Public-private cooperation key to supporting Canada’s shift from health to wellness

By working together, we can encourage innovations that embrace the shift to viewing patients as consumers and emphasizing lifestyle and prevention.

Canada is moving toward a health-care model in which the patient is at the centre of care. With demographic shifts helping lead to an increase in the prevalence of chronic diseases, patients are taking a bigger role in managing their health and are more actively engaged with health-care systems throughout their lifetime.

At the same time, new digital tools are supporting this increase in patient management and engagement in their health, wellness and wellbeing. For example, they’re helping patients access health information, like diagnostic test results, without ever leaving home. Some of these tools are sponsored by the government, some are privately insured and others are paid for out of pocket.

Consumers are also showing increased interest in health and wellness apps on their personal devices. According to PwC’s Consumer insights survey, 32% of Canadians surveyed said they use a health-care, wellness, fitness or medical app on their smartwatch, smartphone or tablet. That number rose to 37% for those aged 25-34. And nearly half (46%) said they’re somewhat comfortable with accessing health-care products or services from a company with an offering that collates all of their information in one place.

But those tools and products don’t necessarily interact with the health system itself. The increase in chronic disease management and active engagement in health and well-being—along with the overall trend of prioritizing the customer experience—are leading to evolving expectations for an integrated, end-to-end health service experience that reflects personalized health needs.

Increasingly, we see the role of the patients evolving to resemble that of a consumer. At the same time, product vendors and service providers are focusing on removing what people often refer to as friction in the health and wellness experience. All of these changes are leading to what we call the patient-to-consumer (P2C) shift in health care.

32% of Canadians report using a health-care, wellness, fitness or medical app on their smartwatch, smartphone or tablet

Source: 2019 Consumer insights survey

The P2C shift in health care: Creating a data-driven, proactive and seamless experience

P2C means a personalized experience at every touchpoint with health services. An individual might have the following to say about the experience:

My care team knows me, is aware of what works for me and helps me actively manage my health.
I can access care when and how I want. This includes digitally enabled options for contacting my provider and virtual care services.
I see myself at the centre of the care I receive, and I share my information virtually with other providers and caregivers, like family members, as necessary.

"I am able to track my blood pressure remotely, and my care providers have real-time access to my information, which they use to coordinate care and proactively reach out when my results aren’t optimal. I receive alerts when my blood pressure is spiking, which prompts me to take my medication to preserve my kidney function."

To move toward a more integrated and proactive approach, the health system needs to adapt to trends taking root in the sector and shifts among the various health ecosystem players. These include:

Public health care: Our publicly funded health-care system currently focuses on treating the sick as opposed to managing health and well-being and preventative efforts. A transformation toward a more preventative approach would require serious change and is essentially the only option left to sustainably manage costs.

But we are starting to see different approaches in the public sector. In British Columbia, for example, home care patients can spend publicly allocated dollars on whatever is most relevant to them, such as medical devices or personal support workers. This approach is still in its infancy in Canada, with much to learn from other jurisdictions and the private health insurance industry.

Employers: The private sector is stepping into the wellness and prevention gap. Employers, for example, are putting a greater priority on and making strategic investments in health and wellness benefits, which translate into increased productivity, decreased absenteeism and a reduction in the cost of insurance claims. These benefits can also help to attract and retain talent; one study found that 80% of employees would choose additional health benefits over a pay raise.

Some new entrants in the digital health arena are reimagining the employee health benefits experience from the ground up through platforms that offer immediate, seamless and tailored services that give people the flexibility to take control of their total health and wellness. This consumer-focused approach often includes a digital health marketplace, behaviourally incentivized health and wellness programs and relevant and engaging health content.

Another key element is culture change in the workplace that puts a true emphasis on wellbeing and employee needs. One global thought leader had made a prediction that reflects this element: “Wellbeing will evolve from an important HR program to an urgent corporate strategy. Due to our digital, fast-paced world of work, organizations in 2020 and beyond will not succeed unless each individual can thrive.”

Insurers: In line with these shifts by employers, the insurance industry is looking at new, innovative models to offer more personalized employee benefits for large group insurance sponsors. Some insurers have already launched integrated financial, physical and mental wellness programs that support improved outcomes around engagement, absence and disability management and reflect a rising focus on the social determinants of health.

