic product (GDP) rose marginally from 15.5 percent in 2012 to 15.6 percent in 2013. Per capita expenditure was 5,608 euros in 2013, versus 5,537 euros in 2012

rob halkes's insight:

In the midst of the transition period of the health system, since 2006, economic results sshow to appear as trend. Having done not too bad at quality, one might presume that the Dutch have found their way out of the threats of ever growing costs of care. Of course there's just more than this to tell. But it is a good sign.
See for instance:

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Assessing Health Professional Education: Workshop Summary

Assessing Health Professional Education:  Workshop Summary | Health Care Business |
Assessing Health Professional Education is the summary of a workshop hosted by the Institute of Medicine's Global Forum on Innovation in Health Professional Education to explore assessment of health professional education. At the event, Forum members shared personal experiences and learned from patients, students, educators, and practicing health care and prevention professionals about the role each could play in assessing the knowledge, skills, and attitudes of all learners and educators across the education to practice continuum. The workshop focused on assessing both individuals as well as team performance. This report discusses assessment challenges and opportunities for interprofessional education, team-based ...
rob halkes's insight:

Worthwhile for any one to try and innovate in health care and its business

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Patient Österreich: Wo wir im Gesundheitssystem tatsächlich stehen - WATCHDOGS

Patient Österreich: Wo wir im Gesundheitssystem tatsächlich stehen - WATCHDOGS | Health Care Business |

Austria prides itself often to have the best and most efficient health care system in the world. This exagerated statement by accountable politicians, were taken as our starting point to look more closely at the Austrian hospitla landscape. For this purpose, the data by four different sources (OECD, ÖSTAT, Spitalskompass hospital carrier) were evaluated . Are we really as good as we believe? Are there regional differences? How long do we stay in hospital? Where is treated much where little? The results are sometimes amazing.

A siting of Martin Zechner and Tanja Rohrer (data analysis).
We Austrians are world champions once again. This time, however, not downhill, slalom or giant slalom. No, we have brought it to the top in an OECD comparison.

With approximately 274 hospital stays per thousand inhabitants we are international leaders.
In other words: one in four Austrians is hospitalized statistically once a year in a hospital. On the second and third place Germany and Russia follow. In the Netherlands, which is quite comparable with Austria only one in 8 is admitted to a hospital for the same period..

Read the rest (in German)

Translation here in English are mine (RH)

rob halkes's insight:

Good too see journalism as one force in public to look into actual facts of health care in a country.

I'm in great favor of journalistic research!

Austria what are you going to do?

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With Healthbook, Apple Asserts Itself as the Platform for Digital Health

With Healthbook, Apple Asserts Itself as the Platform for Digital Health | Health Care Business |
The tech giant's moves raise new questions about its plans to develop medical sensors.

Emerging details about Apple’s forthcoming Healthbook app suggest the tech giant is asserting itself as a platform for digital health, a clearinghouse for data that could potentially prove as useful, revealing and lucrative as the ad profiles that drive the online economy today.

The Cupertino company’s activities also raise questions about its plans to develop new medical sensors (possibly including a bloodless glucose monitor), integrate existing ones into forthcoming wearable devices or partner with companies developing these capabilities.

“I wouldn’t be surprised if Apple has grand designs,” said Skip Snow, a senior health care analyst at Forrester Research. “They don’t usually do things on a small scale.

But he and others said it was unclear whether Apple would come to dominate this space, as other tech companies are equally eager to plant themselves at the center of the health ecosystem — a sector that adds up to 17.9 percent of the nation’s gross domestic product....

It’s not certain how close to a final product Healthbook is or what it will look like when it hits the market. Early designs for the app appear to allow consumers to closely track health, fitness and activity information, as first reported by 9to5Mac and largely confirmed by Re/code’s own reporting. Apple declined to comment for this story...

Why is Apple making such a big play here?

Many observers believe we’re at the beginning of a transformation in health care, a consumerization of the space driven by the same online tools, apps and devices that have overhauled retail, media and finance. People have access to more information to make their own decisions about doctors, treatments and lifestyle choices...

