Mr Cheng Wai Keung
Professor Ivy Ng
Group CEO, SingHealth
Mr Tan Jack Thian
Singapore Healthcare Management Congress 2021
Mr Kevin W. Sowers
President, Johns Hopkins Health System, USA
Colleagues and friends
Good morning. It is my pleasure to join you today for the 11th Singapore Healthcare Management Congress. I am happy to see many of you gathered here virtually, representing different parts of the healthcare family.
2. The past year and half have been turbulent for the entire world, as COVID-19 swept across borders. The healthcare sector was greatly challenged as infections spiked and had to quickly adapt, alongside the rest of the nation. It was through these difficult times that we saw the bravery and courage of every member of the healthcare family. Standing firm in our fight against COVID-19, stepping up beyond the call of duty to serve, as we mounted a whole-of-nation response to stem the virus. I would like to express my deepest appreciation to every healthcare professional – for your unwavering commitment and the many personal sacrifices that you have made in keeping our nation safe throughout the crisis.
Meeting Healthcare Challenges Beyond COVID-19
3. Even as we continue our fight against COVID-19, we must not lose sight of our long-term focus to strengthen our healthcare system and ensure its sustainability. Singapore’s healthcare expenditure has been and will continue to increase, as our population ages rapidly. By 2030, 1 in 4 persons will be aged 65 and above. We can expect to see a corresponding rise in age-associated conditions. Compared to 2017, in 2019 and 2020, while the prevalence of diabetes has remained stable, we have observed an increased in the age-standardised prevalence of high blood pressure and high blood cholesterol. This underscores the need for us to invest in enhancing preventive upstream health efforts. For example, through encouraging more active lifestyles, smoking cessation, addressing mental well-being and more to reduce the burden of chronic diseases. We will need to innovate and find ways to keep the growing workload sustainable for our workforce, as we deal with long-term manpower constraints and challenges across all sectors.
4. This means designing better interventions so that we can continue delivering affordable, accessible and quality healthcare in a sustainable manner for our people. I would like to challenge everyone to deliberate, ideate and brainstorm on what care delivery can look like to us in the New Normal. Today, I will sketch out how we can see this at three levels – first, our patients; second, our healthcare workforce; and three, our healthcare financing system.
Enhancing the Care Delivery to Patients
5. Let me start by speaking about how we can enhance care delivery for our patients – the people whom we serve. In the healthcare setting, most of our services have to be provided in a direct and personal manner, where there is great room to leverage technology to transform the way we deliver care. Artificial Intelligence (AI) is a promising tool which we can do more to encourage adoption and scaling up. As with the adoption of any new technology, there will always be some initial hurdles, especially for the early adopters. But as long as we tackle these challenges systematically, in a stepwise manner, we will be able to pivot in our shift towards digital transformation readily.
6. I will share one example of how we have transformed care delivery beyond the hospital into the community. This was achieved through a pilot trial to bring hospital care to the patients’ homes that was spearheaded by a partnership between the MOH Office for Healthcare Transformation (MOHT) and NUHS. Unlike traditional home care, the NUHS@Home programme specifically caters to patients with acute conditions who will otherwise need hospitalisation for intravenous treatment and monitoring. It leverages tele-consultations, portable investigations, and multi-disciplinary home visits to substitute hospital care. Remote monitoring systems, including wearables, transmit real-time vital signs to a consolidated dashboard, helping the 24/7 care team monitor the patients. This allows them to respond quickly and effectively to any changes in their condition, without affecting the overall quality of care.
7. More than 70 patients have been enrolled in the pilot to date, including many elderly patients who felt more comfortable staying at home rather than in the hospital. Based on preliminary findings, it is also heartening to note that the costs of medical incurred by these patients were about 20% lower than they would have in hospital wards. While further studies are warranted before such programmes can be scaled up, it is certainly a good start and vision to see how technology can enable us to create alternatives to hospitalisation.
Transforming and Caring for our Workforce
8. Next, moving on to my second point on transforming and caring for our healthcare workforce – who are at the heart of our entire system. As I mentioned earlier, our manpower needs will continue to grow, even while the local labour force growth is tightening. We must therefore not neglect our existing workforce – for example, by making their work easier and looking out for their well-being. This will contribute towards building a more resilient workforce.
