Best practices and new approaches – from post-COVID-19 care to chronic disease management
This year’s CARE 2025 was the first fully digital conference by the Global Clinical + Care Coordination Forum (GCCCF). It welcomed participants from 32 countries in five continents. The live-streamed presentations by renowned speakers sported more than 600 views. Their focus was on healthcare post-COVID-19, on how to implement digital innovation in managed-care programs, and on chronic conditions including measures aimed at prevention.
In the context of mastering COVID-19, the key word is solidarity, underlined Ljubisav Matejevic when launching CARE 2025. The President of the Global Clinical + Care Coordination Forum went on to describe the importance of prevention in controlling drivers of enormous cost and harm – chronic conditions.
It’s a journey, said Chai Chuah about the transformation of care. According to the Former Director-General of Health & Chief Executive Officer, Ministry of Health of New Zealand, the transition to the future of healthcare that we want is hard but achievable. It requires a transformational approach – a shift from rescue and acute care to wellbeing and prevention as broader determinants. How should we implement those rapid technology advances we have been witnessing? Barriers, challenges present themselves in obsolete leadership and institutions, in the lack of team orientation and of courage. Plus – gaps are widening affecting affordability, access, and equity, added Chuah. COVID serves to accentuate this, deprioritizing routine services and exposing flaws in the system. To improve health services, we need to address also cultural, social, environmental, and economic determinants … and the “silver tsunami” with the resulting enormous health expenditures.
What will future healthcare be like? Chuah’s answer is, it needs to be personalized and precise, requiring precision medicine. It needs to be earlier, closer, and smaller. We need an emphasis on prevention and wellbeing. Future care will be consumer-driven; and privacy, security, equity, as well as affordability will be required to build trust and embracement by the public.
According to the expert, the future of healthcare is a transformation journey – we need to improve what is available now, and also create the new delivery of care, together! The approach needs to integrate culture change and viable courageous, team-oriented leadership to manage egos and build that new culture we need as a foundation.
COVID-19 is a forerunner of the disruptions in store for us due to climate change, continued Chuah, quoting visionary Klaus Schwab: there has never been a time of greater promise or potential peril – we need to think strategically about the forces of disruption and innovation shaping our future.
The future of healthcare in the UAE
The UAE bases its health system on international standards – and is eager to collaborate internationally to foster better care, said HE Dr. Amin Al Amiri. Innovation development and implementation are underway, the Ass. Undersecretary for Public Health Policy and Licensing, Ministry of Health and Prevention of UAE explained. This is demonstrated, e.g. by apps which support booking appointments, the management of prescriptions, diet and exercise, cardio monitoring, and many more. The UAE has been employing digital and biological innovations in fighting COVID-19, such as stem cells and antibodies taken from plasma.
HE Dr. Al Amiri went on to describe innovative activities in the UAE: the Emirates are working on developing and implementing technologies such as artificial intelligence, 3d printing, robotics, and many more during the upcoming 50 years. New legislation supports innovations such as these in the health services. He quoted HH Sheikh Mohammed bin Rashid Al Maktoum: Innovation is what defines our status among nations and the value we add to the world around us. – Let’s consider the future of healthcare, and the mission to Mars, a joint effort!
Non-valvular atrial fibrillation (AF) increases the risk of stroke nearly fivefold, said Prof. Dr. med. Paulus Kirchhof at CARE 2025. Studies show that, for prevention, early detection enables early anticoagulation, early rhythm control, and detection as well as treatment of concomitant cardiovascular conditions, the Professor of Cardiovascular Medicine, and Director, Department of Cardiology, University Heart and Vascular Center UKE Hamburg, went on to explain. Screening using conventional technology is resource-intensive, not very sensitive, and requires expert analysis – whereas consumer electronics can help to efficiently detect rare and frequent atrial arrhythmias.
So, remote monitoring can be done – but cardiologists are unsure as to what treatment to offer. Screening is not recommended per se because patients may not actually benefit from results, according to the cardiologist. The range of technologies to detect AF ranges from Holter ECGs to wearables, from implanted devices to consumer electronics including smartphones and smart watches enabling broad coverage, described Prof. Kirchhof. He finds constraints in the Apple Heart study with its focus on younger people, while the prevalence of AF is higher in people aged 55 years or more.
The current AFFECT-EU project will develop a targeted, risk-based AF screening algorithm, and thus contribute to the reduction of AF-related health inequities, of morbidity and mortality in Europe. Will it provide answers to what we don’t know in the context of technologically advanced screening for AF, asked the cardiologist: how to identify at-risk populations e.g. elderly people, stroke survivors, people with elevated biomarker levels, and patients presenting to hospitals? How should we react to rare and short atrial arrythmia episodes detected by screening – should we resort to treatment only after ECG documentation? What is the limit of ‘normal’ for AHRE, what is the arrythmia threshold to initiate therapy? No matter what the technology, evidence and smart health professionals are required, was the experts closing verdict.
Smart tech saves lives – and costs
Each year, 1.1 million strokes put lives at risk in Europe, incurring costs of 60 billion Euros to the healthcare systems – and these numbers are going up. Technologies can help master this challenge, stated Dr. Thomas Huebner. Technology-enabled screening can help master this challenge, the Founder and CEO, Preventicus GmbH went on to explain. Studies demonstrate that, per 100,000 participants, 600 strokes can be avoided, saving 12.9 million Euros in Germany. Preventicus offers end-to-end managed care programs which, e.g. in Germany cover remote screening (e.g. through smartphones), expert diagnosis, and treatment. The company operates contracts with 20 payors, covering more than 6 million insured lives.
