Challenge tenders are a new model designed to solve urging needs of the health system which usually aren't attractive enough for the start-up industry to engage in, such as fall prevention among elders, improvement of geriatric care in long term facilities and others. In order to attract digital based solutions to enter the health system, we initiated an innovative method of intervention which allows quick testing of technologies in health organization with MOH support for fast proven outcomes.
Challenge tenders are an innovative initiative that offers a different than usual solution to the health system's needs. Although Israel is well known for its startup nation abilities in different domains and health is a major one of them, innovative digital solutions often don’t succeed in entering the Israeli health system, especially when dealing with less attractive needs, such as nursing elders in long term institutions, prevention of falls in elder, etc. The MOH understood that in order to answer these urgent needs we need to intervene and actively bring the startups into health organizations to test if their technologies can solve such problems. We understood that by supporting pilots with digital solutions to our burning problems and measuring their outcomes, we can achieve fast results and later support larger implementations. Unlike classic governmental tenders, challenge tenders allow an innovative approach to solving burning issues in our health system.
We define our problem, usually a problem which isn’t attractive enough for the startup ecosystem to intervene by itself, and we allow companies to offer different digital solutions, from different domains, in order to solve our problem. We do not limit the number of solutions and we encourage as many different solutions and technologies to apply. After receiving all applications, we start the screening process which is very meticulous and combines quality and cost measurements in order to choose the best solutions for pilots. The selected solutions are fully funded and accompanied by the MOH in executing a pilot in a health organization (usually an HMO or a long term care institution). The funding is given through all the pilot's stages for support of licensing, developments and necessary adjustments of the product to the health organization.
The pilot is executed in a health organization for 6-12 months in which the product is being tested for efficiency, clinical results and compatibility with work flow. In this period the health organization is measuring the outcomes of the pilot in order to establish whether it meets its needs and solves the problem we defined. This collaboration between a startup, a health organization and the regulator in order to test a technology that can solve a major problem in the health is a new, groundbreaking method that eventually will lead to embracing new, innovative technologies into our health system allowing it to be more efficient, more valuable and produce better clinical outcomes for patients.
Our first pilot executed this way was in the field of fall prevention of elders above 65. Falls are one of our most urgent concern regarding elders being the 6th cause of death among elders. Elders who fall are more likely to deteriorate physically and mentally and consume more health services (ER visits, hospitalization and medication consumption). In the challenge tender dealing with falls among elders we defined the problem as preventing falls among elders over 65 and asked startups to suggest solutions and technologies that prevent falls. We were looking for technologies which actually help prevent falls and not just sensors or smartwatches with only monitoring abilities. We received a few dozens of solutions from which we chose two technologies to test in health organizations.
One of these two technologies was an evidence-based digital-therapeutic solution for customized motor-cognitive training, walking rehabilitation and fall prevention named "GAITBETTER". Maccabi, the second large HMO in Israel was chosen to be the pilot's test site and alongside with the physical care department of Maccabi and the MOH, we initiated a 6-months pilot intervention. The pilot involved 200 elder patients that were considered in the 'medium –to high-risk' category for falls. They participated in a 15-visit training program averaging 40 minutes per visit, for 6~7 weeks. The trainings included multitasking exercises involving negotiating virtual obstacles, while attending to cognitive demands. 7 GaitBetter’s systems were added to existing treadmills in six clinics. Comparing 6 months before and after intervention, the results were magnificent. 71% reduction in number of falls and major improvements in fall predictive measures (Fall Efficacy Scale, Timed Up and Go and Berg Balance Scale), results achieved despite the challenges of running the pilot during COVID-19. Following the successful pilot, Maccabi rolled this system to dozens of sites throughout Israel, making it available to its relevant patients.
Such pilot wouldn’t have been executed without our initiative and our focus on such an important health problem, fall prevention of elders. This urging need to prevent falls wasn't an attractive enough issue for the ecosystem of health organizations and digital industry to try and solve without our incentives, but once the challenge tender allowed it, it turned out into a successful pilot and a large scale implementation.
What Makes Your Project Innovative?
Challenge tenders are an innovative way of addressing burning problems in the health system (such as fall prevention among elders). While traditional tenders seek to find the best of a few given solutions, challenge tenders describe a burning problem without stating the desired solution. Companies with different solutions can submit their technology as a potentially solution to the problem. By allowing companies to offer their solutions we are exposed to a wide variety of different technologies and different solutions and services that can potentially solve our problem. This challenge tender method allows us to be more open to solutions and technologies we may didn't even know exist that can answer our problems. The method of funding and co running a pilot alongside a health organization in order to examine the technology and how it is executed in the health organization, allows us and the health organization to fully measure outcomes, usability and weather the problem is being solved
What is the current status of your innovation?
