Telerehabilitation after Total Knee Replacement: Business model proposals and insights from Tuscany Francesco Fusco, Maral Mahdad, Giuseppe Turchetti. Institute of Management-Management and Innovation (MAIN) Scuola Superiore Sant’Anna Pisa, Italy e-mail: f.fusco@sssup.it, m.mahdad@sssup.it, g.turchetti@sssup.it Abstract—In the last years, Total Knee Replacement (TKR) has become one of the most performed surgical procedures and according to recent forecasts, its incidence is supposed to increase further. Rehabilitation after TKR is an effective treatment to ensure full recovery after surgery and its economic burden in Italy accounts for almost 182 million of Euro per year. By considering the impact in other sectors, the adoption of Information and Communication Technology was welcome as a tool able to reduce costs and preserve the quality of care. However, the actual adoption is not as high as it was expected. Perhaps it could be the results of a partial involvement of the stakeholders included into the telemedicine services. Decision makers, physicians, patients and informal caregivers, should be involved in business model development to elect the best one to satisfy their needs and increase the value of the telemedicine service. This article describes the preliminary results of the business modelling phase belonging to a broader project aiming at involving the whole set of stakeholders interested in telerehabilitation after TKR. Keywords-Business model; telemedicine; telerehabilitation; healthcare management. I. INTRODUCTION Total Knee replacement (TKR) showed to be cost- effective in the last 30 years and it was largely performed in Italy (21st most performed procedure in Italy in 2013) [1]- [3]. According to “Agenzia Nazionale per i servizi Sanitari” (Age.na.s.), the trend observed in the last years by “Istituto Superiore di Sanità”, from 26’694 TKR performed in 2001, to 63’125 in 2011, is going to further increase since the reduction in average age of TKR patients and the extension of life expectancy [4][5]. Likewise, rehabilitation has a pivotal role in patients’ recovery after surgery [6][7]. By considering the high incidence of TKR in the last years, the related rehabilitation has a considerable socioeconomic impact both on Italian National Healthcare Service (Ita- NHS) and on patients [8]. According to Piscitelli et al., TKR patients lose on average 9 working days per year; this value increases up to 20 days per patient considering hospital length of stay. During 2005, a loss of 368’586 working days was estimated for TKR patients younger than 65 years, leading to a monetary loss of approximately 24 millions Euro (a working day is assumed to last 8 hours; average wage is assumed to be 7.73€ per hour) [9]. From Ita-NHS perspective, the costs accounted for TKR rehabilitation were about 158 million of euro in 2005 (47 million in hospital rehabilitation and 111 million in home rehabilitation) [8]. By considering the results from the recent report of the “Agenzia Nazionale per i servizi Sanitari” (Age.Na.S.), the rehabilitation expenditure is expected to increase since the number of TKR will grow in the next years [5]. In this framework, digitalization seems to be a pivotal milestone to reduce costs and ensure at least the same quality of care. Many efforts have been made investigating telemedicine sustainability and the factors leading to successful business models without reaching a definitive conclusion [10][11]. Likewise, telerehabilitation after TKR was tested in different technical approaches (e.g. videoconferencing CODECs with cameras; wireless sensors) and contexts; especially in rural areas, were it could be an alternative to home visit and could reduce travelling expenses [12][13]. Although the social impact of rehabilitation is evident, to date there is little knowledge on the drivers leading to successful implementation of knee telerehabilitation programs. According to Osterwald [14], the final aim of a business model has to switch from creating value only for the firm, to creating value also for the society. Therefore, we believe that the approach to involve the most important stakeholders in the design of the business model could be a reasonable way to detect the best business models, and to assess and promote them in order to improve the societal value chain for telerehabilitation. A. The importance of the stakeholders in healthcare Freeman defines stakeholders as “any group or individual who can legitimately affect or is affected by the achievement of the firm’s objectives” [15]. Every firm or organization has different set of stakeholders who can influence the performance of the organization directly or indirectly. For some type of organizations, different stakeholders should be weighted out differently from other stakeholders. Scholars introduced the importance of different stakeholders in NHS, from low to high [16][17]. Stakeholder’s perspective for health care can be different from other type of organizations. The role of stakeholders in health care can be underlined taking into account the differences between patients and customers. In the process of decision making in health care, relevant “stakeholders” should be more involved especially when introducing a new technology [18]. In terms of operationalization of stakeholders' theory, many scholars formed various models to show the relationship between 33 Copyright (c) IARIA, 2015. ISBN: 978-1-61208-384-1 eTELEMED 2015 : The Seventh International Conference on eHealth, Telemedicine, and Social Medicine