Healthcare organization and the digital world: in search of the optimal care pathway

The government’s “My Health 2022”[1] strategy places the improvement of the organization of care, particularly in chronic diseases, as well as the digitalization of the health system at the top of its priorities. Alcimed explored the relevance of digital solutions for the organization of care as well as the perspectives offered to healthcare stakeholders.

Optimizing the organization of care, particularly care pathways in chronic diseases, is the first step in the government’s healthcare strategy up until 2022. Among the five priority areas there is also digital technology for quality of care, which will have to meet patients’ need for information on health or care, exchanges with health professionals, access to prescriptions and online appointments. As digitalization is clearly considered as one of the means to optimize the organization of care pathways, Alcimed has identified some existing digital solutions and analyzed the potential implications for health actors.

Optimizing the organization of care: what is it about?

According to the definition of the High Authority of Health (HAS)[2], the organization of care covers the modalities of coordination of providers (both at the level of health establishments and ambulatory care or networks), as well as the principles of financing and pricing.

Optimizing the organization of care, in the context of chronic diseases, means optimizing care pathways on two main dimensions. On the one hand, it is a question of setting up appropriate patient follow-up which not only makes it possible to provide appropriate care for patients, but also to rationalize the location, frequency and content of procedures and consultations according to profiles and needs. At the same time, this follow-up, adapted to the patient’s profile, works to prevent acute events or complications linked to the disease, and allows for a minimum of early management of these events in order to avoid a more complex journey and additional costs for the health system. On the other hand, it is necessary to promote coordination between all the actors involved in monitoring, both in the city and in the hospital, a sine qua non condition for optimizing the pathways.

Digital solutions that have already demonstrated their potential

When it comes to appropriate patient follow-up, remote monitoring solutions make it possible to adapt the follow-up procedures to patient profiles, enabling doctors to interact with them when necessary. Lilly’s myDiabby platform, launched in 2015, allows patients with gestational diabetes to be monitored remotely: patients share their daily blood glucose levels, and the medical team manages alerts and communicates with them as needed. The solution was then extended to type 1 and 2 diabetes, with more than 110 user healthcare facilities, 18,000 patients followed, 25,000 remote monitoring procedures per month and 1,500 new patients per month in 2017[3]. In addition, the prevention of possible acute events or complications related to diabetes is ensured during follow-up and can therefore be facilitated by digital remote monitoring solutions. Like the myDiabby solution, other remote monitoring solutions are being developed for various diseases and listed by the General Direction of Care Provision[4]. These include the Bepatient Cardio+[5] solution deployed in 2018 in ELSAN group clinics for remote monitoring of chronic heart failure patients and Sanofi’s Diabéo[6] in diabetes, which was launched in 2017.

In addition, digital technology can provide a solution for better coordination of health professionals between the city and the hospital. In the same vein as the Shared Medical Record[7] launched by the Health Insurance, digital solutions have been created by publishers to create a unique digital space around a patient, while bringing together all the actors involved in their journey. In 2016, the software publisher Inovelan launched the IPPS (Health Paths) platform[8], which aims to coordinate care pathways between the city and the hospital using an interface common to all health professionals including the patient’s file. This solution has been deployed at Cancer Control Centers such as the Gustave Roussy Institute in Île-de-France and the Oscar Lambret Centre in Lille. In addition, other solutions are emerging, particularly those based on blockchain, and make it possible to group together all the personal information related to patient care, offering even broader perspectives on the coordination between actors in the care pathway.

The impact on patient pathways, care organization and funding

The new digital solutions will inevitably have an impact on the organization of care, particularly that provided by health care institutions who will have to rethink their approach to care pathways. New services such as remote monitoring and follow-up or reading the data of connected devices will potentially be part of the care offer and consequently, new professions such as pathway coordinators or remote monitoring managers will be created.

The ” My health 2022 ” plan provides a flat-rate funding approach rather than an activity-based one for chronic diseases, in order to better adapt to the reality of care pathways in these diseases, and therefore to the potential new services that can be offered (remote monitoring, coordination…). This flat-rate financing encourages on the one hand the implementation of solutions to optimize the organization of care, which can be easily considered to be in a digital format, and on the other hand implies the possibility of public funding.

In this context, it seems relevant for health actors, particularly private ones (companies in the medtech sector, publishers of digital solutions, pharmaceutical industry) to think about the role they could play in this new organization of care, especially via digital technology.

“This role is twofold: first of all, it involves supporting changes in the care pathway, in particular by working with health care institutions on points to improve current care, in order to capture the opportunity to position oneself on new offers that meet identified needs“, comments Séverine Robineau, Business Unit Director at Alcimed.

A strong sign of progress is Article 51 of the 2018 Social Security Finance Act[9], which has opened the door to all private actors with innovative projects in terms of access to healthcare or the coordination and relevance of healthcare pathways.

[1] https://solidarites-sante.gouv.fr/IMG/pdf/ma_sante_2022_pages_vdef_.pdf
[2] https://www.has-sante.fr/portail/jcms/fc_1250012/fr/sante-publique-et-organisation-des-offres-de-soin
[3] http://www.mydiabbyhc.com/uploads/8/0/7/3/80734578/mydiabby_presentation_courte.pdf
[4] https://solidarites-sante.gouv.fr/IMG/pdf/liste_fournisseurs_solutions_techniques_120219.pdf
[5] https://www.bepatient.com/blog/2018/01/18/le-groupe-elsan-ouvre-un-service-de-telesurveillance-de-linsuffisance-cardiaque/
[6] https://www.diabeo.fr/
[7] https://www.dmp.fr/
[8] https://inovelan.fr/solution-ville-hopital/
[9] https://solidarites-sante.gouv.fr/systeme-de-sante-et-medico-social/parcours-des-patients-et-des-usagers/article-51-10918/article-51