9. We can free up our healthcare professionals’ bandwidth by reducing the burden and time spent on repetitive tasks. This is an area where digitalisation can have a big impact not only for our professionals but can also bring convenience to patients. I will share one example of how we had used technology to aid with the booking of consultation slots and diagnostic tests at Specialist Outpatient Clinics (SOCs). Traditionally, these are done very manually and in a time-consuming manner for both patients and Patient Service Associates (PSAs). To tackle this problem, SingHealth’s Future Outpatient Journey (FOJ) taskforce rolled out a successful pilot which used an intelligent triaging and appointment-booking system at the Bukit Merah and Outram Polyclinics. The system uses an algorithm that intelligently facilitates the booking of consultations and ordering of diagnostic tests at the SOCs automatically. This facilitates earlier referrals and clinical interventions, especially for higher-risk patients.
10. The results have been promising so far. Between August 2019 and June 2021, it has saved close to 320 man-hours on appointment bookings and 1,200 hours of patient waiting time! Additionally, around 3,000 appointments were automatically booked and referred to National Heart Centre Singapore (NHCS), including 260 chest pain cases for frontloading of tests. When scaled up, this initiative can potentially save PSAs up to about 14,000 hours and patients 50,000 hours annually. Through this, SingHealth’s PSAs and clinicians were able to devote more of their time towards caring for our patients’ needs. An inspiring example of how we can streamline system workflows through digitalisation and where technology has complemented the human touch in healthcare.
11. Besides improving workforce productivity, we also need to be mindful of the wellbeing of our professionals and workers. A sustainable workforce is one that is made up of resilient professionals and workers, whose well-being and needs are being taken care of. This is regardless of whether they are serving at the frontlines or at the backend – everyone plays a crucial role in sustaining our healthcare system. It is our responsibility to ensure that our healthcare workers are well supported to perform their duties. This has to go beyond COVID-19, as this will not be our last health crisis.
12. To this end, we will continue working with our tripartite partners to establish supporting systems for a resilient workforce. At the national level, MOH has worked with representatives from our public healthcare institutions to establish a cross-cluster Staff Well-being Committee (SWC). This will enable the sharing of best practices and creating an avenue to provide feedback on possible system-level interventions for staff well-being. As our carers put patients at the heart of what they do, we too, should remember their sacrifices and give them the best support we can to enable them to serve our people.
Creating a Sustainable Healthcare System
13. Finally, improving the affordability and sustainability of our healthcare system. Doing this well requires funding mechanisms that creates an impetus for providers to come together in delivering integrated care for patients. And at the same time, allowing some flexibility to adapt to the changing healthcare landscape.
14. MOH has started two financing innovations. The first is what we call “bundled payments” – where funding is tied to a patient’s entire care episode, even across multiple healthcare settings or attendances. This encourages providers to optimise care, reduce costs, and pass on savings to patients. Such models are best suited for medical conditions where the clinical care pathways are defined. Next, MOH has implemented a “Pay for Performance” (P4P) framework to further empower institutions in improving clinical outcomes in a cost-effective way. Clusters are financially incentivised to perform well in key priority areas.
15. The financing system should also be sufficiently flexible to meet evolving healthcare needs. Through the pandemic, we have seen a pivoting towards remote care. MOH responded by making video-consultations eligible under the Chronic Disease Management Programme (CDMP) and Community Health Assist Scheme (CHAS) on a time-limited and exceptional basis. It also covered medications delivered or collected on patients’ behalf without in-person consultations. Allowing patients to continue tapping on their MediSave and CHAS subsidies to manage their conditions, while minimising the risk of exposure to COVID-19.
16. These are part of our ongoing journey to review and evolve our healthcare financing structure to incentivise better health outcomes and reduce waste. Enabling it to be more sustainable for the longer term.
17. These ideas and examples are just the beginning of what we can achieve, if we work together and transform the way we deliver care, empower our workforce, and finance our systems. I am confident that today’s Congress will set the stage to generate even more ideas and solutions. Bringing us closer towards creating an innovative, value-based quality and future-proof healthcare system. Together, we can bring better health, better care, and a better quality of life to Singaporeans.
18. In closing, I would like to thank all healthcare professionals for your contributions and hope that you will have a fruitful time sharing and learning from one another. Thank you.