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karan singh
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1
Healthcare IT Controlling Non Communicable Diseases
Karan Singh, Bain & Company
2
NCDs account for 53% of all deaths in India
NCDs estimate to cost India $6.2T by 2030
A 10% rise in chronic disease will result in 0.5% lower rates of annual economic growth
3
0
20
40
60
80
100%
2030
Africa
America
Europe
Middle East
Asia
52
2030
Africa
America
Middle East
Europe
Asia
900
Quarter of global productivity loss by 2030 will be borne by India
Source: WHO, Bain Analysis
NCD deaths(M)
DALYs lost(M)
India share 17% 24%
0
5
10
15
20M
Years of life lost due to CVD in population
aged 35-64 years, in 2030
India
18
China
11
Russia
3
USA
2
South
Africa
0.4
11.5 7.8 3.3 1.7 0.32010E
4
Rapid urbanization in India expected to add to disease burden
Growing urbanization
High prevalence of risk factors
Resulting high NCD burden
0
100
200
300
400
500
1991
217
2011
377
2021e
496
Urban population (M)
26% 31% 36%Urban (%)
Prevalence Rural Urban
Central obesity 55% (M) 72% (M)
Work related sedentariness 39% 64%
Prevalence Rural Urban
Hypertension 10% 25%
Ischemic Heart Disease 2.5% 6.4%
Source: Planning Commission document on NCDs
5
India has narrow window to reverse NCD epidemic
Source: Planning Commission
•Major proportion of NCDs are preventable by tackling modifiable risk factors
•Potential to prevent ~75% of stroke, heart, diabetes and 40% of cancer
0.02
0.05
0.1
0.2
0.5
1
2
5
10
0.5 1 2 5 10 20 50 100
USA
Brazil
Australia
Nominal GDP per capita
( 2010, $K )
Healthcare expenditure
per capita (2010, US$K )
Philippines
Vietnam
United Arab Emirates
United Kingdom
Thailand
South Africa
Singapore
Saudi Arabia
Qatar
Pakistan
Oman
Malaysia
Kuwait
Indonesia
India
Hong Kong
Egypt
China
Cambodia
Bahrain
R² = 0.90
India
6
Need fundamental change in health system to tackle NCDs
Prevention Diagnosis TreatmentFollow
upPrevention
EarlyDiagnosis
PromptTreatment
Follow up
•Proactive, care seeking behavior (prevent vs treat)
•Public health focus, incl. mass screening
•Primary care focus, early intervention focus
•Protocolized care delivery
•Care support & follow up to increase adherence
“Sickness focus”
“Wellness focus”
7
Learnings in tackling NCDs from developed markets
Note: CVD data includes men and women 25 to 84 years old, Diabetes data includes men and women >30 years old, MI-Myocardial infarctionSource: Explaining the decrease in U.S. Deaths from Coronary Disease, 1980-2000, Ford et al, N Engl J Med 2007, American Society of Nutritional Sciences, American Heart Association, Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000, Unal, Critchley Et Al, British Heart Foundation, Action on Smoking and Health, National Screening Committee website, Explaining the Decline in Early Mortality in Men and Women With Type 2 Diabetes, Charlton Et Al; New England Journal, Cancer Prevention and Early Detection Facts and Figures 2013,American Cancer Society, National Cancer Institute ,US, The growth of Palliative Care Programs in US Hospitals, 2005, Morrison et.al, Journal of Palliative Medicine, Secondary research
50% DECLINE IN CHD MORTALITY
35% DECLINE IN DIABETES’ MORTALITY
20% DECLINE IN CANCER MORTALITY
0
200
400
600
800
1,000
CHD mortality per
1L male/ female population
1980
Men
Wom
en
2000 1981 2000
0
10
20
30
40
50
Men
48
25
Women
37
28
Age-standardized mortality
(per 1,000 person-years)
within 24 months of diagnosis
0
100
200
300
1991
215
2010
172
Cancer mortality per
1L population
8
Significant portion of reduction from prevention & early diagnosis
Source: Explaining the decrease in U.S. Deaths from Coronary Disease, 1980-2000, Ford et al, N Engl J Med 2007, American Society of Nutritional Sciences, American Heart Association, Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000, Unal, Critchley Et Al, British Heart Foundation, Action on Smoking and Health, National Screening Committee website, Explaining the Decline in Early Mortality in Men and Women With Type 2 Diabetes, Charlton Et Al; New England Journal, Cancer Prevention and Early Detection Facts and Figures 2013,American Cancer Society, National Cancer Institute ,US, The growth of Palliative Care Programs in US Hospitals, 2005, Morrison et.al, Journal of Palliative Medicine, Secondary research
Prevention Diagnosis Treatment
Diagnosis & Treatment
• Large scale awareness campaigns
• Medications for co-morbidities/ risk factors (hypertension, tobacco)
• Multiple screening programs
• Secondary prevention (Aspirin, β-blockers)
• Formulation and use of evidence based therapies
• Increased use of advanced treatments
• Lifestyle interventions • Increased access to advanced drugs
• Large outlay for R&D
• Increased use of advanced drugs
Prevention
45-60% 10% 30-45%
60% 40%
Cardiovascular disease
Diabetes
9
Early intervention can lower cost & improve outcomes
-100
-80
-60
-40
-20
0%
Cervical Cancer
-40%
HIV
-60%
Chronic Kidney Disease
-75%
Chronic Artery
Disease
-85%
% decrease in cost of treatment by early diagnosis
Note: Cervical Cancer, CKD and CAD data is for US; HIV data is for UK and Canada; Late Stage implies Stage III/IV of cervical cancer, AIDS stage for HIV and ESRD stage for CKD; For CAD – comparison is across stable angina (early stage) and acute myocardial infarction (late stage)Source: Bain Analysis; PubMed, US National Library of Medicine and National Institutes of Health; UK Department of Health; Litholink; Health Protection Agency, UK; Nature; Aidsmap
2x 10x 8x 2xIncrease in survival rates by early diagnosis
10
Where are IT/technology points of intervention to improve outcomes?
