Top 10 Canada Healthcare Game Changers

Insight Driven Health

Top 10
Healthcare Game Changers
Canada’s Emerging Health Innovations and Trends

Copyright ©© 2011 AccentureAll Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.
Copyright 2011 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

The time has come for healthcare
transformation in Canada…
From health reform and skyrocketing costs to consumer expectations and technology advances,
healthcare in Canada is undergoing significant transformation. The entire health community from
private providers and public health organizations to patients themselves is feeling the impact and
looking for new outcomes.

What emerging trends and innovations are driving Canada’s healthcare transformation—
from today and into tomorrow? And what organizations are leading the way to change?

Accenture works across the global health community helping our healthcare clients achieve high
performance by using knowledge in new ways to deliver more effective, efficient and affordable
healthcare with Insight Driven Health. Our thought leaders have drawn on this experience—along
with our work with health organizations in Canada—to provide our insights on the Top 10 Healthcare
Game Changers to watch.

Take a moment to explore our future vision for the nation’s healthcare landscape. Discover a range
of technology-driven, information-powered trends—including organizational and structural
reinvention, new options for providers and care delivery and innovative consumer empowerment
tools and approaches. While each is unique, together, they will contribute to a new model of Insight
Driven Health for Canada.

Copyright © 2011 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 2

Canada’s Top 10 Healthcare
Game Changers

1 Healthcare Clouds
Taking health records off the mainframe 6 Social Networking
Patient-connected online communities

2 Health Analytics
Data insight into action 7 Point-of-Care Diagnostics
De-centralizing the centralized lab

3 New Payment Models
Toward outcomes-based funding 8 Hospital at Home
Home is where the care is

4 Tablet Computing
The key to health IT adoption 9 Regionalization 2.0
Aggregate then integrate

5 mHealth
The rise of the mobile health consumer
10 Exporting Health
New pursuit of commercial opportunities


1 Healthcare Clouds
The Internet and cloud computing will take health records off the mainframe
for secure and unprecedented access to health stakeholders anywhere in
the world.
Taking Health Records off the Mainframe
Today. Electronic health records today are most often housed on
siloed, institutional databases that do not facilitate easy information
access for cross-organizational data sharing and are not available
to patients and consumers.

Tomorrow. Part of the utility computing trend, healthcare clouds will
push the trend away from large monolithic systems to point-of-care
systems. Clouds are secure Internet-based platforms used to link,
access, store and manage health information. Healthcare clouds
will help providers access and store information in more efficient,
flexible and secure ways while helping save money—driving the
push toward physician electronic medical records. For patients and
consumers, healthcare clouds will be a platform for personal health
records, offering new access, control, visibility and convenience.
While clouds are focused on information, services may also be
delivered over these emerging health care platforms.

Leading the Way. Microsoft HealthVault is an online health
information storage tool with services for consumers and providers.


2 Health Analytics
With more health data at their fingertips, decision makers will rely on
analytical capabilities to evolve to the next level of healthcare delivery.

Data Insight into Action
Today. Current systems typically measure healthcare
as a series of transactions rather than a process that
may or may not be executed as designed. To reach the
next level of quality and innovation in care delivery,
practitioners require a comprehensive set of facts
around healthcare delivery including compliance with Visualizing and
every aspect of the protocol and care outcomes. comparing
hospital
Tomorrow. Canada’s growing network of electronic performance
medical records lays the groundwork for advanced Visualizing future
analytics. Together, advanced analytics and new data chronic care costs
visualization techniques will help unlock the power of in the future by
data to drive more informed decision making and, New ways of geography
presenting
ultimately, higher quality, lower cost care—from public Access to health lab data
health monitoring and prevention to the treatment of information to deliver
chronic illnesses. high quality care

Leading the Way. GE is a leader with data visualization
projects in its groundbreaking Healthymagination effort.
NHS Evidence provides access to a wide range of
health information to deliver quality care.


3 New Payment Models
Future payment models will be tied to quality and outcomes in a pay-for-
performance model that will ultimately replace output-based funding.