Our first challenge tender pilot was in the field of fall prevention among elders. We chose an evidence-based digital-therapeutic solution for customized motor-cognitive training, walking rehabilitation and fall prevention and ran a successful 6-month pilot in the second large HMO in Israel which gave wonderful results, mainly succeeding in preventing falls by 71%. Seeing how well the pilot turned out we chose the next field of intervention, improving treatment and care in long term facilities. This Is also a field in which innovative technologies have a hard time entering due to lack in resources, market failure and speed issues. We called the technological industry to find digital solutions to the urgent problem of improving care in long term facilities by improving documentation of care, streamline patient care and the work of the overly worked caregivers and reduce their reliance on paper and manual reporting instead of digital tools. Our next step is to incentivize implementations
Collaborations & Partnerships
The challenge tenders are a collaboration between a start-up, a health organization and the MOH. The start-up, the technology owner, is responsible for testing it in the health organization and making adaptations to the health organization's needs. The health organization is the pilot's site. It brings patients who test the solution and clinicians who design it to their and their patients' needs and measure its outcomes. The MOH brings funding, regulation and project management specialists.
Users, Stakeholders & Beneficiaries
The main beneficiaries of the pilots that challenge tenders made possible are patients. By using this unique model, we were able to choose different solutions, some of which we didn't know exist. In the fall prevention challenge tender, we were able to choose a solution that was added to existing treadmills in physical therapy institutions, adding a fall prevention aspect to the given treatment. The successful pilot turned into a large implementation affecting thousands of patients.
Results, Outcomes & Impacts
The first outcome using the challenge tender method was in the field of fall prevention among elders. The product we chose was designed to train elders, as part of their physical therapy sessions, and prevent them from falling. The pilot, involving 200 patients considered in 'medium-to-high' risk category who received 15 sessions of training over 6-7. The results after comparing 6 months before and after intervention showed 71% reduction in the number of falls; 46% reduction in ER visits; 34% reduction in hospitalization days; 28% reduction in FAS; 19% reduction in TUG. These amazing results led to deployment of this solution to dozens of sites throughout Israel. An enormous focus is being put on measuring clinical, usability and financial outcomes in order to value impact. We expect that by giving incentives to health organizations to conduct pilots and measure outcomes, technologies with great impact will be implemented into our health system and solve concerning problems.
Challenges and Failures
The first challenge in executing a challenge tender is choosing the problem we want to address. There are many health needs and problems in our health system and in order to choose a solution that has great impact we need to a well define the problem. We chose to focus on fall prevention and on improving care in long term care facilities. These both 2 topics are one's that innovation and technology have a hard time entering to due to market failure, lack of resource and time issues. Then there is choosing the digital solution from a variety of different solutions in different domains of intervention which enters the tender. We need to make sure that we choose a solution that actually prevent falls, that is clinically tested and that has a high chance of being adopted into the health system. For that purpose, we assembled a committee composed of both clinicians from the MOH, geriatric experts and project management experts, which had to choose the best digital solution for the pilot.
Conditions for Success
I think first of all it is important to challenge ourselves and come up with 'outside the box' thinking. We took traditional tenders and by adapting ourselves to the needs of the health system, came up with a different method, challenge tender, in order to answer needs of the health system which weren't being answered (prevention of falls, geriatric institutional care). Then we need to create a high enough incentive for start-ups to submit their technologies. We need to create a collaboration between the start-up, a health organization and the MOH strong enough in order for the pilot to succeed, answering each party's needs and demands. We need to put together a team, a management and professional team from the MOH and a management and professional team from the health organization to establish the guidelines for intervention and the success measurements. Also we need to fund all pilot's aspects and provide a road map for future scaling and implementation if the pilot succeeds
After a successful fall prevention pilot, we took out a challenge tender seeking ways to improve geriatric care in long term institutions. Caregivers in geriatric institutions have very high workload, poor digital skills, language barriers sometimes even illiteracy, they have a very high turnover rate, high reliance on paper instead of digital tools and low reliable documentation abilities. These all, lead to gaps in continuity of care and have high impact on patient care. We asked the start-up industry to offer digital solutions to these urging problems and received a few dozens of solutions. We chose a digital icon based app that enables caregivers to replace manual reporting, that streamlines their work and has an interface with patient EMR. This pilot turned out to be very successful and we now give incentives for geriatric institutions to implement such solutions. This type of challenge tender has the potential to be replicated for other urging problems in the health system.
There are a few lessons I would like to share. First, not to be afraid to try and do things different than before. Even strict fields like governmental tenders can transform and be a bit more flexible if we think 'outside the box'. The second lesson is not to limit yourself to what you know. We knew many digital solutions to many of our burning problems, and still, we were surprised to learn how many good solutions there are out there that we didn't know. By only defining the problem and allowing the start-up industry to offer different solutions from different domains, we eventually chose to test and pilot wonderful solutions we may have never even knew existed. Third, collaboration is the key to successful outcomes. Without the engagement of clinical teams, project management teams and IT, from the MOH, the health organization and the start-up, we wouldn't have been able to reach such fast and great results. And last lesson, but not least, Try, maybe you will even succeed!
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
2 January 2023