GPI Spa outlines a number of current trends that are influencing the growth of interest in Population Health Management. The company’s work illustrates how today’s model of healthcare is changing, and how the new model is supported by digital health, care management, and artificial intelligence (AI). Indeed, GPI’s vision of healthcare shows that the future is already underway. In the company’s own words, this means proactively “taking the initiative on healthcare rather than waiting for healthcare”.
Taking the initiative on healthcare rather than waiting for healthcare
Today, a paradigm shift is taking place in healthcare systems through the redesign of processes, organisations, models and service-offering strategies.
There are three main reasons why this paradigm shift needs to be sped up:
- The progressive aging of the population, and the need to manage more chronic conditions.
- Technological developments that are enabling systems which can improve the structure of the “health offer”.
- The pressures exerted on hospitals and health systems by the COVID-19 pandemic (these negative effects are accentuated in a manner that is inversely proportional to the level of development of proactive and personalised medicine).
As a result, the ‘waiting for medicine’ or ‘waiting for healthcare’ approach needs to be shifted instead into “personalised initiative medicine”. This change of perspective must be supported with tools, technologies, devices, and processes that facilitate this transition.
Population Health Management: an evolved healthcare model and its benefits
The model of healthcare is therefore evolving. The effectiveness of tools, technologies, devices, and processes can become real only if they are contextualised in a systemic strategy – it can be called Population Health Management (PHM). The organisational structures underpinning PHM provide an operational model intended to “simultaneously improve health, costs and experience (engagement and empowerment) for a given group of people”.
PHM is based on a conceptual approach which has four interconnected dimensions:
- Identification and characterisation of health demand.
- Definition of basket of services dedicated to clusters of populations with similar risk profiles.
- Organisation, coordination, and taking charge of the stakeholders involved in the care pathway.
- Offer of tools (the enabling technologies) that support the delivery and measurement of health services.
The development of PHM strategies that adopt innovative technologies leads to many benefits. It:
- Improves the experience of all the players involved in the health process.
- Increases patients’ adherence to therapeutic paths.
- Improves coordination, efficiency, information sharing, and timely responses on the part of the entire health system.
Together, these benefits increase both the positive outcomes of individual care pathways and the sustainability of the whole system.
Technical developments: AI, algorithms, software, and digital therapeutics
Enabling innovations through application of a systemic strategy implies three main developments. It means the transfer of the health offer to the patient’s home; significant reduction in costs; and allowing the collection of information for the development of artificial intelligence (AI). These AI algorithms are oriented to the prediction of the evolution of pathologies for each individual patient (i.e., Augmented Telemedicine).
Training AI algorithms brings considerable advantages. Being able to train AI systems in prediction enables a shift from the ability to map the demand for health to anticipating the demand. But this advantage is not the main one; another emerges. Digital therapeutics, the new frontier in eHealth, will have the ability to express great potential for the future.
Software is now considered to be an active ingredient in therapeutics. A digital therapy can be defined as a complex method available through virtual care technologies. Through specific documented clinical trials, it demonstrates the production of positive outcomes in the treatment of specific pathologies. Its scope covers either modifying behaviours that affect chronic diseases or its use in the rehabilitation field.
Digital therapies represent a step towards a new frontier both in Italy and in the world. GPI’s presence in the Digital Therapeutics field began with work on a first post-Covid respiratory rehabilitation module, which will go into trial in 2021.
Human resources: The Care Manager - the key connecting figure
Developments are occurring not just in the area of technology. The evolution of the health system cannot be complete without the development of the most important component: human resources.
In fact, as technological interfaces continue to develop and make the patient / provider experience more friendly and accessible, it is becoming necessary to train the key figures who will be increasingly central, such as the Care Manager – in various specialisations. To enable PHM to develop as a systemic strategy, a figure is needed who is capable of involving, supporting, monitoring, and speaking with patients, doctors, and health professionals.
Care Managers can be seen as key connecting figures. Care Managers have a connecting role to play among the various players in the healthcare supply network. Through their technical, psychological, and medical skills, they will be able to support the management of people’s/staff relationships and adherence to individual care pathways.
The future is already underway
The evolutionary process of health systems is already underway. It requires the adoption of a strategic approach that includes both an overall vision and one that is specifically linked to personalised initiative medicine. Responding to these needs by basing the initiatives on the PHM model represents the current best opportunity to ensure the sustainability, quality, and universality of health systems.
The use of algorithms is enabled thanks to the real-time monitoring of parameters.
Two example AI algorithms can be derived from recent GPI experiences. They describe the current reality of Augmented Telemedicine:
- Developed and Validated COVID-19 Monitoring Algorithm, based on Respiratory Rate and Heart Rate.
The algorithm recognises frequency peaks that are due to the motor activities of the person being monitored. It distinguishes the frequency peaks from positive covariance trends which are typical of a trend towards respiratory failure. The algorithm is therefore able to issue timely alarms. We tele-monitored around. 100,000 COVID-19 positive patients in Lombardy region.
- Developed and Validated Algorithm Predictive of Acute Phases of Heart Failure.
The clinical parameters used in this algorithm are respiratory and heart rates, and blood oxygen saturation (SpO2). The algorithm carries out an evaluation of the patient’s physical activity through continuous evaluation of the frequency peaks and analysis of the ‘distance’ between them over time.
Indeed, AI is one of the several pillars of GPI’s research.
The company’s other research interests concern Predictivity in the field of Augmented Epidemiology, Natural Language Processing (NLP), Automatic Pattern Recognition, and Voice Interpretation to determine a person’s emotional state.
As a result, GPI has:
- Developed the first stratification algorithm of risk cohorts for chronicity and the priorities of the vaccine plan which stratifies a population (Valle D’Aosta, Italian Region) through Machine Learning (PHM).
- Created a Semantic Search Engine on Ontology for the Tuscany Region of Italy on the labour market. It supports the reduction of the mismatch between supply and demand. This demonstrates that when innovations spread, they may be adopted for health and social challenges too.
- Created a Predictor of Mean Glycemia and co-morbidities, as part of the RIPE project thanks to a dataset of about 8 million records.
The rapid progress on these technologies, and their availability already on the market, shows that the future is on the way. Exciting progress is happening not only in Italy, but can be spread rapidly throughout the European continent.
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