PHM Opportunities Outside the US

Publication Date: 05/10/2017

Written by

Alex Green


The Affordable Care Act (ACA) has defined and driven the population health management market over the last five years, resulting in North America representing approximately 70% of the global market in 2016. It has also resulted in North American vendors dominating the competitive environment with companies such as Optum, Cerner, Allscripts, IBM (via its Truven Health acquisition) and Evolent Health taking market leading positions. However, the drive to better manage the health of populations, particularly those that are managing long-term conditions, is global and over the coming years this will present opportunity in other regions.
But how do vendors identify which geographic markets to target, and how do vendors need to adapt their offerings?

Why the US in the Driving Seat?

The ACA, and with it targets set by the CMS via Meaningful Use and MACRA, have driven a demand for a product that aids providers in transforming their models of care. In particular, providers that have become part of an Accountable Care Organisation (ACO) or those that have started the process of evolving their operational model away from fee-for-service to a value-based care model. Demand here isn’t just for the care management and care coordination tools to support the transformation process, but it goes as far as reporting tools (embedded in the PHM solution) that support providers reporting back outcomes to the CMS that measure the success of the transformation process. Further, the data aggregation and risk stratification tools developed to drive PHM solutions are tied heavily to integrating data from provider EHR solutions. EHR solutions that have also been defined by US legislation.

The result is two-fold, a dominant US market and PHM products highly tuned to address North American health provider needs.

Indicators of a Demand Outside the US

As US vendors now look to international markets to expand their business, the major challenge they face is how to sell a product so highly tied to the demands of US legislation, outside of the US. In assessing which markets to address a vendor should examine several different factors, two are outlined below:

EHR/EMR deployment – With existing PHM solutions designed to interact closely with provider EHR solutions, a potential starting point would be to target countries that are also advanced in terms of EHR deployment. Examples include some Nordic countries (such as Denmark), Singapore, certain regions of Spain, Switzerland, New Zealand and the Netherlands. EHR deployment is just the starting point though; another factor to consider is the sophistication of those EHRs deployed. Countries where a significant proportion of EHRs deployed are advanced in terms of functionality (e.g. patient portals, external data sharing and clinical decision support tools) indicate a demand and a readiness for greater sophistication in the tools used to manage patients.

Local initiatives – Without the monolithic legislative processes seen in the US, the stimulus for adoption in other countries is expected to be more focused on specific projects that are aimed at managing certain cohorts of the population. Deployment of all-encompassing PHM solutions that address the needs of the well, differing cohorts managing a variety of chronic conditions, comorbid cohorts, recent hospital discharges and those managing palliative or end-of-life care is not expected to be seen anytime soon.

Instead demand at first is forecast to come from individual initiatives focused on specific cohorts. The European Innovation Partnership’s (EIP) Active and Healthy Aging (AHA) initiative provides some good examples. Over 100 projects have been deployed under the AHA banner, many of which use technology to support managing the needs of specific cohorts. These projects range from limiting hospital readmissions of COPD patients in Spain, to empowering patients during the hospital discharge processes in Sweden, to identifying and better managing high risk frail populations in Italy. The driving pillars of the AHA also align reasonably well to some of the US legislative goals. AHA goals such as improving personal health management, putting in place comprehensive case management tools, greater remote monitoring of patients, improving health literacy, more patient empowerment and improving medication adherence, all chime with several MACRA targets. Therefore, in theory initiatives such as those under the AHA umbrella breed opportunity for PHM vendors to capitalise on.

A significant hurdle however is funding, and ultimately, moving projects beyond the pilot stage. This is where the comparison of MACRA and AHA falters. Funding is an issue that plagues many AHA projects, despite various EU funding opportunities being available. Indeed, without the financial penalties and incentives that legislation has put in place in the US, funding remains the largest barrier to innovation in care delivery, and in turn PHM deployment, in many regions of the world.

Another area where opportunity exists for PHM vendors is local initiatives to redesign models of care where health care interacts with social care. A good example is in the UK where a number of vanguard projects have been established around this issue as part of the NHS’ Five Year Forward Plan. In particular the care coordination, care planning and patient engagement functionality that can be offered as part of a PHM solution can be utilised for projects of this nature. Cerner has seen success in deploying its HealtheIntent PHM solution with Wirral Partners in the UK to address (amongst other things) this specific need. The use of PHM to connect health and social care agencies and better manage patients that regularly interact with both health and social care is projected to be one of the primary drivers of growth for PHM in several countries in Europe and other regions of the world.

One final comment on local initiative drivers; although the point was made earlier that a developed EHR environment is a potential early indicator of nascent demand for PHM, many local initiatives of the type described above don’t necessarily adhere to this trend. Although EHR deployment may be one good indicator, it is just that – one indicator. There will be many examples where it doesn’t hold true.

Local Vendors

The challenge of identifying the most promising geographies and evolving products to suit those markets is not the only challenge for US vendors looking overseas. In many cases the markets they target will be served by local vendors that have legacy relationships with the local providers. Examples include Senyint, Neusoft and Univalsoft in China, Graphnet, Patient Knows Best and OLM Systems in the UK and Maincare Solutions and Acetiam in France, to name just a few. The PHM solutions offered by local vendors may be less mature, and more limited in functionality than those offered by US vendors, but their design will have been driven by regional requirements and legacy relationships, not US legislation.

New Market Report from Signify Research

Signify Research will be publishing a new report on the PHM opportunities in EMEA, Asia and Latin America at the end of 2017. The report will provide market estimates and forecasts for PHM platforms in over 20 countries globally with qualitative analysis provided for each. The report will also assess the competitive environment with focus on local regional/country vendors and international vendors. For further information about purchasing this report please contact