1. What did MALT contribute? Dr Lizzie Coates & Dr Praveen Thokala ScHARR, University of Sheffield 2015 – How have we changed the business model? ALIP and Medilink Workshop 12.12.12

2. Research aims Aim Our project aims to understand how telehealth might be used in wide- scale clinical practice. Rationale The future large-scale deployment of telehealth and other assisted living technologies crucially depends on: –Establishing cost-effectiveness at scale, –Overcoming barriers to uptake, –Devising viable service and business models. Overcoming the barriers to Mainstreaming Assisted Living Technologies

3. Research collaborators Chief Investigator Mark Hawley Economic Analysis Health Economics & Decision Science ScHARR, University of Sheffield Project Manager Project Support Business Modelling & Analysis Leeds University Business School Staff, Patients & Carers Analysis Assistive Technology Research Group ScHARR, University of Sheffield

4. Research phases Phase one: Map, model and design current ALT pathways Interview staff, industry representatives, carers and patients Design financial models Review current practice Design user acceptance questionnaire Phase two: Implement, evaluate and refine Test financial models Test user acceptance questionnaire Implement organisational change projects in four health services sites Phase three: Disseminate Produce methods to assist health and care providers, commissioners and industry Share findings with patients, carers and wider public

5. Research outputs in 2013-14 Financial model Business & organisational models Patient acceptance tool In-depth analysis of facilitators Tools to support mainstreaming

6. MALT Objectives Describe the pathway of patients with COPD and HF with and without telemonitoring (TM) Develop financial models for the costs of implementing TM as functions of time/scale To build a flexible and comprehensive TM financial model incorporating the most up-to- date methodologies (e.g. time profile of costs and business models) to allow a number of TM scenario evaluations. 22/11/2016 © The University of Sheffield

7. Model structure 22/11/2016 © The University of Sheffield

8. Level of detail in the Model Trade-off between - Ease of use vs Generalisability - Transparency vs Robustness Levels of patient severity, Multiplicity of TM options, Detail of service models and contractual arrangements Flexibility to evaluate a large number of potential scenarios! 22/11/2016 © The University of Sheffield

9. Patient case mix scenarios 22/11/2016 © The University of Sheffield

10. Patient data Severity can be disease specific (i.e. NYHA class for HF, FEV1 status for COPD, etc) or generic (i.e. Kaiser classification) Four is the optimum number of levels 22/11/2016 © The University of Sheffield Severity ASeverity BSeverity CSeverity D HF 20001500 1000 Incidence (per month) 16.712.58.34.2

11. Implementation scenarios 22/11/2016 © The University of Sheffield

12. TM Implementation TM variations α, β, g and ω for different severity levels. So four is chosen again as the optimum number of options 22/11/2016 © The University of Sheffield DeploymentTM αTM bTM gTM ω TM at t = 040 TM at 12months100 TM at 24 months400 TM at 36 months400 TM at 48 months400 TM at 60 months400 TM at 72 months400 TM at 84 months400 Duration of TM (in months)6

13. Service model/Contract 22/11/2016 © The University of Sheffield

14. Service & contract models for Sheffield and Kirklees 22/11/2016 © The University of Sheffield SiteActivitySupplierPayerContract Type Sheffield EquipmentHoneywellCCG Per unit fee for 3 years, additional warranty fee InstallationNHS ProviderCCG MaintenanceHoneywellCCG PeripheralsVariousCCGFixed price for review Communications (hosting the service) Honeywell/BTCCGFixed price per patient/ month KirkleesEquipmentTunstallPer unit fee Telehealth SolutionsCCGPer unit fee InstallationCIC/Local AuthorityCCG Telehealth SolutionsCCGPer patient fee MaintenanceTelehealth SolutionsCCGPer patient fee + mileage TunstallCCGAnnual fee Communic (hosting the service) Telehealth SolutionsCCGFixed price per patient/ month TunstallCCGFixed price per patient/ month Clinical follow-upNHS providerCCG

15. Cost estimation (using service and contract type) 22/11/2016 © The University of Sheffield Activity Supplier ID Payer ID Cost type # Cost Device costs 15 1£40.00 Installation and training 3 52£85.00 Monitoring/hosting 2 5-- Communications 2 51£13.33 Technical triage 2 51£12.00 Clinical triage (1st and 2nd) 4 51£67.86 Maintenance/admin 2 51£10.50 Service review 4 5-- Removal 3 52£85.00

16. Clinical and other cost data 22/11/2016 © The University of Sheffield

17. Case study: Different TM implementation plans 22/11/2016 © The University of Sheffield

18. Results: Distribution of Patients 22/11/2016 © The University of Sheffield

19. Transition of TM Patients 22/11/2016 © The University of Sheffield

20. TM costs per activity 22/11/2016 © The University of Sheffield

21. Hospitalisation costs 22/11/2016 © The University of Sheffield

22. Income by stakeholder 22/11/2016 © The University of Sheffield

23. Any Questions 22/11/2016 © The University of Sheffield