Care coordination in a business-to-business and a business-to-consumer model for telemonitoring patients with chronic diseases

Introduction For telemonitoring to support care coordination, a sound business model is conditional. The aim of this study is to explore the systemic and economic differences in care coordination via business-to-business and business-to-consumer models for telemonitoring patients with chronic diseases. Methods We performed a literature search in order to design the business-to-business and business-to-consumer telemonitoring models, and to assess the design elements and themes by applying the activity system theory, and describe the transaction costs in each model. The design elements are content, structure, and governance, while the design themes are novelty, lock-in, complementarities, and efficiency. In the transaction cost analysis, we looked into all the elements of a transaction in both models. Results Care coordination in the business-to-business model is designed to be organized between the places of activity, rather than the participants in the activity. The design of the business-to-business model creates a firm lock-in but for a limited time. In the business-to-consumer model, the interdependencies are to be found between the persons in the care process and not between the places of care. The differences between the models were found in both the design elements and the design themes. Discussion Care coordination in the business-to-business and business-to-consumer models for telemonitoring chronic diseases differs in principle in terms of design elements and design themes. Based on the theoretical models, the transaction costs could potentially be lower in the business-to-consumer model than in the business-to-business, which could be a promoting economic principle for the implementation of telemonitoring

Care coordination in a business-to-business and a business-to-consumer model for telemonitoring patients with chronic diseases

__Introduction:__ For telemonitoring to support care coordination, a sound business model is conditional. The aim of this study is to explore the systemic and economic differences in care coordination via business-to-business and business-to-consumer models for telemonitoring patients with chronic diseases. __Methods:__ We performed a literature search in order to design the business-to-business and business-to-consumer telemonitoring models, and to assess the design elements and themes by applying the activity system theory, and describe the transaction costs in each model. The design elements are content, structure, and governance, while the design themes are novelty, lock-in, complementarities, and efficiency. In the transaction cost analysis, we looked into all the elements of a transaction in both models. __Results:__ Care coordination in the business-to-business model is designed to be organized between the places of activity, rather than the participants in the activity. The design of the business-to-business model creates a firm lock-in but for a limited time. In the business-to-consumer model, the interdependencies are to be found between the persons in the care process and not between the places of care. The differences between the models were found in both the design elements and the design themes. __Discussion:__ Care coordination in the business-to-business and business-to-consumer models for telemonitoring chronic diseases differs in principle in terms of design elements and design themes. Based on the theoretical models, the transaction costs could potentially be lower in the business-to-consumer model than in the business-to-business, which could be a promoting economic principle for the implementation of telemonitoring

Assessment of a Business-to-Consumer (B2C) model for Telemonitoring patients with Chronic Heart Failure (CHF)

Background: The purpose of this study is to assess the Business-to-Consumer (B2C) model for telemonitoring patients with Chronic Heart Failure (CHF) by analysing the value it creates, both for organizations or ventures that provide telemonitoring services based on it, and for society. Methods: The business model assessment was based on the following categories: caveats, venture type, six-factor alignment, strategic market assessment, financial viability, valuation analysis, sustainability, societal impact, and technology assessment. The venture valuation was performed for three jurisdictions (countries) - Singapore, the Netherlands and the United States - in order to show the opportunities in a small, medium-sized, and large country (i.e. population). Results: The business model assessment revealed that B2C telemonitoring is viable and profitable in the Innovating in Healthcare Framework. Analysis of the ecosystem revealed an average-to-excellent fit with the six factors. The structure and financing fit was average, public policy and technology alignment was good, while consumer alignment and accountability fit was deemed excellent. The financial prognosis revealed that the venture is viable and profitable in Singapore and the Netherlands but not in the United States due to relatively high salary inputs. Conclusions: The B2C model in telemonitoring CHF potentially creates value for patients, shareholders of the service provider, and society. However, the validity of the results could be improved, for instance by using a peer-reviewed framework, a systematic literature search, case-based cost/efficiency inputs, and varied scenario inputs

Extending the Business-to-Business (B2B) model towards a Business-to-Consumer (B2C) model for Telemonitoring Patients with Chronic Heart Failure

