What is Plan Data Health? a translation of a guideline for introducing Plan Data Health published in Dec. 2014 by MHLW of Japan

Suda Yasuji (sudays17@gmail.com)

Japan national cabinet required in Japan revitalize strategy “Japan is back”(2013.6.14), "all health insurance organization from municipal-base to private-base will implement Plan Data Health to analyze data of medical receipts and a like to promote better health condition of its member."

http://www.kantei.go.jp/jp/singi/keizaisaisei/pdf/saikou_jpn.pdfsource(Japanese)

Why Plan Data Health introduced ?

According to this MHLW issued 2 revised-directives of health promotions applying to all health insurance organizations. • to apply business management system cycle to health promotions for more efficient and more effective way• to implement them based on analysis of digitized health and medical data

Why Plan Data Health introduced ?

source(Japanese) : directive of health promotions private health insurance org. directive of health promotions public health insurance org.

What is Plan Data Health ?Plan Data Health （ PDH ） is …

to do a business (health promotions) based on analysis of data of health checkups and medical receipts.is a game changer from cost(burden) to invest in employee health management.

to apply to all payers (health insurance organizations) under Japan national health system.focusing to improve preventive health management performance using PDCA business cycle. (A)(B)(C)

Make a plan based on data analysis ・ target health issues and business ・ set purpose ・ select activities considering cost-effectiveness

Revise a plan for next cycle

Review effectiveness of planned activities(numerical base)

Execute planned activities ・ tailored information to each member ・ health check ups and coaching ・ actions to progress of health problems

（ A ） management system approach to managed 　　　　　　　　　　　　　　　　　　　　　　 health services

PDHof

private health

insurance org.

Step 2

Target health issues

Step 3

Select business depending its health issues, set KPI

Step 4Apply management system approach

Step 1

Survey health stats.

Planning steps Examples of activitiesUse medical

receipts info. sys.

Use info. sys. of outsourcer

Get analysis results・ expenditure per capita of cardiovascular disease

Execute walking program

Distribute brochures

Support smoking cessation

Prevent diabetes advancing

Newly grouped to metabolic syndrome⇒notify them what

are needed

（ B ） PDH execution steps model

investpurchase health

products & services

Effect

providers &venders

health exam.

counsel& coach

sampleanalysis

productspayer employee

employerimprove productivity& corporate image

improve member’s healthmanage expenditure

promote healthprevent life-style related diseases

Golden cycle to create or expand markets Cycle of investment for health

Focusing collaboration with occupational health⇒Occupational health could be a leverage of PDH.

（ C ） Conceptual model of investment for health

Features of PDHfor employee of private companies(private sector health insurance org.) ※ these feature also fit for member of municipal health insurance org. １ handle health and medical info. including specified medical check-up and medical receipts ２ set managed health services depending its financial and business environment ３ collaborate with employer(occupational health) for services, namely “collabo(ration)-health” ４ will use experts outside of org.

Data driven managed health service providers

Features of PDH

service providers

①ideal scheme of employee health management

Source : about plan data health

payer(health insurance org.)

core tasks・ execute business with PDCA・ finance and recruit・ data management

core roles・ make alliance principle with payer・ provide resource topayer

collaborationemployer

outsource

report member’s health conditionsreport about health promotion

financestuff

・ planner ・ info./data provider ・ coach/counselor

member (employee and their dependent)

improve and maintain their health

Focusing collaboration with occupational health

Why will they use experts outside of org. ?• Health insurance organizations have been positioned as administrative center. • And small and medium size organizations have insufficient stuff. ※health insurance law require these organizations to provide health promotions to its member, but their main task is to collect premiums and pay medical fees. For this reason, quite a few of them have data experts, enabler of PDH . PDH create business opportunity for outsourcingmanaged health service providers. Sure thing ?

Features of PDH

Good practices of PDH19 practices are awarded as excellent empirical studies in 2013, 2014. ・ managed health services based on analysis of medical and health data

Some of them •Designing occupational health for high blood pressure employee•Designing services using ICT•Designing “healthy scores” and “programs for married couples”•Preventing services for MI advancing •Supporting programs for asthma •Designing prediction models of disease advancement•Designing personalized managed health services •Designing programs with visualized health status

Timeframe of PDH

　　　　　　 PDHround Ⅰ 　 2015 － 2017

round Ⅱ 　 2018 －

Synchronize to specified medicalcheck-up execution plan

round Ⅱ 　 2013 － 2017

round Ⅲ 　 2018 －

Specified medical check-up

Recap what PDH isPlan Data Health （ PDH ） is a framework of data driven managed health services. ★empowering payers (health insurance org.) and indirectly empowering its member ★somewhat limited to basic statistical approach PDH is not a data maniac

approach, but strengthen feedback loop using systematic review of previous activities (12p, “guideline introducing Plan Data Health”)

In my view, PDH is a challengeand somewhat skeptical.

Checkup

follow up assumednecessary cost

additional money

Unavoidable to implement this package

expecting curve out cost

Stay on track(healthy zone)

(out of medical account)

Motivated by any type of incentives

A > B ?

B

A

Regimen adherence assistance is not more useful ?

－ point programs 　　　　 get more attention