The healthcare system of the future – “Digitization isn’t an end in itself, but aims to support people”

Mr Benstetter, how can patients be actively included in the design of outpatient and integral care concepts to better meet their needs and improve satisfaction levels?

Successfully implementing outpatient and integral care concepts requires a change of perspective from the actors in the healthcare market and the active involvement of patients and their families. Patient-centered care involves surveying and identifying the current and future needs of the target groups, for instance by linking verbal and written questionnaires with the design thinking approach. Involving regional support structures, such as patient associations and social services, in the analysis of requirements and definition of new care concepts is also vitally important. One successful example is Finland, where prevention programmes set up at municipal level feature collaboration between various actors to promote healthy lifestyles. Determining the public’s needs and assessing new forms of care provision in terms of acceptance and quality is a key factor, too. Outpatient concepts should be supported by monitoring care objectives, with the inclusion of feedback from patients, especially from PREMs* and PROMs**. More participative research into care is vitally important to develop accepted care solutions and to ensure more widespread use in the respective healthcare systems.

You indicated that lower costs can be achieved through the shift to outpatient care. Has that happened as hoped for?

Studies indicate that outpatient care leads to greater cost efficiency and takes account of opportunity costs, for example, by improving medical care in rural areas. Successful models in Spain, Denmark and the USA include overall remuneration for treatment paths, such as bundled payments and regional healthcare budgets. These models represent highly promising approaches to ensure effective and efficient outpatient and cross-sector care provision. Operationally successful country case studies show that inpatient and duplicate services can be avoided through innovative and stringent remuneration and outpatient care strategies, and opportunity costs reduced, for example, through shorter waiting times. Healthcare systems that enable a high proportion of outpatient operations out of the total number of operations through sector-aligning remuneration systems are generally better integrated systems with greater potential for cost savings. To leverage efficiency, lawmakers, service providers and funding providers need to eliminate sector obstacles at the interface between outpatient and inpatient treatment.

Which countries have the greatest potential for successful outpatient care and integrated treatment? And what can Switzerland learn from them?

International examples, such as Finland, France, Spain and Denmark, which are relevant for Switzerland and many other countries, highlight the potential of outpatient and integration concepts to improve efficiency and quality levels. Although successful care solutions can often not be fully replicated owing to the complexity of different systems, concepts and individual elements of successful implementation can deliver incentives for innovation. Finland, for example, offers patients low-threshold access to prevention and care services through walk-in clinics. In France, targeted outpatient care is promoted through preventive healthcare programmes, in particular, thanks to the early introduction of the electronic patient record. And in Denmark, treatments are given preference and consistently provided as part of outpatient provision through integrated care delivery with the standardization of patient pathways, digital healthcare services and by placing transparency and accountability obligations on service providers. These examples highlight how the potential for outpatient care can be created along the patient pathways. Active feedback from patients on the quality of the process and results is important here. Implementation also needs to be supported by care goals, monitoring and quality-based remuneration components.

How does the shift to care at home affect the treatment of elderly and chronically ill patients? What challenges and opportunities do you envisage?

In disease management programmes in various countries and research projects, such as DeinHaus 4.0, existing applications and digital technologies are combined based on requirements and care is delivered in the patient’s own home. An integral part of these programmes is the continual monitoring of vital parameters, enabling remote analysis of patients’ health and the identification of critical trends as well as supporting lifestyle changes and self-management of chronic illnesses. For example, Daman National Health Insurance in Abu Dhabi introduced a patient-centered disease management programme for obesity combining telecoaching, telemonitoring and participant training to improve lifestyle habits. So digitization isn’t an end in itself, but aims to support people, although the tangible benefits and promotion of healthcare and digital capabilities represent major challenges in terms of implementation.

In your view, which digital tools or platforms are particularly promising for improving outpatient care?

A highly developed IT and communication infrastructure is becoming increasingly important in optimizing outpatient care as it extends, supports and integrates existing care pathways. Patients have access to more and more evidence-based digital healthcare applications that support diagnostics, treatment and rehabilitation for chronic conditions. Data-based information in the healthcare system provides a variety of options for healthcare monitoring, individual healthcare planning and accurate forecasting of health risks. Data analysis, particularly the use of artificial intelligence (AI), enables effective use of the potential of information to maintain and improve health. Electronic patient records play a key role in electronic communication and the inclusion of relevant data in patients’ medical history and for emergency care. Digital healthcare platforms enable the provision of seamless networks and collaboration between the actors in the healthcare system, including telemedicine and sensor technology. And future healthcare platforms will integrate care chains, as previously mentioned, into the home environment as a point of care, improving outpatient care performance.

* Patient-reported experience measures (PREMs) focus on process-oriented indicators of medical care (e.g. communication with doctors and nursing staff, waiting times, coordination and discharge). There are other types of patient-reported information (e.g. on exercise and alcohol consumption) and patient-generated data (e.g. fitness tracker, self-monitoring of blood pressure).

** Patient-reported outcome measures (PROMs) assess a patient’s state of health, e.g. restricted mobility, continence, etc.

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