Physician reimbursement models: There’s a need to integrate telehealth and virtual visits into the physician reimbursement model to increase adoption of consumer-focused health solutions. In the meantime, a Canadian task force is examining national licensure for virtual care, including the various privacy rules that make it difficult to share health data across jurisdictions. The results of the task force are expected in 2020.

Another privacy concern is the question of service provider access to the data generated from wearable devices, patient apps and other consumer technologies. It also includes information sharing among health professionals — whether physicians, pharmacists or home care providers — on matters relating to patient health. We need to develop a system that lets patients give consent to different providers across the health-care system to access their health information, regardless of their location in Canada.

While in the past, creating a full patient record was about connecting the various systems, it’s now more about making information accessible in one place for all aspects of treatment and prevention. This is where technology will play a role, but consumer understanding of the limitations and implications of consent could be a barrier. One key initiative is Canada Health Infoway's ACCESS Health program, a technology-enabled gateway aiming to unite health data across industry and health-care providers, as well as the provinces, territories and Canadians, over the coming years.

There’s also the significant issue of interoperability among digital solutions. Many digital health solutions are available on the market, but relatively few integrate with one another. Developing interoperable standards, application program interfaces (APIs) and technical utilities will lead to more seamless communication between solutions and let health providers—and even family members—take a more active role in ongoing care management.

A recent survey of Canada’s digital health experts found health interoperability resulted in more effective care (59%) and improved patient safety (52%). The report also found it improved the accuracy of medication information and reduced duplication of lab tests and prescriptions.

To deliver a personalized, holistic and preventative approach to health, our health-care system must prioritize integrated care and incorporate innovative health technology. This means examining developments and roles on both the public and private sides:

Public role: In Ontario, we’re seeing a move toward integrated care through provincial health teams. Nationally, we’re also seeing efforts to facilitate the commercialization of innovative health solutions through public-private cooperation. For example, the proposed CAN Health Network will link health technology start-ups with hospitals and health-care institutions to speed procurement and help bring new solutions to scale. A nimble, responsive policy framework is necessary to make this happen. Start-ups also need access to relevant medical data to support outcome-based payment arrangements.

Private role: Non-traditional players can also play a role in coordinating care and interactions with the health-care system for patients and their families. According to our Consumer insights survey, two-thirds of global respondents said they’re willing to access health services through companies, like Amazon, Apple and Facebook, not typically associated with health care. Many of these companies are already active in this area, with Amazon having just launched Amazon Care, a virtual health clinic for its own employees.

It’s clear there are opportunities for less traditional models of care to emerge and for other types of organizations—including retailers and pharmacies—to use their deep understanding of consumer behaviour to better meet patient needs. Neighbourhood pharmacies, for example, may have an opportunity to expand services to include primary care, point-of-care diagnostics, prescriptions, insurance, financing and insights into how to be and stay well.

Consumer interest in non-traditional care settings

A transformative opportunity for health care in Canada

To sustain itself and deliver improved outcomes, our public health-care system needs to adapt to Canadians’ evolving behaviours and expectations. Until we reach the P2C vision as an integrated public-private system of health and wellness, we’ll see increased strategic investment in health and well-being through proactive prevention efforts, innovative solutions and integrated delivery models involving private players like retailers, pharmacies and employers. A recent analysis of the future of health projected that global health budgets will grow by 42% between 2018 and 2030. During this time, we expect traditional care and drug budgets to shrink in their overall share as other areas, like digital health, prevention and diagnostics, grow significantly.

The question remains: Who will be responsible for this shift to a truly integrated health system with curated consumer experiences, and how will the private and public sectors continue to work together to improve health outcomes in an equitable manner? To date, we’ve seen several barriers, from funding models to the fragmented nature of health care in Canada, to moving the system forward through the required blend of policy changes and agile approaches.

We believe the barriers are surmountable. Supporting the commercialization of health technology and innovation in Canada, for example, doesn’t have to conflict with the Canada Health Act. The agility and nimbleness of private sector organizations can help accelerate transformation and meet consumer objectives while improving care and access. But the private sector needs to be officially part of the process—not scraping at the edges—to help achieve our health objectives.

Tailoring experiences in the health sector to the P2C model is a big opportunity, so we can expect to see continued investment in both the private and public sectors. But if we want to keep health-care innovation in Canada and deliver on its potential, the public and private sectors must work together with an open mind and a shared set of goals that embrace patients as consumers who vote with their feet, wallet and feedback.