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Archive for 24 diciembre 2014

“A value proposition is a promise of value to be delivered and a belief from the customer that value will be experienced.” We, of course, are sure that the product or service we are offering provides value for our customer but, have we identified clearly who our customer is?
Let´s focus on the issue of identifying our customer since, if we don’t know who the customer is, how can we know what they are expecting?
Maybe we could find some answers in the AAL Joint Programme. In its web we find that “AAL aims to create better conditions of life for older adults.” So, our customers are “older adults”. But, is it really so clear cut?
For instance, “better conditions of life” is a broad aim that can only be achieved through a complex array of interventions. It requires the concerted effort of different stakeholders: what we call “Public Health”.
Public Health is “organized efforts and informed choices of society, organizations, public and private, communities and individuals”. With this in mind, the “older adult” becomes only one of the stakeholders expecting the “promise of value”. There are at least two other stakeholders. “What [should then] make a typical value proposition for AAL markets” has to take into account:
a) Payers (public or private organizations): They tend to be conservative minded. They expect new systems and processes to enhance existing infrastructures. They are looking for improvements in the efficiency of care resources.
b) Caregivers (physicians, social workers, informal caregivers): their main interest is to boost processes, leading to a smoother work-flow. They are aiming to reduce their work burden by increasing the efficacy of the care process.
c) Older adults: they are looking for trustworthy and friendly user processes, allowing for better contact with their surroundings, easy access to their data, timely feedback and guidance and, last but not least, the ability to manage their own lives without unrequested outside interference. In other words they are looking for empowerment.
Probably, due to the fact that attending to all those interests at the same time is not easy, AAL has not delivered as was expected when the European Commission launched the first call seven years ago. But don’t despair; the situation is exactly the same for other R&D programmes: “For many are called, but few are chosen.”
It is not only that these three main stakeholders are looking for different things; the real problem is that their interests diverge.
Although it is centred in mHealth, a study by PWC shows that divergence. According to this study, the main drivers in adopting mHealth for payers are:
Reduction in administrative time for medical personnel, allowing greater time for patients
 Improved quality of care and better health outcomes
 Lower overall costs of care for patients
As for professionals, they would be willing to adopt mHealth if it provides:
 Improved quality of care and better health outcomes
 Easier access to care for existing patients
 Reduction in administrative time for medical personnel, allowing greater time for patients
While end-users are driven by the following characteristics:
 Ability to access healthcare providers more conveniently and effectively
 Ability to reduce own healthcare costs
 Ability to have greater control over own health
One can easily see that the three stakeholders do not coincide in any single driver. But it is probably more telling that “Ability to take control over one’s own health” is not even a concern for payers or professionals, neither in the three main drivers nor in any of the other eight drivers included in the study. And it is precisely this empowerment that should drive most of our efforts for better care processes.
Of course, the objective of satisfying the three stakeholders at the same time is not new. Something very similar was launched by The Institute for Healthcare Improvement in the USA some time ago in “The Triple Aim” . The Triple Aim states that new designs must be developed that simultaneously pursue three dimensions:
 Improving the patient experience of care (including quality and satisfaction);
 Improving the health of populations; and
 Reducing the per capita cost of health care.
We could easily match each of the three aims to each of our three stakeholders: end-user, professional, and payer.
Seen in this light, we can identify a big problem when confronted with the difficulty of achieving that triple aim, or providing value for our three main stakeholders.
In our domain, R&D is driven mainly either by research or by ICT organizations. The presence of end-users leading consortia is anecdotic, as is that of care professionals acting as such. It is true that the EC is putting a lot of emphasis on fostering balanced consortia, but that does not mean that the project achieves that balance. What we see in forums and gatherings is that most consortia are strongly led either by research or by ICT organizations.
Is there an easy answer to this conundrum? Obviously not, we have to assume that people dedicating their lives to devising new processes aimed at improving public health are wise people and that if only a few have found the philosopher’s stone it is due to the difficulty of addressing the three fronts at the same time.
Nevertheless, there are a few rules that we should follow, the first being, who will drive the car of innovation. I strongly suggest that the end user is the one who should be at the steering wheel, if only because during all this years they have been in the back seat. If the trend is for the end user to assume more responsibilities in the care process, what we call the empowerment of the end user, then we have to design the care process according to their wishes and demands, thinking always of “Improving the patient experience of care” as the Triple Aim states. And who better than the end user will know how to improve the experience?
In the case of AAL there is an added problem with our end users. We are talking about “older adults”, so leading the consortia there should be any of the myriad of organizations of older adults.
Consider the typical AAL R&D project. Year One is the design of the proposal and the signing of the contract; Years 2 to 4 the development phase; with the following three years for the completion of the final product or service. In all, seven years for the product to be market-ready. If our end users were in the range 70-75 at the time of inception of the proposal, by the time the product or service is in the market they will be 77-82, probably too old to use what they thought was a great idea seven years previously. No problem, the end result is for people in the 70-75 range, those people who were 63-68 years old at the time of inception; nowadays almost a generation apart when it comes to ICT skills.
So, selecting the end-user leader is not so easy. The right mix of people has to be found, so that the care process and the tools to implement it go hand in hand thinking seven years ahead.
Now, let’s decide who the co-pilot should be. At this point I have to state that I may have a conflict of interest: I am an economist. But putting aside that conflict, I strongly believe that the co-pilot should be the payer. We may not like it and argue that money should not drive all our decisions, but the fact remains that “money makes the world go around” as the famous song from Cabaret tells us. We may be able to put on the market the most desirable item, but if there is not somebody willing to pay for it, we will have another Tucker car; the best but unmarketable.
And that leaves the back seat for, guess who, those who have been in the driver’s seat so far, the research and ICT organizations. They should accept the fact that they are tool makers serving end users with something that payers can afford.
If you are involved in R&D aiming at delivering value to your customer, take into account at least these 3 stakeholders: end user, payer, care giver, in that order. Otherwise, you will be doomed!

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