Creating outcome-based healthcare offerings
Challenge identifier: DPC6-2018
José de Mello Saúde, a private company with 70 years experience in the provision of healthcare in Portugal. It operates through Private Healthcare Services, Public Healthcare Services and Infrastructures.
To this day, most healthcare providers still structure their clinical offer based on cost and activity performance. The Value-based Healthcare model, designed by Michael Porter, Harvard Business School, paved the way for a change in the way medical services are paid for, impacting how providers bundle their offer and manage their operations. However, patients and healthcare funders are increasingly seeking an offer based on outcomes rather than activity alone.
The mapping of clinical pathways and complete customer journeys is a vital necessity to allow healthcare providers to accommodate this shift; they must establish correlations between patients’ medical information and clinical episodes, and have a better understanding of patient needs. Providers will then be able to progressively align their products and services with positive patient outcomes and reduced cost, in a clear attempt to shift from volume to value. This change will also enhance the perspective of looking into the comprehensive journey of a patient with a given pathology, rather than single clinical episodes.
Using clinical and customer data, identify and analyse patterns in patients’ clinical pathways, allowing healthcare organisations to design patient journeys that provide the best patient care experience possible.
Clinical episodes from 2014 to 2017 for all José de Mello Saúde’s Hospitals* which includes:
- Customer information: Age, gender, postal code, year of first episode
- Activity information: types of clinical interaction (admittance, surgery, consultation, emergency, multidisciplinary team, etc), types of specialities, billing items available if necessary
- Clinical information: diagnosis, acquired intrahospital complications, procedures, length of stay, discharge destination, birth weight (for newborns), etc.**
All data are properly anonymised.
More detailed information about the data can be found in our data catalogue.
Development of tools, software and algorithms that support the reporting of:
- Types of customer analysis
- Mapping of patient internal referral circuits
- Clinical pathways per pathology
- Improved data analysis for healthcare providers;
- More adequate bundling and pricing of correlated medical services;
- Improved catering of medical services to patient needs.
* Excludes 2 hospitals in public-private partnership.
** Corresponds to José de Mello Saúde’s database of hospital morbidity clustered into DRG (Diagnosis Related Group) following ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) – surgical and inpatient episodes