The delivery of healthcare is undergoing significant changes owing to medical and technological advances. These trends are particularly promising for the Gulf Cooperation Council countries, which are grappling with rising healthcare costs and an epidemic of non-communicable diseases (NCDs), such as cancer, diabetes, cardiovascular and respiratory illnesses. Healthcare policymakers in the GCC who understand these changes, and alter their organizations and funding models accordingly, will be able to provide better quality of care and improved health outcomes.
The most significant change is the shift of focus, from curative care to preventative care, that is, from treating sickness to promoting ‘wellness.’ Historically, the healthcare system dealt with individual cases of illness. It was assumed that there was little need to see patients unless they were ill. Today however, there is a growing emphasis on the continual management of a person’s health.
There are two major reasons for this change. First, scientific advances mean that we know more about the risk factors that lead to illness and how diseases develop. The second is the economic burden of healthcare; treating sickness is expensive because it often demands complex, in-patient care. Managing wellness, however, can be achieved through cheaper primary and outpatient care. On top of that, healthcare systems are more likely to have improved outcomes for patients by identifying disease risk factors early, rather than focusing on them when the patient is actually unwell.
These changes are particularly important for healthcare systems in the GCC which have to care for large subpopulations that suffer from, or are at risk of, NCDs. These ailments are now the leading cause of death in the GCC. NCDs, also known as chronic illnesses, force up healthcare spending and diminish individuals’ economic activity, because sufferers typically consume a large volume of healthcare services and are less productive. We forecast that without urgent government action, NCDs will impose a $68 billion economic burden on the GCC by 2022.
One of the new methods that can be used to treat NCDs, and manage their risk factors, is known as next-generation whole-person care models (WPCMs). These involve a coordinated approach to the medical and behavioral needs, among others, of complex populations, tailored to specific subpopulations such as obese young people who are at risk of developing diabetes.
The integration required to implement WPCMs shows that providers can properly meet patients’ needs in a manner that is economically sustainable. WPCMs are emerging in the US and are already improving quality of care and restraining cost — precisely what the GCC needs to do.
WPCMs have five elements. The first is a care coordinator, a central figure collecting information and initiating action among the healthcare providers, who deals with patients and at-risk individuals. The care coordinator also works with informal caregivers like family members, friends, neighbors and local charities.
In the US they have found that the most effective care coordinators are from the same area as their patients and share cultural experiences. For the GCC, that would mean coordinators with a background in nursing or social work who know how to communicate the need for healthier behaviors and better eating habits to young people.
The second element is a multi-disciplinary healthcare team which includes medical, behavioral and long-term care experts. These can include primary care physicians and specialists, such as ophthalmologists treating diabetics (who are more likely to suffer from cataracts and glaucoma). The multidisciplinary team’s professionals can provide care outside of the usual setting of hospitals, clinics and nursing homes. They can see patients at daycare centers or can use email to mentor them on how to manage risk factors such as excessive sugar in their diets.
A team effort
The third element encompasses external care collaborators, such as government agencies, charities, educators, and a patient’s family and friends. They form an invaluable informal caregiver network, and perform a variety of nonmedical but critical tasks, such as driving patients to appointments, arranging for physical exercise for children and ensuring that healthy meals are provided.
The fourth element is informatics, which allows all those involved to gather, generate, and respond to data, such as real-time alerts of unfilled prescriptions. Informatics also help with profiling patients through mass screening programs.
Digital tools enable more effective remote patient monitoring and engagement. For example, electronically programmed pillboxes can ring to remind the patient to take medication. Patients can also have video and tele-health systems at home to decrease their sense of isolation and reassure them that help is at hand.
The fifth element is made up of incentive structures to reward WPCM team members for improved health outcomes. These motivate care teams and collaborators to pursue the best outcomes, while providing feedback to healthcare providers on their success in tailoring WPCMs to the specific needs of different population segments.
Examples of proper incentives in addressing the subpopulation of diabetics would be performance bonuses for care teams that reduce the number of amputations, infections and hospital admissions from this group, or referral fees for social workers who connect diabetics to treatment teams.
What makes the GCC particularly appropriate for this new approach to healthcare is that it already has potential stepping stones towards WPCMs through mass screening programs. Specifically, Abu Dhabi’s Weqaya (Protection) program has been hailed as visionary and has continually grown in scope since its introduction in 2008.
The Weqaya program identifies cardiovascular risk factors for UAE nationals living in the emirate, and helps to improve individuals’ health status. People are eligible for screening every three years. A website gives them access to a personal health report, explanations of screening results and access to information and services such as appointment booking, education and awareness programs, and disease management programs.
To give a hypothetical but realistic example of how a WPCM could enhance and expand the benefits of a mass-screening program, the program may identify a 17 year old student in a secondary school in the GCC who is overweight and has a family history of heart disease. Analysis of the student’s geographic location would show a risk of poor nutrition based on the food available in local shops and an additional risk that the student will be unable to keep doctoral appointments due to insufficient transport options. Further analysis shows that the student’s school lacks exercise facilities, which means few opportunities for physical exertion. Since the mass screening results identify the student as having an elevated risk in the medium term of developing type-2 diabetes and, over the long term, of heart disease, the WPCM approach to his case will enable the healthcare system operator to act early in addressing these risks and help the student in managing and lowering his health risks such as providing him with a digital monitor, or by finding an exercise facility outside the school.
To use WPCMs successfully, GCC providers will have to develop a set of foundational capabilities that apply to all such models, with tailored capabilities and delivery models for those at risk of NCDs. They will need to integrate the five elements of WPCMs to overcome the fragmentation and insufficient coordination that affects so many healthcare systems.
As a new model for healthcare delivery WPCMs will have to be phased in, and coexist side by side with the existing organization of healthcare sectors. We expect that investments and expenditures into the new models will be minimal in terms of staff costs because the required components already exist.
Given the cultural change required, such transformation will require a three-to-five year horizon to ensure it takes roots and delivers results.
Digitization is a core enabler for the holistic approach and an essential aspect in optimizing interaction between healthcare systems and their clients. Therefore, the main cost associated with this new model will be the investments in the information and communications technology (ICT) systems that support it. The existing level of ICT infrastructure in the GCC will support the rollout of WPCMs in the Gulf region but WCPMs can also deliver strong benefits to other countries in the Middle East and North Africa (MENA). Chronic illnesses pose a serious challenge in every country and are already prevalent cost factors in several. While the impact of WPCMs on healthcare burdens in the GCC and across the MENA is hard to quantify, this model in our view has considerable potential for reducing the regional cost burdens of chronic illnesses in the long term.
Health authorities and regulators in the GCC and elsewhere in the MENA should encourage providers to examine how they can customize and use WPCMs to change the delivery of healthcare, and to treat chronic diseases and their risk factors. In the place of sometimes poorly managed and inadequate care for complex populations, health providers can cooperate and coordinate care effectively and efficiently, and so stem the rising tide of NCDs.