Digital Treatment of Asthma Patients in Swedish Primary Care : A Business Model Study

Abstract: The cost of healthcare has been steadily increasing over the last decades and is becoming an increasing liability on the public finances. Much of these resources are directed to the primary care, and more specifically to the treatment of chronic diseases within the primary care. Digital healthcare, which has been highlighted as a potential way of increasing the efficiency within the primary care, has so far been unable to provide continuous care to patients with chronic diseases. New digital business models are needed to properly treat these patient groups. This study has evaluated the feasibility of a new digital business model for the treatment of the chronic disease of Asthma. The feasibility of business models was evaluated qualitatively from a patient, payer and provider perspective. Parameters for evaluating feasibility from the three perspectives were determined through policy reports as well as expert and practitioner interviews. Patient journeys, with their corresponding business models, were developed iteratively together in a series of interviews with practitioners from diverse disciplinary backgrounds. The evaluation of the business model’s feasibility for treating patients with asthma was done on a basis of clinical studies, clinician interviews, five patient interviews as well as financial calculations on provided care from the perspective of the provider and the payer. The study found that business models based on fee-per-action reimbursement, which are dominating in digital healthcare currently, are feasible for treating patients with mild asthma, but not for patients with severe asthma. For patients with severe asthma, business models based on capitation reimbursement are feasible, while the care can be provided 100% digitally by the inclusion of a bluetooth spirometer. A capitation based business model would provide better care for patients with severe asthma, to a lower cost to the payer (the healthcare region) and would be financially viable for the provider of healthcare. Our findings indicate that while asthmacare can be treated digitally with good patient outcomes as well as cost-efficiency, providers need to establish a physical presence in order to adopt a financially viable business model.