Note: USA estimates at an overall level including ruralSource: Diabetes International Foundation; WHO; primary interviews; National Diabetes factsheet, secondary research
38M 21M 9M 2.5M
USA 20M 14M 10.5M 4M
0
20
40
60
80
100%
Number of Diabetes Patients (2011)
Urban India
diabetics (estimate)
Diagnosed diabetics
Patients on oral tablet
Patients on insulin
Patients receiving approprate care
mgmt
USA benchmark
Prevention Diagnosis Treatment Follow up
1
23
11
Opportunities for IT/technology
• Improve access via telemedicine, etc
• Improve treatment – via integrated care and better capture/sharing of information, use of protocols
• Improve adherence – via lower cost IT enabled disease management programs & remote monitoring
1
2
3
12
Improving access is a must for early diagnosis
0
20
40
60
80
100%
Population
1.2B
Hospitals
17K
Doctors
0.7M
Hospital beds
Rural
Urban
1.8M
Percent of total
Source: Bain Analysis
0.0
1.0
2.0
3.0
4.0
5.0
Spain
4.7
3.8
Denmark
3.53.3
UK
2.2
1.7
Brazil
1.3
China
1.1
South Africa
0.6
India
0.6
Doctors per 1000 population
Germany USTurkey
1
13 0
20
40
60
80
100 %
2007
20
2012
69
79
Mobile phone penetration in India (%)
20170
5
10
15
20 %
2007
4
2012
12
2017
17
Internet penetration in India
0
20
40
60
80%
2010
3%
2012
9%
2017
66%
Smartphone penetration in India
MOBILE PENETRATION IS RISING @ ~30%
INTERNET ADOPTION IS RISING @ 25%
SMARTPHONE USAGE IS RISING AT ~80%
Source: TRAI
Connectivity can help us leapfrog access
1
14
What do you expect companies to do to better promote healthy living? Importance
Offer healthier food options
Develop programs that reward people for healthy lifestyles
Promote healthy lifestyles via digital media & social online platforms
Offer stress management programs
Aim to generate broad community movement supporting healthy lifestyles
Invest more in awareness campaigns on healthy lifestyles
Offer online doctor or lifestyle counseling services
Develop new technologies that help to monitor and manage health
Offer novel, consumer friendly diagnostics
Indians sees technology as important means to achieving healthy living
1 5
Note: Importance rating indicates % of respondents who selected a certain option as one of their top 5 choices. None of the above chosen by NY: 9%, Munich 6%, New Delhi 1%Source: Healthy Living Survey, Bain & Company, 2013 (Munich, New Delhi, New York; n=1,200)
MunichNew YorkNew Delhi
HighLow
1
15
Tele services need to be scaled up
Source: Bain Analysis
MOBILE TELEMEDICINE
E-ICU
TELE - RADIOLOGY
1
16
How to improve treatment effectiveness?
• Lack of (& underuse of) guidelines, protocols
• Integrated care
• Sub optimal IT systems/infrastructure to collect, share information
• Inadequate MD-patient communication
2
17
What is potential for “integrated care” in select diseases?
AdherenceTreatment
complications
Source: Secondary research, Expert interviews
Unorganized fitness centers
Optimal information/communicationUse of tools to capture, share and track progress
RoutineTreatment
Diagnosis Prevention
2
18
Successful integrated care models to consider
Note: *Includes rehabsSource: Bain case studies
Wellness services
DiagnosticDelivery
Insurance EducationDoctors; Hospitals*
0
500
1,000
1,500
2,000
Clinical acute patient bed days
per 1,000 patients
Medicare FFS
1,706
Kaiser
1,057
0
20
40
60
80
100
Coomparison of key
health costs stats (US avg indexed to 100)
100
83
100
64
US a
vg.
100
Geie
inger
73
Medical spend
per person
ALOS # Doctor
visits
IT/ Analytics
2
19
Significant unmet needs in IT identified by institutions
•Cost effective- Segment specific needs, capex to opex based- Cloud based
•Integrated, scalable- Piecemeal/disparate offerings, obsolescence
•“Right spec”- Customized, easier user interface, etc
•Reliable service & support- 24x7 support, quality of response
2
20
Opportunity for adopting disease mgmt, remote monitoring solutions
• Enrolment: >90%;
• Clinical: 30-60% reduction in severe complications in diabetics
• Economic: ~10% decrease in Diabetes’ treatment costs
• Govt-sponsored SMS alerts & callbacks to TB patients in Thailand raised medication compliance rates to ~90%
• China: Patients to input data (BP, glucose, weight, etc.), sends to provider via phone
• Provider send back customized treatment plans remotely to patient
• Govt. offering ‘call-back’ service to give counsel on HIV testing; Global Health shares educational videos via mobiles
3
21
In summary
•NCDs need to be top global & national priority
•Need a paradigm shift: from sickness to wellness
•IT/technology can play a critical role in- Improving Access – via telemedicine- Improving Treatment Effectiveness – Guidelines/protocols & IT
tools/systems to capture, sharing of medical information- Improving Adherence – via IT enabled disease mgmt and remote
monitoring