The Act@Scale program: why size matters when it comes to population health (and what to do about it)

Featuring a Q&A with Professor Stanton Newman, Vice-President (International) of City, University of London and head of the Act@Scale program

The baseball legend Yogi Berra is often quoted as saying that, “in theory, there’s no difference between practice and theory. But in practice, there is.” Until now, that’s also been true about innovative new projects in healthcare: even fantastic ideas often fail to scale up to reach large numbers of patients. And without large scale change, health services won’t be able to deliver better outcomes at lower cost, otherwise known as value-based care. 

This is the challenge that members of the Act@Scale program set out to tackle three years ago. The first-of-a-kind initiative – which includes Philips, European healthcare regions, industry leaders and academia – aimed to deliver a practical guide to scaling telehealth in Europe to the elderly or people living with chronic conditions. Earlier this month we revealed the results of the EU-funded program in a handbook, which contains case studies across six European regions as well as recommendations for best practices in connected care.

To find out more about the potential of Act@Scale, I spoke to the program head Professor Stanton Newman, Vice-President (International) of City, University of London:

 Carla Kriwet: Why do we need to scale telehealth so urgently?

 Prof. Newman: Fundamentally, we’re all standing on a burning platform. A global increase in chronic diseases is putting our health services under huge strain, and the model we have to manage them is financially and clinically unsustainable. We need to reduce costs and keep people healthier for longer by using care coordination and telehealth.

 CK: What are the challenges to scaling care?

 Prof. Newman: Achieving organizational change, along with appropriate reimbursement for activity, and a robust business model. The Act@Scale programs are designed to hopefully reduce hospital admissions; but if the payment model rewards activity -- such as hospital admissions -- it will work against change. For each potential project you need to ask: whose savings are you trying to affect and if you save in one area, who benefits?

 You also need to consider the timescales involved. To transform healthcare, as one of the most complex types of organization in the world, you need an understanding that it takes vision and commitment from many different people and services over multiple years.

CK: How do you go about making large scale change?

Prof. Newman: This is what we lay out in the handbook. We know that telehealth technology works. And we know that pilot projects can get great results. The danger is that we assume that a small research project carried out in one environment will translate easily to another. 

I think the key to scaling projects is organizational change. For me, that means changing peoples’ way of working, enabling integration across services, and new models of care. You need support from clinicians and management together with political support. I think the Scottish online self-management platform My Diabetes My Way, which reached 22,000 diabetes patients across the nation is an excellent example of widespread support for changing practice.

CK: How have patients reacted to these pilots?

 Prof. Newman: Traditional healthcare is very paternalistic. Young people – and increasingly the elderly – no longer subscribe to that approach; they want to know what their risks are, what the likely health outcomes are, and what they can do about it. When you get patients involved in self-managing their condition – which we call “citizen empowerment” in the Act@Scale handbook -- then this is where the real gains can come from.

 CK: Which pilots stood out for you and what can we learn from them?

 Prof. Newman: I think the Spanish projects are worth highlighting because of the way they integrated political and financial support from regional government. The Basque Country multi-morbid integration program successfully scaled up to 16,000 patients with multiple conditions across the region by integrating a diverse set of programs that combined clinical monitoring with patient self-management. 

 CK: What are the next steps for the Act@Scale program?

 Prof. Newman: I think that this program has answered skeptics’ comments about whether it’s possible to make changes on a large scale. You certainly can and it’s vital that we do. From here, I want to prioritize funding for mutual visits to the best examples from other countries so that we can inspire each other. 

For more information on ACT@Scale, visit https://www.act-at-scale.eu and download the full ACT@Scale handbook for more detail on best practice analysis, examples and results here.

[1] This quote is variously attributed to Yogi Berra and the computer scientist Jan L.A. van de Snepscheut. The earliest known appearance of the quote in print is Walter J. Savitch, Pascal: An Introduction to the Art and Science of Programming (1984), in which it is attributed as a “remark overheard at a computer science conference”.