Toward Outcomes-Based Funding Hospital Funding in Canada
Today. Fee-for-service is the principal method of “Variable” case complexity adjustment
remuneration for more than 70 percent of physicians in “Variable”
100%
Canada.1, 2 Only a minority are paid by salary, capitation or outcome-
alternative payment plans. Hospital funding is based mainly linked
on global budgeting. None of these methods are linked to funding*
80%
service quality or outcomes.
Per-patient
Tomorrow. The convergence of health reform, new data funding
60%
availability and access, and the push to lower healthcare Case
“Fixed”
costs will drive the shift toward outcomes-based funding in complexity
block
Canada and globally. New funding models will be linked to 40% adjustment
funding
meeting specific targets, adjustments for patient case mix
and other measures related to achieving quality outcomes. “Fixed” block
20% funding
Leading the Way. In Canada, there are new payment
model pilot projects underway. There are also initiatives
focused on intermediate steps such as “patient-based 0%
payments.” While there are no clear leaders globally, Current Future?
Sweden, Geisinger Health System and Blue Cross Blue
Shield of Massachusetts have value-based purchasing
mechanisms in place.
1) CIHI National Physician Database 2008-2009; 2) Canadian Medical
Associationhttp://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Statistics/39-Chart-DistRemun.pdf)

4 Tablet Computing
Easy-to-use and portable, tablet computers will play a critical role in unlocking
clinical adoption of technology like physician electronic medical records.

The Key to Health IT Adoption
Today. Tablet computers have been well received by the
public. The healthcare community has shown interest in using
tablet computing to transform healthcare. Tablet computers
offer the advantage of ease of use, portability and long battery
life and allow users to have “visual” conversations with patients
for an engaging “user” experience.
Tomorrow. More than 60 percent1,2 of physicians have
expressed interest in using the iPad for healthcare purposes.
The combination of consumer and provider interest could drive
a preference for tablet computers over traditional computers.
Tablets could become an educational tool at the point of care
and a catalyst for increasing physician adoption of health care
IT.
Leading the Way. Stanford Medical School announced it will
provide all incoming students with an Apple iPad as part of a
trial to improve and transform medical education.3 Kaiser
Permanente, among other organizations, announced plans to
test the iPad for clinical use by physicians and nurses.

1) Business Wire. http://www.businesswire.com/news/home/20100204006741/en/Physicians-Purchase-iPad-60-Percent-Intrigued-Device
2) Morningstar;http://news.morningstar.com/all/business-wire/20110302005507/ipads-are-the-tablet-of-choice-among-us-physicians.aspx
3) Stanford : http://med.stanford.edu/ism/2010/august/ipad.html


5 mHealth
Health apps for mobile devices will empower healthcare consumers,
change their behaviors and drive new clinical management and
physician-patient interactions.
The Rise of the Mobile Health Consumer
Today. Mobile technology and mobile apps have become a
part of everyday life for many people. Interest in health apps is
exploding with new applications released weekly (100+ percent
growth rate and 78 percent increase in total apps in six
months.1) Bant, developed in Canada, is one of the new class
of apps simplifying diabetes management. Users can record
their glucose readings, links to popular health accounts and
share information.
Tomorrow. More than 9 percent2 of Americans reported having
at least one health app on their smartphone in 2010. The
popularity—and consumer appetite for—mobile health apps will
continue to rise worldwide. These apps will become more
sophisticated, empowering consumers to change their
behaviours by making it easy to monitor health information.
Mobile apps will become another channel for providers to
interact in real time with patients.
Leading the Way. There are no clear leaders in the consumer
mobile app space, but Epocrates has been developing clinical
applications for several years.
1) MobiHealthNews: http://mobihealthnews.com/9396/number-of-smartphone-health-apps-up-78-percent/
2) Pew Internet & American Life Project, Mobile Health 2010: http://www.pewinternet.org/Reports/2010/Mobile-Health-2010.aspx


6 Social Networking
Social media/networking tools will make it easy for patients to connect and
share information, empowering them to take greater control of their health.

Patient-Connected Online Communities
Today. Patients are using the Internet and social
networking tools to connect with one another and to share
information about their health and healthcare
experiences.
Tomorrow. Moving beyond initial trends of connecting
and information sharing, the next wave of opportunity will
be around patients managing and “curating” healthcare
information via social networking sites. Consumers will be
able to access trusted sources and reliable information
that reflects patient needs. Social data on healthcare
(perception of care, treatment regime, experience, etc.)
will be a key part of this content.
Leading the Way. PatientsLikeMe.com is one of several
leading Web sites that has created an online community
for patients with similar diagnoses to help improve their
quality of life. Members can chart symptoms with tools
that collect outcomes-based patient data and share
experiences and resources with other patients and
partner healthcare stakeholders.


7 Point-of-Care Diagnostics
“Point-of-care” and “lab on a chip” testing technologies will transform
diagnostic services and de-centralize the lab.

