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ACTIVITIES :: eTen :: Projects :: Projects of the Month :: Spex

February 2006 Project of the Month: Spex

Continuous Mobile Services for Healthcare

Issues being addressed

SPEX is based on the idea that clinical Centres of Excellence (CoEs) have a strong motivation to build a delivery network over a wide geographical area (typically a region or country but possibly the whole of the EU or a sub-set of Member States) to serve five different purposes:

• filtering the patients treated directly to avoid the risk of misusing the CoEs’ highly specialised clinical resources by saturating them with relatively ordinary clinical cases;
• improving the service offered to patients by providing care to them, whenever possible, where they live or work in order for them to avoid spending money and time on unnecessary travelling;
• expanding the catchment area for the clinical cases that fall in the CoEs’ mission;
• enhancing the financial performance of the CoEs by redirecting simple cases towards the peripheral outlets and by focusing all their highly qualified but expensive resources on more complex diagnostic and therapeutic cases;
• guaranteeing the critical mass flow of complex clinical cases to maintain professional skills.

Currently the functions described above, especially in countries with a public health system, are delegated to a rather hierarchical and rigid escalation system (the referral procedure) and that the CoEs ultimately do not control. This makes the CoEs dependent on others in terms of volume and mix of cases that they treat.
 

Objectives of the project

To address these problems, SPEX has market validated a business model referred to as a specialty Network of Excellence. This takes different forms depending on the type of health system in place in each country, and on the public or private nature of the organisations involved in the network. In the case of insurance-based health systems or private organisations in general, the Network of Excellence can take the form of a franchising network, very common in the commercial marketplace but practically unexplored in the healthcare sector. In public health systems and when the organisations involved are public, other contractual frameworks have been devised to adjust the Network of Excellence concept to the culture and the constraints that characterise these environments.

In the SPEX model, the Centres of Excellence (CoEs) create a network of Points of Care (PoCs) and use these as “outposts” to reach patients and provide clinical expertise to them over a wider geographical area. The PoCs are existing public and private healthcare outlets, which are trained and accredited by the CoE for a given specialty and are given access, via a set of services described below, to the specialist knowledge of the CoE.

A Network of Excellence should be supported by a contractual framework that defines the split of responsibility between CoE and PoCs; this avoids a possible “cannibalisation” of the business of the former by the latter. When established in this way, the Network of Excellence creates a win-win situation where the CoE gains control of its destiny while the PoC improves its image and reputation, increases its solution providing capability and its patient catchment ability. 

Services

In the Network of Excellence scheme, the CoE provides the PoCs with a number of services centred around:

• accreditation for excellence, where the CoE checks if the PoC qualifies for membership of the Network of Excellence and allow the PoC to boast the CoE’s “brand”;
• professional development of medical personnel (through eLearning applications but also through “traditional” face-to-face training activities) leading to the fast spread of medical knowledge and early adoption of innovative diagnostic and treatment techniques;
• sharing of clinical guidelines, clinical protocols and patient records;
• remote consultancy services on specific cases through second opinion and interactive tele-consultation applications.

In a franchising scheme, the services above are provided in exchange for a fee. In other cases, the nature of the contractual relationship can be different but the ultimate goal is always to create the win-win situation evoked above.

Achievements

During the Market Validation phase trials are being focused on plastic surgery, specifically burns, chronic ulcers and pressure sores (Sweden); management of cardiac conditions (Spain) and on cardiology as well as on outpatient specialist activities (Italy).

Apart from the evidence collected during the trials about the clinical acceptability and the economic sustainability of the SPEX business model and supporting services, the other major achievement of SPEX consists in the definition of a contractual framework which clearly defines the rights and obligations of the parties within a specialty Network of Excellence. This paves the way for a smooth transition from the Market Validation to the Deployment phase.

The Partners

Reference Data

http://www.spex-project.net
Contract Type: Market Validation
Start Date: May 2004
End Date: January 2006
Duration: 21 months

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