Of course, most of this is just potential for now.

To date, companies developing wearables have seen significant attrition rates and have struggled to translate raw health data into genuinely useful information for consumers...

“No average consumer knows what to do with the blood oxygen content from their finger,” Forrester analyst Frank Gillett said. “What they really want is something like, ‘Hey, you need you to take a walk today, and if you do that every day we’ll knock $5 off your insurance’ or something.”

“So what we’re seeing,” he added, “are the foundation elements for something that may be more practical than the things we see in today’s activity-trackers.”

rob halkes's insight:

Apple is taking its turn to enter into health care. They have chosen the sensor route, not the easiest one, but will it be the mainstream to better care with better outcomes - I see it as a sideroute. You?

See here for a more information about Apple's Healthbook.

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Top 10 Health Care Issues and Opportunities for 2014

Top 10 Health Care Issues and Opportunities for 2014 | Health Care Business |
Ankota's look at the top issues and opportunities in health care for 2014, with a focus on delivering better care at lower cost.

From Ankota's vantage point though, the changes happening in our industry present a number of opportunities and issues not generally presented by the media. 

Please let us know what you think of our list or what would be in your Top 10:

  1. Healthcare Delivery at Home is Catching On;
  2. Corporations are Promoting Workforce Health;
  3. Health Information is Getting Ready to Share;
  4. People are Starting to Comparison Shop;
  5. Mobile Health Apps are Taking Off;
  6. Chronic Care is Becoming More Proactive;
  7. Roles are Changing in the Health Care Ecosystem;
  8. Exchanges are for Companies Too;
  9. Technology is Driving Productivity;
  10. Opportunities are Emerging for Smaller Healthcare Technology Providers.

rob halkes's insight:

Well just one more time, but I promiss you this will be my last sharing of preedictions for this year. See my analysis form them all here: and more specifically about what I think The trend should be here:

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What Are the Top Challenges in Reducing Readmissions? - Healthcare Intelligence Network -

What Are the Top Challenges in Reducing Readmissions? - Healthcare Intelligence Network - | Health Care Business |

While great strides have been made in the reduction of 30-day all-cause hospital readmissions, CMS still penalized more than 2,200 hospitals in 2013 for exceeding 30-day readmission rates for heart failure, pneumonia and myocardial infarction.

In 2015, CMS penalties will extend to acute COPD and elective hip and knee replacements.

2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.

Development of post-acute partnerships with home health, skilled nursing facilities (SNFs) and hospice is emerging as a key strategy to stem hospital readmissions, according to new market data from the fourth annual Healthcare Intelligence Network (HIN) Reducing Hospital Readmissions Survey.

More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, respondents say.

Looking at more conventional approaches, medication reconciliation and telephonic monitoring of patients post-discharge emerged as frontrunner strategies to curb readmissions. Moreover, the 2013 survey revealed significant upticks in the use of each tactic over 2012 levels: medication reconciliation is now conducted by 73 percent of respondents, versus 54 percent in 2012, while the use of telephonic monitoring jumped from 48 to 71 percent over the same 12-month period.

In other new data, almost half of respondents — 47 percent — aim programs at individuals already assessed at high risk for readmission as well as the traditional Medicare (53 percent), Medicaid (28 percent) and high utilizer (23 percent) populations.

rob halkes's insight:

Preventing readmissions - The pictured graph speaks for itself . It also turns out that any attention to discharged patients will have effect on prevention of readmissions, IF the hospital organizes the attention. SImple telephinci monitoring already contributes, leave alone what structural ehealth applications will mean! See also here!

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News -

News - | Health Care Business |

August 29, 2014- Detroit Medical Center Awarded National Health Care Innovation Award

The Detroit Medical Center (DMC) has been selected to receive an award of $9,966,608 as part of the Centers for Medicare and Medicaid Services’ (CMS) Health Care Innovation Awards program. The Principal Investigator and DMC Chief Medical Officer Dr. Suzanne White is one of only 39 recipients of about 3,000 applicants across the United States. The award will enable the DMC to test an innovative primary care and preventative health model that reaches patients who use some of Detroit’s busiest emergency departments.

