Business Models of eHealth Interventions to Support Informal Caregivers of People With Dementia in the Netherlands: Analysis of Case Studies

Abstract

Background In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented in practice, and much can be learned from their counterparts (commercial, governmental, or other origins) that are already being used in practice. Objective This study aims to examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia that are currently used in the Netherlands; to investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions; and to apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. Methods In step 1, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: delivered via the internet; suitable for informal caregivers of people with dementia; accessible in the Netherlands, either in Dutch or in English; and used in practice. The contacted experts were academics working on dementia and psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organizations, and people with dementia and their caregivers. In step 2, contact persons from the suggested eHealth interventions participated in a semistructured telephone interview. The results were analyzed using a multiple case study methodology. Results In total, the response rate was 7.5% (36/483), and 21 eHealth interventions for caregivers of people with dementia were recommended. Furthermore, 43% (9/21) of the interventions met all 4 criteria and were included in the sample for the case study analysis. Of these 9 interventions, 4 were found to have developed sustainable business models and 5 were implemented in a more exploratory manner and relied on research grants to varying extents, although some had also developed preliminary business models. Conclusions These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology services externally, and their offer of fixed, low pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modeling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice.

Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping

“…Most documents were excluded because they did not discuss the current reimbursement or financing pathways in place in the studied countries. We included 9 original research articles [ 11 , 20 , 44 - 50 ], 5 reviews [ 8 , 18 , 27 , 51 , 52 ], 4 conference abstracts [ 53 - 56 ], 18 gray literature sources [ 28 , 57 - 73 ], 3 reports [ 74 - 76 ], and 1 commentary [ 25 ]. In terms of country focus, 3 documents focused on Belgium [ 57 - 59 ], 8 on France [ 11 , 28 , 51 , 54 - 56 , 60 , 61 ], 6 on Germany [ 18 , 27 , 44 , 52 , 54 , 62 ], 3 on Israel [ 45 , 63 , 76 ], 4 on Italy [ 46 - 48 , 64 ], 5 on the Netherlands [ 8 , 20 , 49 , 65 , 75 ], 5 on Poland [ 50 , 66 - 68 , 74 ], 3 on Sweden [ 69 - 71 ], and 6 on the United Kingdom [ 28 , 53 , 54 , 56 , 72 , 73 ].…”

“…In addition, some digital health solutions are made available through sponsorships from nongovernmental organizations (eg, Alzheimer Netherlands sponsoring 2 digital health apps for dementia) [ 8 , 20 ].…”

“…However, applying a value-based framework to digital health care requires the use of comprehensive frameworks to determine the value of digital interventions and can be challenging because of the continuous improvement of digital health apps through performance data and patient feedback [ 11 , 12 ]. Finally, there is a dearth of data and assessment frameworks in use to evaluate the cost-effectiveness of digital health care [ 18 , 19 ] as well as a scarcity of established pricing models that can be used to streamline the introduction of digital health apps to the health care market [ 20 ].…”

Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial

“…Previous research has demonstrated that guidance by a coach could be a valuable contribution to online interventions, as blended eHealth interventions (that is, eHealth interventions that combine online and offline support elements) for caregivers appear to be more effective than nonblended interventions [ 15 ]. Moreover, integrating eHealth interventions for caregivers of people with dementia into existing (dementia) care organizations is an important determinant of their sustained implementation success [ 40 ]. This approach would necessitate thorough training and monitoring of the implementing health care professionals, as research has shown that implementer self-efficacy and sense of ownership are important predictors of sustainable implementation of online interventions for caregivers of people with dementia [ 41 ].…”

“…Inspiration for methods to evaluate (new functionalities to) eHealth interventions can be gained from industry, where many commercial platforms use real-time evaluations to gain feedback from users. These can include pop-ups, which ask the user to rate their experiences, or the launch of different versions of the same functionality in order to assess which of the 2 versions is more successful [ 40 ]. It is possible that the retrospective measurements used in this study could not capture the kinds of practical benefits (ie, increased time savings and positive interactions) that are highly important and ecologically valid for informal caregivers.…”