Karen Taylor, Deloitte. Presentation at Health-Tech Innovation LAB Connected Health Conference 18.09.2015

1. Connected Health How technology is transforming patient care today and tomorrow Karen Taylor 18 September 2015

2. 2 Publications Deloitte UK Centre for Health Solutions Established November 2011 to generate insights and thought leadership based on the key trends, challenges and encourage collaboration across the health value chain, connecting the public and private sectors; health providers and purchasers; and consumers and suppliers. www.deloitte.co.uk/centreforhealthsolutions blogs.deloitte.co.uk/health/

3. How technology and cross industry working are transforming patient care today and tomorrow Centre for Health Solutions3 Healthcare and Life science predictions 2020 Disrupting traditional healthcare and life science industries How digital technology is transforming patient care today

4. Our industry is changing quickly – requiring a bold response that is often difficult to implement What we know today and estimate about tomorrow 4 2. 2015 Global Life Sciences Sector Outlook, Deloitte DTTL, 2014 3. Informa Plc Market Line Extracted 181014

5. Patients becoming more like consumers Informed and demanding patients are now partners in their own healthcare 5 • Individuals are better informed about their own genetic profile, their health status and risks. • Informed consumers demand specific treatments and the best services. • Fully engaged with the ‘quantified self’ & prevention agenda and use information and data to get best treatments. • Increasing number of people comfortable consulting with a doctor or other HCP through video or skype • Consumer access to EHRs continues to increase • Increasing number of Government initiatives to empower patients via digital - increase in online patient communities PatientsLikeMe over 300,000 members/ 2,300 conditions. • In UK still only small % people engaged • UKs 100,000 genome project; growth in precision medicine, 23andMe actually advertising on UK TV • Insurance companies/employers providing incentives that reward good behaviour • Clinicians are becoming more actively engaged (Dr Now; Babylon) 2020 prediction Today’s evidence

6. Healthcare delivery systems in 2020 6 • The home is where much of the standard TEC care takes place. • Specialist hospital treatment is reserved for trauma and emergencies – electives largely day surgery. • Many doctor–patient contacts are now virtual and informed with real world evidence. • New funding models including year of care, pooled budgets capitation, etc. • PatientKnowsBest ‘patients own their own healthcare information and decide who they share it with • Increasing number of GPs using telephone triage and eVisits - Kaiser number “e-visits” has grown from 4.1 million in 2008 to 12 million in 2014. • New provider models /entrants ( Walmart, Apple, Google, Pharma) The era of digitised medicine - new ideas drive new models 2020 prediction • Home monitoring of patients with LTCs (COPD and Diabetes leading way) – but also home administration of insulin/ warfarin/ chemotherapy • ACOs with vertically integrated care and care pathways designed around the patient overcoming silos - New models of care being piloted (FYFV) Today’s evidence

7. Wearables and mHealth applications in 2020 7 • Affordable wearables shape the quality of life of the 2020 consumer, monitoring & managing their condition. • Seamless integration of information from different devices provide comprehensive view • New clinician/ patient partnerships based on more equitable relationships, co-creation and a focus on prevention. • Venture funding of biosensors and wearable technology continues to increase significantly • mHealth market revenue reached USD 2.4bn in 2013 and is projected to grow to USD 26bn by the end of 2017 • Consumer engagement with their own data is starting to improve medication adherence and management of chronic disease Measuring quality of life not just clinical indicators • Proliferation in health apps and wearables (6% adult population) with Apple watch latest gimmick? • Accuracy and interoperability between devices/ analysis tools still to be addressed • 50% of people who download apps say its to improve understanding of own health and well being 2020 prediction Today’s evidence

9. In last 5 years healthcare systems in most countries have come under increasing pressure in terms of costs, funding, demand, supply, access and expectations 9 Escalating healthcare costs Increasing care complexity A change in patient Expectations Evidence for use of TEC services • More expensive medicines • Increasing demand for diagnostics • Increasing staff costs and reducing supply • Expanding funding deficit • Aging population • Rising prevalence of multiple long term conditions • ‘high and increasing bed occupancy and delayed discharges • Patients expect and demand better quality care - co-creation • Support needs to be patient-centred • Desire to move to outcome based/value based funding • Mobile and digitally enabled technology increasingly seen as a solution to overcome todays challenges improving: ‒ productivity ‒ efficiency ‒ cost ? Why TEC is important and how it can help transform health and social care

10. Deloitte Global Mobile Consumer Survey, 2015 10 Source: UK edition, Deloitte Global Mobile Consumer Survey, May-Jun 2013 & May - Jun 2014 Base: All respondents, UK, 2015: 4,000, 2014: 4,000, 2013: 4,020 In 2015 Smartphone and tablet penetration in UK has continued to increase, fitness bands and smart watches still very low penetration N/A 76% 62% 36% 29% 1% 75% 70% 50% 31% 1% 2% 79% 76% 60% 31% 2% 4% 0% 50% 100% Laptops Smartphone Tablet eReader Smart watches Fitness bands Penetrationrate 2013 2014 2015 16% 23% 14% 8% 3% 15% 25% 19% 5% 4% 5% 16% 26% 19% 4% 6% 6% 0% 5% 10% 15% 20% 25% 30% Laptops Smartphone Tablet eReader Smart watches Fitness Band Penetrationrate N/A Q. Which of the following devices, if any, are you likely to buy in the next 12 months? Q. Which, if any, of the following devices do you own or have ready access to?