The project, entitled Gateway to Health: An Innovative Model for Primary Care Expansion in Detroit, will make patient-centered medical care immediately accessible to individuals without existing primary care physicians, arriving to four DMC emergency departments at DMC Harper University Hospital, DMC Detroit Receiving Hospital, DMC Sinai-Grace Hospital and DMC Children’s Hospital of Michigan. By embedding primary care services in those areas of highest emergency department use, the DMC project intends to meet patients where they are already seeking care to develop meaningful doctor-patient relationships, improve care coordination and implement strategies to promote wellness. The ultimate goals are to deliver improved health care access, quality and efficiency for the surrounding community.

“As a Detroit emergency physician, I understand the challenges and barriers our patients face as they try to access high quality primary care services. I see each day how the system could be improved. Patients lack access to after hours care, unscheduled visits, transportation, and most importantly, a welcoming environment where they feel comfortable and safe,” said Dr. White. “This award is an incredible opportunity for DMC to create a culture of patient partnership, where we start by listening to each patient's story, try to understand their unique challenges and goals, and then match them with the best health caremore team.”

The focus will be on improving the care provided to patients with diabetes, asthma, hypertension, heart failure, chronic lung disease, depression and HIV.  Emergency department “super-utilizers” who have 10 or more visits annually are another program target group. Medicaid, Children’s Health Insurance Program (CHIP) and Medicare fee-for-service beneficiaries will be the dominant populations.

A multidisciplinary team of caregivers will work closely with each patient to help them achieve wellness through prevention and self-management of their conditions. Face-to-face visits, telephone contact and texting will all be used to better connect patients to the care team. Patient coaches and navigators are essential to the model as well. Read more here

rob halkes's insight:

Although it seems akward that acces to care needs an award, one can easily seen that services are intensified by the model DMC is trying to develop. Specifically buylding services around patients' ease of access! 

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Amazon meets with FDA; healthcare is likely the topic, experts speculate

Amazon meets with FDA; healthcare is likely the topic, experts speculate | Health Care Business |

The road to the Food and Drug Administration's Silver Spring, Md., office this year has been well-traveled by the big technology firms. Both Google and Apple have met with FDA leadership to talk about healthcare plans, and a recent review of FDA's public calendar reveals has joined the FDA healthcare parade.

Speculation about the company's meeting with the FDA ranges from the possibility of Amazon selling FDA-regulated healthcare products, to the big online retailer moving into the mobile health space. Whatever was discussed, Amazon's interest is further evidence that big tech wants into healthcare in a big way.

On July 22, “Amazon leadership” met with Howard Sklamberg, the agency's deputy commissioner for global regulatory operations and policy, and “various FDA leadership,” according to the agency's public calendar. The FDA declined to provide details beyond the information on the calendar. Amazon has not responded to a request for comment.

Google reportedly met with the agency to discuss its plans for a contact lens that could sense a patient's glucose levels through tears. Apple reportedly advanced its plans for its HealthKit application and iWatch smartwatch in an FDA meeting. According to a report obtained through the Freedom of Information Act, Apple claimed it “may have a moral obligation to do more” in the healthcare space.

Experts surveyed anticipated Amazon's requests and plans—whatever they may be—to be big. “It would seem to me that they would be exploring changes in high-level policy,” Bradley Merrill Thompson, a lawyer at Epstein Becker & Green, and a member of a panel that advised FDA on health information technology regulations, wrote in an email. Thompson said Sklamberg is a high-ranking official with broad responsibilities, including drug policy and FDA's field force, which might indicate the breadth of's interests.

The meeting might have “something to do with the retail distribution of FDA-regulated products, and that the company needs some sort of change in policy to do whatever it is they have in mind doing,” Thompson speculated. “Amazon is always so creative that they tend to enter markets in a big way, disrupting existing business models. It will be fascinating to see whatever they have in mind.”

Dan Haley, a vice president for government and regulatory affairs at cloud-based electronic health records firm Athenahealth, speculated that Amazon might have an interest in wearables or mobile health, given its recent introduction of a smartphone.