De-centralizing the Centralized Lab
Today. The at-home pregnancy test was one of the first
mass market point-of-care tests (PoCTs). The test gave
women new control over their health information. Today,
newer and more accurate tests for other diagnoses and
monitoring of chronic conditions are available, bringing
new convenience, control and ease-of-use to consumers.
Recent advances toward “lab on a chip” allow for Total PoCT Spending in Canada, 2003-2013
thousands of tests to be run on just a few drops of blood. $400
Tomorrow. PoCTs will continue to simultaneously drive $350
consumer empowerment and improve care with the ability $300
to provide reliable and “instantaneous” results without the Millions $250
need for a large centralized lab. This transformation can $200
also play a role in lowering healthcare costs. $150
$100
Leading the Way. There is no clear leader in this area
today, but pharmaceutical companies are already making $50
significant investments in new PoCTs. $0
2003 2005 2007 2009 2011 2013 2015 2017 2019

POCT spending in Canada estimated based on 1) Point of Care Diagnostic Testing Sector Trends
http://trimarkpublications.ecnext.com/coms2/summary_0230-4082_ITM?referid=3470&gclid=CLKh-IjWkZsCFSAhDQodGFEZpg and 2) Point of Care testing established world-wide: Tran
NK, Kost GJ. Worldwide point-of-care testing: compendiums of POCT for mobile, emergency, critical, and primary care and of infectious diseases tests. Point of Care: The Journal of
Near-Patient Testing & Technology 2006;5:84-92. using official US/Canada exchange rates and OECD health expenditure reports

8 Hospital at Home
Advances in remote-monitoring technologies will transform healthcare
delivery, driving the rise of at-home care options for eligible patients.

Home is Where the Care is
Today. Looking to control healthcare costs and provide
quality, effective care, there is a push to deliver more
services within the home for patients whose diagnoses
meet certain eligibility requirements. Advances in
technology allow for remote monitoring and delivery of
services without the need to stay in an acute care facility.
Tomorrow. Technology advances will continue to enable
more hospital at home options for diagnostics, the care of
chronic conditions and post-surgical recovery. This trend
is key in lowering hospital admissions and costs,
eliminating hospital-acquired infections and supporting
the patient’s comfort and the physical and mental well
being so essential to recovery.
Leading the Way. Kaiser Permanente is emphasizing the
“home hospital” as a method of providing flexible, patient-
centered and cost-effective care. Ontario Telemedicine
Network is one of the world’s largest telemedicine
networks.


9 Regionalization 2.0
The push to deliver better, more cost-effective healthcare will lead to the
emergence of “super regions” in order to truly integrate care and services.

Aggregate then Integrate
Today. The clear need to lower healthcare costs in the
wake of an unprecedented global health reform mandates
has sparked moves toward the regionalization of
healthcare. The overall aim is to achieve true integration.
Already, regional integrated care networks are emerging
to drive new efficiencies and economies of scale.
Tomorrow. The emergence of these larger regional
systems along a centralized governance model and
stable funding will continue to enable better integration.
Key benefits will include the consolidation of systems,
standardization of care protocols and the development of
shared service models or managed services contracts.
Leading the Way. In Canada, Alberta Health Services is
an example of this trend. And in the United States,
Geisinger Health System is a regional integrated network.


10 Exporting Health
To pay for rising healthcare costs, public health organizations will become
more entrepreneurial and pursue and export commercialization opportunities.

New Pursuit of Commercial Opportunities Health Expenditures in Canada, 1975-20101
$200
Today. Healthcare organizations outside of Canada are
entering new markets—foreign markets in particular—in $180
an attempt to generate new revenue. Opportunities $160
include partnerships, licensing deals, expansion into new
markets and commercialization of IP. $140
$120
Tomorrow. While the need to generate new revenue will
continue to drive this trend, other factors such as the $100

Billions
need to develop new skills, maximize existing resources $80
and build a healthcare brand will come into play.
$60
Leading the Way. The Swedish government has
$40
announced plans to export its model of healthcare and
will partner with private sector firms to pursue $20
opportunities aggressively. $0
The University Health Network and the Cleveland Clinic 1975 1985 1995 2005
are both exploring private, for-profit initiatives to generate
new revenue sources. Private Spending Public Spending

1 Figures for 1975 through 2005 taken from National Health Expenditure Trends 1975-2005 (NHET), published by the Canadian Institute for Health Information (CIHI).


What Do You Think?
• Today. Which trends do you see influencing your
organization today?
• Tomorrow. Which trends do you think will have the most
impact on your organization in the next two years?
• Business. What trends do you think best align with your
short and long term business objectives?
• Environment. What other healthcare trends are you
tracking today?
• Challenges. Do you have any concerns about how these
trends will impact your organization and its stakeholders?


For more information
To learn more about these healthcare game changers—and how they
might impact your organization, please contact:

Sanjay Cherian
Health Industry Lead, Canada
Sanjay.Cherian@accenture.com
416-641-3718
http://www.accenture.com/insightdrivenhealth


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