Israeli eHealth: The Rx for Obamacare - Levi Shapiro

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The Affordable Care Act, better known as “Obamacare”, begins enrollment next week. In this context, Bloomberg’s World Healthcare Efficiency Index, released last month, makes for very interesting reading. Among 48 countries worldwide, the US ranked 46th. The top four (Hong Kong, Singapore, Japan and Israel), emphasize the role of Government. Israel is unique in that digital healthcare, an area heavily incentivized by Obamacare, is a key factor. The eHealth suite example of Clalit, Israel’s largest HMO, is an interesting case for developed markets like the US, and frequently featured at digital health events like TedMed or the upcoming mHealth Israel conference.

Clalit Health Services is Israel’s largest HMO (4.2 million members), second in size globally to Kaiser Permanente. This includes 14 hospitals, 1400 clinics and 7,500 physicians. Four years ago, Clalit launched an e-Health suite that now has nearly two million monthly users. According to one insider, Clalit achieved an ROI during this period of 415%.

While there is plenty of hype (and some good old fashioned chicanery around mobile health applications, real change comes from system-wide deployments. In most countries, these efforts have failed to reach nation-scale. After some trial and error, Clalit has found success in Israel through a five layer approach:

1. Personal health Record Layer (what the patient SEES): Medical history, diagnoses, allergies, vaccinations, laboratory results, hospital discharge letters etc. All medical terms are accompanied by explanations with suggestions, called an information prescription (Ix). Each Ix is reviewed by 2 different experts and "translated" into layman's language by a medical linguistic editor.

2. Personal Knowledge Layer (what the patient KNOWS): Personally tailored preventive medicine and health recommendations, such as mammography and lipid profile screening recommendations, based on sex, age, medical history and previous medical tests. Recommendations are in textual, visual and interactive formats to increase patient engagement. Compliance in this mode is 63.6% higher than for patients informed by traditional means.

3. Personal Health Services Layer (what the patient DOES): Patients carry out their own administrative and clinical self-service. Giving patients the ability to refill chronic prescriptions, get medication and refill reminders has improved adherence rates by 80-85%). Patients can e-consult their physician or pharmacist either via 1-on-1 platform or video conference,. Currently more than 11,000 synchronous e-Visits are done per month, from more than 900 locations, reducing unnecessary ER visits by 47.5%.

4. Remote Patient Monitoring Layer (personal metrics the patient MONITORS). This layer takes a proactive approach to health promotion and chronic disease management. Sensor infrastructure, paired with mobile apps and wearable bio-sensors, allow remote physical examination, monitoring and broadcasting of various physiological measurements such as physical activity, food intake and sleep patterns.

5. Hybrid Layer (Integrating offline and on-line care). The Hybrid layer brings more medical services to patients in their homes. Some examples:

a. Smart vital sign sensors, transmitting patient data for real-time professional interpretation via Bluetooth, WiFi and GPS

b. Home-lab offering comprehensive lab services (such as blood & urine) at the patient's home

c. Interactive digital pillbox, addressing the issue of non-adherence

Applying this Hybrid-Health holistic approach yielded a reduction of 15,496 hospitalizations days per year (YOY) in a population of 74,000 patients aged 65-85 years old. The annual direct financial ROI for this layer is 357%.

The United States has colossal challenges facing its healthcare system. Obamacare provides explicit incentives for health providers to offer eHealth services. Israel’s experience in digital healthcare can potentially be a valuable reference.

Levi Shapiro is a Partner at TMT Strategic Advisors, a research and strategy firm focusing on the technology, media and telecom sectors. He can be reached at or via twitter:Levi Shapiro@levshapiro

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