Amazon is already involved in healthcare. Mike Payne, head of medical affairs at startup Omada Health, said Amazon's cloud computing services, Amazon Web Services, was an “incredibly big part of the growth of our business,” once it certified as being compliant with Health Insurance Portability and Accountability Act regulations. David Shaywitz, chief medical officer for DNAnexus, agreed.

However, Paul Misener,'s vice president for global public policy, previously testified on Capitol Hill that his firm finds HIPAA-compliance burdensome. But HIPAA is not an FDA matter, so it's unlikely that was under discussion.

Another potential conversation between the FDA and Amazon might involve pharmaceuticals. Dr. Ford Vox, writing for Slate, has criticized in the past for serving as a marketplace for prescription drugs, and testified for the FDA to assert its jurisdiction to ensure Amazon didn't sell such drugs in the future.

By Darius Tahir @dariustahir

rob halkes's insight:

Really, All big companies are seeking the way into helping themselves into the big market of health care! Orientations are under way and implications for regulations seem to be discussed. It may go quick now.

However, there is just one critical edge to it all: Development and implementation will need some reconciling of interests of several and different, but definitely concerned stakeholder parties. One of them being patients (representatives). To enable that, one needs to adopt a co-creative method to both mutual and group discussions. See here!

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Reforming Healthcare in Europe - The Need to Transform the Medtech Model in Europe

Reforming Healthcare in Europe - The Need to Transform the Medtech Model in Europe | Health Care Business |

Pressure is rising in Europe and will force the medical-technology (medtech) industry to fundamentally change how it operates.


The outlook for medtech in Europe is deteriorating as pricing pressure mounts, competition intensifies, and payers demand clear evidence of the cost-benefit tradeoff for products.


Medtech companies need to make the most of their current operations by taking steps to transform their commercial model, prove the clinical and economic value of products, and improve their cost structure.


Medtech companies must also reinvent how and where they compete—an effort that includes innovating differently, expanding to adjacent markets, and exploring the “value” segment.

See BCG report here

rob halkes's insight:

Great Insight originated by Medtech Europe about the need for change of Healthcare in Europe specifically looking for value based innovation! Inspiring read. Look at the executive summary of the Economist Report here


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How Care Collaboration Can Lower the Cost of Healthcare Delivery | NaviNet

How Care Collaboration Can Lower the Cost of Healthcare Delivery | NaviNet | Health Care Business |

It is not news to anyone that healthcare costs are spiraling out of control, threatening to equal more than one third of the U.S economy by 2040. This dilemma is everyone’s problem: the government, health plans, employers, physician offices, and patients. In a survey of 1,400 chief financial officers in a stratified random sample of U.S. companies, healthcare costs ranked as the number-one concern.

2012 | Laura McCaughey


The care collaboration model embodies a team approach to healthcare. It includes the health plan sponsor, the physician office, and the employer as part of the patient’s care team, along with the physician acting as quarterback, managing specialists, procedures, and all aspects of care. This effective care leadership team—including the new team member, the care coordinator—is essential to achieving success in clinical care outcomes and engaging the patient to ensure compliance with a given treatment plan. And
the right technological solution can enable all parties to contribute to better outcomes.

Download document here

rob halkes's insight:

Great stuff to read: Opinions and approaches lead to integrated care.

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Leaders in search of followership

Leaders in search of followership | Health Care Business |

In a conversation with Barbara Kellerman journalist Kenneth Mikkelsen explores why leadership is so hard to exercise today. This is a must read for everyone interested in leadership and management trends. 

The interview with Barbara Kellerman relates to her latest book: "The End of Leadership."


Barbara raises the important questions: Why are our leaders so widely disdained—and why is our trust in leaders of every stripe at a leaden low? Why do incompetence and intemperance continue rampant? Why are ethics so elusive? Why is teaching leading full of “flaws”? Why has it proved so hard to build a body of knowledge? Why has the leadership industry, for all its apparent successes, failed on so many levels? 


