Healthier SG: From enrolment to execution

LAUNCHED in July, Singapore’s Healthier SG programme aims to shift the healthcare system’s focus from treatment to prevention, and deliver better healthcare value. The broad and ambitious programme is off to a promising start, with an average of 3,000 daily sign-ups since it was introduced.

However, enrolment is just the beginning. To truly realise the potential of Healthier SG, the entire healthcare system must be fundamentally reoriented.

As the largest healthcare providers, Singapore’s public healthcare clusters play a pivotal role in this. They face two major questions. First, how must they transform to align with the Healthier SG vision? Second, how can this be done at scale, even as healthcare clusters handle the considerable challenges of business as usual?

The required transformation

Discussions of how Healthier SG will affect healthcare clusters often centre on the shift of cluster financing: from workload to capitation. However, while the financing framework is a powerful influence on cluster behaviour, it should not be the starting point for designing the necessary transformation.

First, clusters must determine what specific shifts in their care model are desired, and what the target care model looks like. Next, to achieve that model, they need to design adjustments to clinical and operational processes.

Thirdly, to enable these adjustments to happen, clusters need to design their organisational structure, incentives, technology stack, data and analytics capabilities, as well as financial and human resource allocations.

Designing the appropriate funding model within clusters, or between clusters and third-party entities, thus needs to follow this initial care-model design.

Considerable work is required at each step. In determining the target care model, clusters must first have clarity on the current outcomes and costs for each patient group, key drivers of value, and what levers can be pulled to improve value.

Even after establishing these facts, there will be data gaps to be bridged, differing opinions among stakeholders in assessing outcomes, and conflicting views on the desired target care model. Ensuring a way to build consensus is vital to overcome these.

At the other end, the funding model must be designed carefully, because this is almost always highly intertwined with service delivery.

The first step is to understand the current sources of financing, the basis upon which financing is disbursed – whether it is block funding, outcome-linked, or fee-for-service – and how funding levels are determined.

Second, clusters need to understand how incentives should be designed or adjusted to achieve the intended changes in the patient journey. Third, potential funding models need to be shortlisted, taking reference from global case studies.

Finally, a detailed design of shortlisted funding models should be carried out. This involves defining which patients the funding model is to be applied to, the trigger for payment, disbursement timing and deviation handling, funding amounts, and how funding levels are to be adjusted over time.

In Singapore’s context, any funding-model design also needs to consider how various sources of funding – subvention, MediShield Life, MediSave, MediFund, Integrated Shield Plans, employee benefits, cash – will interact.

Adding another layer of complexity: any planned changes should be aligned across multiple organisations. Patients today interact with a wide variety of services, not all of which are under the clusters’ control.

For instance, any disease care pathway with a primary care component must consider how private general practitioners fit into the picture. It is also often necessary to involve social service organisations in providing holistic care to elderly patients.

The perspectives, roles, capabilities, and incentives of each organisation must be considered throughout the transformation process.

Changing at scale

Healthier SG will require a massive and challenging transformation of Singapore’s healthcare clusters. Compounding this challenge is the fact that clusters are already under severe pressure to deliver business-as-usual services. The strain comes from high bed occupancy, patient waiting times, and attrition of healthcare staff, particularly nurses.

No healthcare system has attempted to achieve all that Healthier SG aspires to. In addition, Singapore’s operating context is unique. Not only does it seek to preserve patient choice while incentivising them to stay within one cluster, it has multiple payers with different payment principles.

While there is no predetermined road map, some principles and frameworks can help chart the course. One such framework is the idea of being “agile at scale”.

The agile approach has been around for a while. It is well-suited to situations where the path is unclear, and there is a need to iteratively test and learn to find the best solution.

There are three core features of an agile organisation. First, the fundamental building blocks are relatively small, multidisciplinary, persistent teams with end-to-end responsibilities.

Second, teams work in an iterative fashion, with frequent feedback from customers or end-users. Third, teams are enabled to work autonomously, with a strong focus on organisation-wide alignment of goals.

One way for clusters to approach transformation could therefore be to establish agile teams. Each team can focus on a particular patient group or clinical scenario, developing and implementing initiatives for that group in an end-to-end manner.

This would include developing and applying clinical and operational changes, and implementing necessary adjustments to back-end functions such as technology and finance.

The potential benefits of Healthier SG are significant, in terms of both more sustainable healthcare spending and better health outcomes. To realise these benefits, healthcare clusters must navigate this journey of change, so they can optimally perform their role.

Prasanna Santhanam is managing director and partner, and Alan Ong is a principal at Boston Consulting Group