Health-as-a-Service

Over years doing exclusively eHealth business, experience taught me that all talks, assessment and initiatives end on the question, why would we invest in eHeatlh? What is investors’ return on investment? And this article is all about fragmentation between interests, drivers and overall responsibilities within the healthcare sector. This is the single most important cause of weak traction for eHealth industry.

The fact that there is still no provider of Health-as-a-Service on the market, shows enormous potential for the largest international companies. The concept is usual “Something-as-a-service” business model. You pay certain fee under certain condition and some service provider guarantees to you a certain service level agreement condition for your health.

Who does what and why?

• There are tons of particular healthcare service providers like diagnostics, healthcare treatments, medications, vital parameter monitoring devices, rehabilitation, prevention and any many other health related services/products, but no one goes from end-to-end taking overall responsibility. Not even close.
• Healthcare services organizers, e.g. ministries of health/payers, depending on regional healthcare service organisation structure, are talking and maybe even trying to cover end-to-end, but are at its maximum achieving data exchange between primary and secondary care.
• Each healthcare service provider is competing exclusively within its own niche domain. Healthcare service financial reimbursement tools, e.g. DRG, are also trying to act like equalizer and common denominator for provided healthcare service quality, but in fact it is not reaching nowhere close to what is actually necessary that service recipients are not exposed to constant redirections and excuses why their healthcare experience still have huge potential for improvement.
• “Value based healthcare” concept is very interesting and promising buzzword, but main challenge remains, who will take the ownership for health-as-a-service and how wide it will reach? Will it really go end-to-end? And what happens when it is not reached?

A perfect example

At one of numerous healthcare events, there was a perfect example where after one payer representative presented plans to cover end-to-end healthcare service, first comment from audience was an executive representative of one of one hospital who asked how exactly do payer plans to execute that? Hospital representative claimed that his hospital is providing exceptional quality of service level and is reimbursed by that very payer exactly the same as other hospitals who are nowhere close in with quality service delivery. The representative of payer replied with fast “slice backend” asking which by which exact measuring unit is this hospital claiming that their service is superior? After this discussion went in direction where main topic about end-to-end service was very soon long forgotten. Similar discussion we are witnessing regularly between various healthcare ecosystem stake holder; rehabilitation vs. clinical, payers vs. pharma, GPs’ vs. hospitals, and so on.

Exactly in this I see main challenge for eHealth concept. Interest,/drivers and above all success measure parameters, which should be resulting in responsibility of healthcare ecosystem stakeholders, are completely detached from other healthcare ecosystem stakeholder success measure parameters. In the end, no one is taking responsibility to handle all existing health impacting factors in one simple service, guaranteeing that under exactly defined conditions, people will remain healthy, and when they get ill, same contracted legal entity will arrange all it takes to return this client back in to healthy condition in most efficient and quality assured manner.

Is it really so complex?

Surely it is not simple, however we must take into account the fact that market potential basically cannot be larger as it is. Healthcare in all developed countries represents single largest total GDP participation and also when it comes to illness, people are not choosing measure in order to get healthy again.

Once someone will proved Health-as-a-Service, then all this BI, AI, DSS and similar technology tools will have much more sense, because there will be super strong driver for prevention of illness as this will increase sustainability healthcare sector. On the other hand, Health-as-a-Service providers will be actually driven to compete for clients cause single most important selection parameter for Health-as-a-Service provider will be pure price performance.

To break it down in super plastic example; Based on my age, weight, medical history, lifestyle and similar health impacting parameters, I can get Health-as-a-Service package which would provide me my health single point of contact. In case of some illness, I don’t need to search which kind of physician is most appropriate for first interaction, second interaction, diagnostics, therapy delivery, pharmaceuticals, food supplements.. anything. Also for some premium level of service I can opt-in for package in which I would like to finally get rid of my belly fat. Based on my track record of previously consumed service, I will have some market score so that service providers can know how risky I am as a client.

One of the most easy to corelated analogy from other industries would be car leasing. I can get monthly package which takes care about any smallest details related to my transportation vehicle. I don’t need to think which tires, oil, insurance or any other parameters are the best for this vehicle and for which type of drivers habits.

Organizing the system

With such market condition, no one will ask why should we invest in to eHealth? It will be crystal clear which (digital) tools are improving quality of service level and Health-as-a-Service providers will actively compete on the market to attract as much clients as possible. In today’s reality this occurs mostly on declarative basis. Ministries of health are there as a given fact, while hospitals, general practitioners, care givers and others are aware that they will get patients either way and the fact that they would invest in eHealth solution will not significantly change their reality .

On top of this, the fact that in many healthcare systems there is a financial cap regardless of quantity, and often not quality of provided service, is totally devastating.

Just to assure all extreme socialists who read this article, I am aware and fully agree that healthcare under no condition cannot become luxury and it must be available to everyone. My point is that also ministries of health/payers, should be driven to transparently compete and be responsible for quality of service they provide and exposed to market conditions. In many examples from various industries we have evidences how public service organisation were not able to make it sustainable nor profitable until they got competition.

What do you think?

Unfortunately, from today’s perspective, we are quite far from such service organisation. This allows each healthcare service providers to point finger at other healthcare ecosystem stakeholders, while claiming that they are doing their job flawlessly.

Who do you see as most prominent company profiles and how could they offer to us Health-as-a-Service?