Barbara has strong opinions about the leadership industry. She doesn't believe that becomming a leader is a quick fix that can be learned from a seven-step guide written by former CEOs or short and expensive leadership courses.


For futher information:


Visit Barbara Kellerman’s personal blog:


Barbara Kellerman discusses some of the core topics of her book in this video:


Get inspirered from this video about followership: Leadership from a dancing guy:


Curated by Kenneth Mikkelsen on



Via Kenneth Mikkelsen
rob halkes's insight:

Leadership : as much a factor in good health as medical knowledge..

Fernando Mazzuli's curator insight, August 23, 2013 9:00 AM

Real leadership development - something that takes time and reflection, involves personal values, context and effective practices.

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WHO/Europe | Publications - Realizing our vision: report of the Regional Director on the work of WHO in the European Region in 2012–2013

WHO/Europe | Publications - Realizing our vision: report of the Regional Director on the work of WHO in the European Region in 2012–2013 | Health Care Business |
World Health Organization Regional Office for Europe
rob halkes's insight:

Curious what it will tell..

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Internet Trends 2014 by KPCB

Internet Trends 2014 by KPCB | Health Care Business |

Insightful and nuanced overview of internet trends 2014!

Maybe you like my take on health care trends 2014, just a summary,  see here:

Since its founding in 1972, Kleiner Perkins Caufield & Byers has backed entrepreneurs in over 500 ventures, including AOL, Amazon, Citrix, Compaq, Electronic Arts, Genentech, Google, Intuit, Juniper Networks, Netscape, Sun, Symantec, Verisign and Zynga. KPCB portfolio companies employ more than 250,000 people. More than 150 of the firm's portfolio companies have gone public. Many other ventures have achieved success through mergers and acquisitions.

rob halkes's insight:

Internet trends 2014. Specific overview by KPCB.

No easy read, but great data.

You might want to have a look at the mustbe trend for health care 2014, my take of it, that is, here:

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"Co-creation" and "Experience Co-Creation" in Health Care

Co-Creation and Experience Co-Creation are two terms which appear usually as puzzling to those who learn about it for the first time. They often think it is like doing or working together. Instead, it is just because of failing cooperation and collaborative work approaches that co-creation is relevant. It is highly successful in many of branches. To health care there are  projects that worked with it. But in general the Health Care Business is not easily changing to these unavoidable methods to create personalised care, and an effective eco system and context to enable self management by patients. Here's the introduction.

rob halkes's insight:

Here's my take on co-creation of health care. Based on my experience with health care innovation and reform, it is the most suitable method to arrive at sustainable innovation with all stakeholders. This is an introduction.

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Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary

Establishing Transdisciplinary Professionalism for Improving Health Outcomes:  Workshop Summary | Health Care Business |
Establishing Transdisciplinary Professionalism for Improving Health Outcomes is a summary of a workshop convened by the Institute of Medicine Global Forum on Innovation in Health Professional Education to explore the possibility of whether different professions can come together and whether a dialogue with society on professionalism is possible. Most of the 59 members making up the Global Forum were present at the workshop and engaged with outside participants in active dialogue around issues related to professionalism and how the different professions might work effectively together and with society in creating a social contract.

The structure of the workshop involved large plenary discussions, facilitated table conversations, and small-group breakout sessions. In this way, the members - representing multiple sectors, countries, health professions, and educational associations - had numerous opportunities to share their own perspectives on transdisciplinary professionalism as well as hear the opinions of subject matter experts and the general public.

