The network simplification
The modernization of the health chain, essential for its own sustainability, goes through new technologies, the simplification of processes and regulations. A good strategic planning is critical to reduce costs and ensure efficiency.January-March | 2018
Ask a professional what benefit he most values in a company. There is a good chance the answer will be the health plan. Then, ask an HR department which payroll items worries them most in terms of budget – certainly, the health insurance will be remembered too.
What explains the dichotomy of perceptions – problem or solution – of a same component in the job market? The answer goes through the many links that constitute the health chain.
Rodrigo Aguiar, Sector Development director from ANS (National Regulatory Agency for Private Health Insurance and Plans), says that the sector is complex by nature. “The operations depend on many players, each with their goals, principles and interests”, he explains. “In this scenario, the actions are implemented in a very fragmented way, with waste of resources. As we increase the control over coverage access to the beneficiaries, we add significant administration and transaction costs”, says Aguiar.
The aging of the population, the incorporation of new technologies, growth in the use of the services, waste and eventual fraud are other aspects that raise the system’s operational costs.
This happens worldwide, according to Deloitte’s survey “2018 Global Health Care Outlook”. The study highlights the factors for the financial pressures that public and private health systems have faced. Companies in the industry are seeking ways to reduce costs, in addition to exploring new revenue sources – like capitalizing on intellectual property or investing in joint ventures – to add up efforts on the optimization of procedures.
For this reason, it is necessary to change the traditional models. The results of the report indicate that there is a need to think about health holistically, shifting the focus from treatment to prevention. Data collection and accuracy in the analysis play a vital role in this goal.
One of the functions of new technologies is favoring the establishment of protocols that guide the professionals’ decision-making. “The more we adhere to these standards, the more predictable the costs will be” said Enrico De Vettori, Deloitte’s lead partner for the Life Sciences & Health Care industry. “With them, providers will be encouraged to follow protocols and methodologies. It will be easier to identify those who are out of place in performing the profession, distorting its fundamentals and overloading the system”, he adds.
According to Rodrigo Aguiar, when dealing with organization, articulation and intermediation of the industry’s value chain, it is important to highlight the composition of the network of health entities and professionals accredited by health care providers. “In general, these are the market players that negotiate the purchase of supplies and medical materials used in the service with suppliers”, he says. “Given the wide variety of options available on the market, the supply chain mapping is necessary, in order to identify the flaws that cause waste”, explains Aguiar.
One of the trends in the demand for more efficient practices, according to Vettori, from Deloitte, are specialized institutions, such as hospitals that only handle heart or cancer ailments. Specification enables important gains and the development of centers of excellence and reference. He considers investing in disruptive technologies the best way to reach scale and reduce costs, their incorporation is not the villain when it comes to increasing expenses.
The “2018 Global Health Care Outlook” report, in fact, recommends that organizations bet on digitalization as a development strategy, even if it requires expenditures on electronic patient records and on system interoperability. It is also necessary to invest in training the workforce that will handle these innovations.
Another imperative is to enhance data protection mechanisms, aimed at quality services and patient safety by mitigating fraud and cybernetic threats. These practices require electronic resources tied to cloud storage of information and to the Internet of Things (IoT).
Both patients and employers will effectively re-educate and redirect the chain. Patients are increasingly empowered and connected to social networks, with the advantage of communicating about treatment options and their development. And employers are fundamental players as a source of finance for the entire private system., Enrico De Vettori, Deloitte’s lead partner for the Life Sciences & Health Care industry.
Thus, in a process of learning with other industries, health care providers need to broaden the focus beyond the price and quality of the services provided; setting a relationship focused on the customer and on his loyalty. Among the tools available for this purpose are social networks, remote services and augmented reality practices.
The knowledge from other branches are also fundamental on the journey towards the “hospital 4.0”. Dr. Miguel Cendoroglo Neto, medical director and superintendent from the Albert Einstein Hospital, explains that new technologies increase the capacity and improve health care. “First, we sought partners that could help us implementing these innovations, and we were able to stablish prediction algorithms with machine learning. Each day, they learn something different and refine their data, making the prediction model better and more accurate”, he details.
Governmental or international regulatory means also have authority in these adaptations. “If the industry does not take a stand on their own, it will be pressured regarding the adoption of best practices against misuses, frauds and wastes”, says Enrico De Vettori.
In Brazil, the ANS has adopted measures and initiatives in order to reduce waste and increase the care providers’ efficiency. “The agency has a working group to debate the implementation of innovative models of compensation in the supplementary health, to link the payment of the services rendered to the quality of care and the added value, away from the current model, which pays by procedure”, says Rodrigo Aguiar.
The ANS works in the implementation of the Electronic Health Record (RES), a tool that seeks to mitigate the impacts of information fragmentation to establish a single, integrated and interoperable repertoire of clinical and administrative information. “Moreover, we have the creation of the Supplementary Health Beneficiary Information Portal (PIN-SS), which gives transparency to the industry by making the costs and prices practiced in the market available to beneficiaries, in addition to information on consultations, examinations and hospitalizations. For Companies, the portal gathers the technical criteria adopted for adjustments, as well as the demonstration of the calculation memory performed for the definition of the applied percentage”, explains the ANS director.
Still with regard to transparency, the Exchange of Information on Supplementary Health (TISS) tool establishes a mandatory standard for electronic health care data transfers of beneficiaries. Another initiative, the Health Care Providers Qualification Program (PQO) annually assesses the quality of private plan providers in the health care and management of revenue, expenses and financial resources. The performance of each company is measured by the Supplementary Health Performance Index (IDSS).
One of the companies that are alert to these movements is the Fleury Group. As the group performs in the diagnostic medicine area, it has a very strong sense of its impact on all processes of the chain. “When we treat the individual, a diagnosis made with quality and precision, or resolvability, is essential for the doctor to make the right decisions in the patient’s care” he exemplifies. “We don’t deliver only the test results, but a whole integrated diagnostic solution”, says Dr. Jeane Tsutsui, Business Executive Director of the group. “We prioritize the right examination at the right time.” In order to achieve accuracy of content, the test results of a patient are brought together in a single report.
The Fleury Group is also concerned about working with diagnostic research protocols. For that, it uses algorithms in the definition of the most suitable exams for a certain clinical condition, taking into account each patient’s profile and history. The genomic and precision medicine, which maps the DNA to identify diseases that a person is more likely to develop, is also on the laboratory’s radar.
The group has a staff of highly qualified professionals to deal with more advanced methodologies, according to Dr. Jeane Tsutsui. Another strategy is to invest in medical education, both for the provision of educational content in their own portal and magazine and to promote events in the category’s associations, at no cost to the participants. “There are skills that are very specific and cause doubts among those who aren’t experts in a particular field of medicine. We work in the dissemination of this information”, says the doctor.
Information is in fact one of the major determinants of transformation in the new era that imposes itself in the health chain.