Purpose: We describe and perform an initial evaluation of the extension of the Business-to-Business model to a Business-to-Consumer model for telemonitoring of patients with chronic heart failure. Design/methodology/approach: We explored the problems in implementation of telemonitoring via the B2B model by means of a root cause analysis, including the 5-whys method to help us understand the shortcomings of the B2B approach, and then the 5W1H method to explore whether the B2C is a better strategy. The extension of the model was executed in the Business Model Generation framework. By using qualitative content analysis techniques, we supported our argumentation with findings from other studies. Findings: The B2C model is based on the interplay of agents – healthcare provider, equipment manufacturer, payer/regulator and distributor/promotor – all working together to improve patient outcomes. In our opinion, the success of the extended model in telemonitoring CHF patients hinges on two entities – the Telemonitoring center and Telehealth nurses – being repositioned in the out-of-the hospital setting. Social implications: Penetration of mobile telehealth via B2C model will allow for greater availability, access and equity in healthcare. Originality/value: We introduced a fourth pillar to the existing B2B model (i.e. distributors and/or promotors). The B2C model we propose might allow for scalability, generalizability and transferability of telemonitoring currently unattained with the B2B model. &nbsp

Value of information analysis in telehealth for chronic heart failure management

Objectives Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. Methods The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands—patients in all NYHA classes of severity, and patients in NYHA IV class only. Results The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. Conclusions Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities

The Cost-Effectiveness Analysis of Philips Motiva Telehealth System

Objectives The clinical effectiveness of Motiva Monitor platform was established in the previous study (TEN-HMS). Patients randomly assigned to receive Usual Care had higher one year mortality (45%) than patients assigned to receive Nurse Telephone Support (27%) or Home Telemonitoring (29%) (p=0.032). Our intention is to provide insights in the cost-effectiveness of Motiva telehealth system by modeling the intervention and running the analysis on top of the reported data. Methods Effectiveness was established by mining the EuroQol-5D from the original database, while the information on costs came from the literature and the manufacturer of the equipment. Direct healthcare costs considered ER visits, GP, Specialist, Hospitalist and Nurse time and resources utilization. The induced (indirect) costs were not considered in the analysis. The approximation of the cost of medical consumption came from the Netherlands only, although the original study was run in three European countries. We assumed the payer perspective for our analysis. Results The results clearly show, within the parameters of our model, the increased effectiveness of Home Telemonitoring and Nurse Telephone Support in comparison to the Usual Care. The deterministic results show ICERs of € 14.842 and € 12.547 per QALY (discounted at 1.5% a year) for HTM and NTS respectfully. Probabilistic results show that NTS was the most effective strategy in health systems that pay more than €12.500 per QALY. In the subgroup analysis HTM dominated both NTS and UC at the threshold of €16.500 in NYHA IV group of Chronic Heart Failure patients. Conclusions Home telemonitoring by Motiva Monitor system reduces mortality and lowers the in-hospital length of stay. On the quality of life dimensions, Home Telemonitoring was similarly effective as the Nurse Telephone Support, but with more costs. The cost-effectiveness analysis shows that both NTS and HTM dominate the Usual Care at WTP of €15.000

Statistical Model Checking for Stochastic Hybrid Systems

This paper presents novel extensions and applications of the UPPAAL-SMC model checker. The extensions allow for statistical model checking of stochastic hybrid systems. We show how our race-based stochastic semantics extends to networks of hybrid systems, and indicate the integration technique applied for implementing this semantics in the UPPAAL-SMC simulation engine. We report on two applications of the resulting tool-set coming from systems biology and energy aware buildings.Comment: In Proceedings HSB 2012, arXiv:1208.315

Design and Analysis of Dynamic Leader Election Protocols in Broadcast Networks

The well-known problem of leader election in distributed systems is considered in a dynamic context where processes may participate and crash spontaneously. Processes communicate by means of buffered broadcasting as opposed to usual point-to-point communication. In this paper we design a leader election protocol in such a dynamic system. As the problem at hand is considerably complex we adopt a step-wise refinement design method starting from a simple leader election protocol. In a first refinement a symmetric solution is obtained and eventually a fault-tolerant protocol is constructed. This gives rise to three protocols. The worst case message complexity of all protocols is analyzed. A formal approach to the verification of the leader election protocols is adopted. The requirements are specified in a property-oriented way and the protocols are denoted by means of extended finite state machines. It is proven using linear-time temporal logic that the protocols satisfy their requirements..