Let’s integrate multiple diseases and related programs under national umbrellas, urged Huebner.
Regional initiatives in the EU
Societies are aging worldwide – and chronic conditions are on the rise, creating multiple burdens for the society, affirmed Dr. Nick Guldemond. Starting in 2011, across Europe an action group addressed building a community and mobilizing actors to tackle this challenge, reported the Professor of Integrated Care and Technology, Sechenov First Moscow State Medical University. What are the lessons learned from the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) to implement better health and care in regions?
According to Prof. Guldemond, the regional initiative may not have really caught on at city/community levels, but achievements include collaborations and spin-offs – at an international level. A total of more than 80 integrated care plans have emerged worldwide; however, implementation strategies for change have not been effective. What are the criteria for success, for real change? Prof. Guldemond: We need a paradigm shift from a medical-curative model to a social/interconnected perspective; we need a transformation towards a system based on integrated health services delivery, and the link to value-based care. For success, let’s join forces internationally!
Data and health technologies gaining ground in Poland
The Polish e-health ecosystem has been gaining ground – and it manifests digital benefits of digital in times of COVID-19, outlined Wiktor Rynowiecki. The Director of the Architecture and e-Health Services, e-Health Centre in Poland gave examples: electronic health records, e-registration, e-visits – and teleconsultations, e-prescriptions, e-referral, and IKP (online patient accounts).
In the context of e-health in Poland, “medical events and exchange of electronic health records” constitute a solution at the piloting stage, designed to improve the flow of data and to reduce the burden on reporting borne by medical professionals. It works, explained Rynowiecki, by indexing documents stored decentralized by the providers, and connecting these providers across the country plus possibly beyond in future.
A lot more has been set up in Poland in the way of electronic services in times of COVID-19, including the automated confirmation of quarantine with management through call centers, sick leave communication, a chatbot service with forms for epidemiological interviews, and more. This allows to reduce the documentation burden and reduces risk of infection through physical contact.
The Danish approach
The reform of 2007 and the masterplan for digitization have helped to make Denmark’s healthcare system effective, said Hans Erik Henriksen – in a framework defined by budget and demand pressures. Transformed healthcare now enables treatment of 30 percent more patients in the same budget, according to the CEO, Healthcare Denmark. EMRs, electronic medical records, are among key ingredients in the Danish digitization strategy, making patient data accessible everywhere and supporting the country’s focus on early detection, primary care, and specialized treatment. Treatment quality is the general goal across the continuum of care.
There is a shift from accessing a portal to mobile applications, outlined Henriksen: the “My Doctor” app is part of an emerging ecosystem of apps aimed at facilitating information access and communication. Patients demand this, and they become active partners e.g. through patient-reported outcomes (PROs). In his tour d’horizon of Danish Digital Health 2018–2022, the expert also described how COVID-19 is helping to implement planned initiatives: digital solutions have demonstrated their benefits regarding e.g. risk prevention through video visits, robots and AI in hospitals, fast access to testing, and many more.
Tackling the burden of chronic conditions
Why should we tackle the burden of chronic disease with digital health? In countries such as Australia, Singapore, and England, the crisis of fiscal sustainability in healthcare is emerging, explained Prof. Michael Miller. He is a member of the World Health Organization’s Digital Health Technical Advisory Group (DHTAG) Roster of Experts, and CEO of The Care Innovation Corporation. That crisis is taking place in the wake of demographic change, with a shrinking workforce and a growing elderly population. Care for the subsequent increase in chronic conditions amounts to 80 percent of total expenditures in a variety of countries by 2020.
There is a cornucopia of technologies emerging to support chronic conditions, the expert continued, improving diagnosis and therapy as well as helping with linked issues such as mental health. These technologies include artificial intelligence, vital data acquisition through wearables, telemedicine, and so much more. A telehealth pilot had demonstrated already back in 2011 the enormous cost and quality benefits of a virtual ecosystem for handling chronic diseases. Such an ecosystem, according to Prof. Miller, can tie in beneficially with the trend around the world towards a patient-centric integrated care model. A unique patient identifier, an agreed vocabulary across the care spectrum, and interoperability of EMR are key success factors.
Step-by-step: managed care in Germany
Dr. Patricia Ex revisited twenty years of managed care in Germany. The Managing Director, German Managed Care Association (BMC) put it in a nutshell: it is a history of small, of incremental steps. And she presented examples: there are six diseases in disease management programs in the country; approved programs number 8,955, and they enroll, or enrolled, 7.2 million insured individuals – all to improve quality and cost.
Case management, the expert added, is gaining momentum thanks to the German innovation fund which finances 31 projects with 53,000 patients. In recent years, she observed, it has become a lot more normal for projects to have professional evaluation accompanying them, helping to extract lessons learned for future activities. Embracement by stakeholders is still largely lagging, however. Will these approaches help us also to master a major challenge in Germany – recruiting, and adding flexibility in the staff resources arena? What will the current uptake in digital health contribute?
A breakout session on digital managed care programs in Germany and a vivid online discussion by international participants served to round up CARE 2025.
Matejevic, acting as moderator, wrapped up this conference packed with strong statements: “similar challenges, differing political systems with populations from various countries – CARE 2025 has brought together well-founded views on the coordination of care now and in the future. Let’s drive those projects forward and implement them! And let’s continue to interact within the GCCCF community to exchange and vet ideas – for the benefit of patients, communities, and providers!”
Share this Post