Efforts to improve patient care and population health are traditional tenets of all the health professions, as is a focus on professionalism. But in a time of rapidly changing environments and evolving technologies, health professionals and those who train them are being challenged to work beyond their traditional comfort zones, often in teams. A new professionalism might be a mechanism for achieving improved health outcomes by applying a transdisciplinary professionalism throughout health care and wellness that emphasizes crossdisciplinary responsibilities and accountability. Establishing Transdisciplinary Professionalism for Improving Health Outcomes discusses how shared understanding can be integrated into education and practice, ethical implications of and barriers to transdisciplinary professionalism, and the impact of an evolving professional context on patients, students, and others working within the health care system.

rob halkes's insight:

Innovating Health Care is a multidisciplinary effort. It demands of any discipline, and thus from all related professionals, a truly professional attitude, that is: putting the interests of the object of study and development first! That is not the same as once own career, place in the organization, business profit or the like. In my personal history I have only seen a few truly professionals who had the attitude and the skills to deliver multidisciplinary cooperation. In my consultancy to Health professionals I use the "design" approach as described by Donald Schön. Though he delivers the right method to educate professionals to participate in multidisciplinary ways, it is alas not given to all to accomplish this. Co-Creation in design is more the sort of work we seek and need, than just "working together" ..

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The Innovator Hospital Poised to Deliver Future Care | Deloitte 's take

The Innovator Hospital Poised to Deliver Future Care | Deloitte 's take | Health Care Business |

The Innovator Hospital Poised to Deliver Future Care.

Published by HIMMS Media

See eBook, Download and Intro Video Here

The Innovator Hospital: Poised to Deliver Future Care is an eBook that features valuable insights on the changing landscape of the Healthcare IT industry. Learn about leading practices from our thought leaders and their strategic thinking through a series of interviews by Deloitte’s key industry leaders, client interviews, research and thought leadership articles on government reform, new risk-based models such as value-based care, M&A activities, growing patient populations with complex needs and increased competition amid shrinking resources that are driving transformation.

rob halkes's insight:

Inspiring to see Visions on the Future of Care!

Here's Deloitte's take.Core issue? Innovation. They acknowledge that it is not just "a" "Solution" but a task to tailor it to your specific business in care. Couldn't agree more!

Why? Ask me!

We have several strategic and practical workshops that brings to you an overview of your own thought, your opportunities but also barriers to change, and finally your  own roadmap to put it in reality.


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Doctors and Tech: Who Serves Whom?

Doctors and Tech: Who Serves Whom? | Health Care Business |
Giving physicians more say in how to incorporate technology into their work is good for patients, and the field.

If you want to discourage a worker, subject them to policies and procedures that don’t make sense. This principle was first described by Frederick Herzberg, an American psychologist who developed one of the most widely studied theories of workplace motivation. Unfortunately, Herzberg’s principle is being widely applied today in medicine. Changes in healthcare payment systems, the use of information technology, and the doctor-patient relationship have left many doctors deeply discouraged.


It is easy for many healthcare leaders to forget that doctors go into medicine not because they enjoy entering data into complex electronic health records and ensuring that their employer gets paid for everything they do, but because they want to make good diagnoses, prescribe appropriate treatments, and help patients.


What can be done? Weygandt argues that doctors need to play a more active role in all aspects of healthcare’s future, not just implementing but also designing it. Too often, such decisions are currently being made by people who do not take care of patients, and in many cases, have never cared for patients.

“Every innovation should be tested not just to see if it increases revenue or cuts costs,” he says, “but also to ensure that it enhances the doctor-patient relationship.”

Everyone involved in contemporary healthcare—patients, doctors, nurses, hospital administrators, payers, and politicians—needs to recognize the importance of preserving and promoting medical professionalism. Good medical care is an art as well as a science, and the professionalism of doctors is at its core. “Doctors should be encouraged to think first not of their own incomes but the needs of their patients, and that means designing systems that keep the patient front and center.”


New technology can do a better job of helping doctors practice better medicine.... But change isn’t easy. ...

As Frederick Herzberg would put it, “If we want doctors to do better work, we need to give them better work to do.” Medicine practiced well—in such a way that it really makes a difference in the lives of patients, families, and communities—is a great deal more fulfilling than medicine practiced poorly. If doctors are to enjoy the opportunity to make such a difference, they must cease to be the tools of their tools, and instead become their designers.

rob halkes's insight:

The blog does describe neatly the optimal and ideal relationship between engineers and doctors. I would say co-creation of technology by all stakeholders would be the norm. Next to doctors I would also prompt to involve patients into it. Often I have witnessed simple issues that make the difference to them.

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