11. Bio-sensing wearables Functionality is expanding and use is becoming increasingly unobtrusive 11 Hearing device to boost hearing Heart rate monitor patch Wrist band that monitors heart beat, blood pressure, calories burnt Insole sensor that measures weight bearing, balance and temperature Contact lenses that monitor glucose levels Smart pills that monitor medication intaking behaviours and body response

12. Tackling the barriers to the uptake of digital health In 2014 the European commission launched a stakeholder consultation that identified the following barriers to wider digital health adoption Source EC consultation on mHealth Green paper 201412 Barriers to mHealth adoption Lack of data protection, privacy, and security standards Concerns over patient safety, quality and liability and need for a clear legal and regulatory framework Limited cost effectiveness evidence Lack of interoperability and interoperability standards Inadequate funding or reimbursement models Cultural resistance from healthcare providers

13. Connected patients: shifting the balance of power Digital technology empowers people to understand and manage their own health and the health of others 13 75 per cent of the UK population are going online for health information • This can be an important enabler of self-management for patients with chronic disease and provide vital support for a growing number of carers • It is helping shift healthcare delivery, from a traditional paternalistic approach, towards shared ownership Traditional paternalistic model of care Empowered patient sharing ownership Empowered Doctor Empowered Patient Empowered Doctor Empowered Patient Health tech • Patient completely reliant on HCP to provide information, diagnosis and referral • Difficult for patients to navigate within and between health and social care • Interventions usually in response to physical evidence from patient • Fragmented commissioning limited patient choice or financial incentives to prescribe mHealth • Patients informed whenever & wherever using their interoperable electronic health record • Co-creation of care packages, proactive prevention and rapid access to services • Technology enabled supported discharge/ self management • New business models for commissioning TEC at scale and delivering choice

14. Connected providers: transforming ways of working GP practices have led the way in the move from paper to digital record-keeping but they are still slow to adopt technology in their interface with patients 14 GPs were the first to adopt: However: The full potential for technology to support primary care is widely under-developed • Digital record keeping • Email consultations • Telephone appointments & triage • Text messaging How TEC is benefitting providers Airedale NHS Foundation Trust: • 210 care homes • 113 in discussion Hospital • 35% reduction in Hospital admissions, A&E use fell by 53%, Hospital bed days decreased by 59%• Telehealth hub accessed by over 6,000 residents

15. Connected providers: transforming home and community care Supporting prevention, early intervention & early discharge from hospital 15 Supporting care at home – COPD Used by 150 patients 40% savings compared to ‘usual care’ = £100,000 26% decrease in GP appointments 70% decrease in hospital admissions 86% reduction in local out of hours services Virgin Care – a mobile working solution for nurse community visits Patient face-time increased by 29% nurses were seeing ~ 2 more patients/ day 60% reduction in paperwork time Home care TEC initiatives can support people with LTCs TEC can support community care staff and improve services to patients Wireless blood pressure, weight & pulse monitors Data stored in patients ‘HomePod’ Data transferred to physician who responds accordingly Hospital GP Patient Community Nurse

17. Future developments in digital health The rise of TEC is enabling new entrants to better understand customer requirements and enter the provider market as stand-alone providers or partners 17 Solutions that store and integrate health & fitness data Examples include: • Apple HealthKit • Google Fit • Microsoft health vault • PatientsLikeMe Scope to use this technology to allow health providers to receive and transmit data from health check-ups Apple’s launch of ResearchKit in which users decide if they want to participate in a clinical trial and how their data is shared Medical Device/ diagnostic technology • Google are partnering with Novartis, to develop smart contact lenses, which can monitor glucose levels and transmit real time information to a doctor • Google are also working on a nanoparticle pill that could identify cancers, heart attacks and other diseases before they become a problem. • IBM Watson partnering with Apple, Johnson & Johnson and Medtronic among others to develop a health platform. Pharma using technology to aid care delivery • Pharma among the most active mHealth app publisher; but impact is low – 12 companies have published over 700 apps to educate /assist or monitor treatment compliance • Pharma still clarifying ‘best fit’ within the digital health space • Opportunities include  online repeat prescriptions  tele-monitoring compliance  live dose adjustment based on real-time monitoring  early diagnosis – early prescription

18. Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited (“DTTL”), a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.co.uk/about for a detailed description of the legal structure of DTTL and its member firms. Deloitte LLP is the United Kingdom member firm of DTTL. This publication has been written in general terms and therefore cannot be relied on to cover specific situations; application of the principles set out will depend upon the particular circumstances involved and we recommend that you obtain professional advice before acting or refraining from acting on any of the contents of this publication. Deloitte LLP would be pleased to advise readers on how to apply the principles set out in this publication to their specific circumstances. Deloitte LLP accepts no duty of care or liability for any loss occasioned to any person acting or refraining from action as a result of any material in this publication. © 2015 Deloitte LLP. All rights reserved. Deloitte LLP is a limited liability partnership registered in England and Wales with registered number OC303675 and its registered office at 2 New Street Square, London EC4A 3BZ, United Kingdom. Tel: +44 (0) 20 7936 3000 Fax: +44 (0) 20 7583 1198. For further information contact: kartaylor@deloitte.co.uk

Karen Taylor, Deloitte. Presentation at Health-Tech Innovation LAB Connected Health Conference 18.09.2015

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Karen Taylor, Deloitte. Presentation at Health-Tech Innovation LAB Connected Health Conference 18.09.2015

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