The broader alliance primary care, wellness and health insurance

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The broader alliance primary care, wellness and
health insurance

• Australian General Practice Network
• National Forum 2009

Dr Stan Goldstein Head of Clinical Advisory Bupa
Australia 6 November 2009
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Bupa Group
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Bupa

• A Global Health and Care company
• Mission Driven Organisation
• No Shareholders (provident society)
• Invests all profit globally in in growth and
  servicing its customers

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Bupa Australia

• Health Insurance
• Over 3 million Australian lives covered
• Largest privately owned health insurer
• Over 2000 employees
• Strong brands and reputation (HBA, MBF and Mutual
  Community)
• Over 200,000 life insurance, wealth management
  travel, home and car insurance customers
• Aged Care
• Bupa Care Services ( Aus/NZ)
• Over 7,200 employees
• Leading operator of residential aged care
  facilities
• 96 aged care homes provide care for almost 7,000
  people in Australia and NZ

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Building Our Healthcare Reputation, Credibility
And Impact
MBF Healthwatch Survey
Online
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Private Health Insurers and Primary Care
naturally aligned
Actually ... there is a natural alliance between
primary care and health insurers, the most
difficult aspect of which is that at least until
now there hasnt been a financial arrangement
connecting us. The common thread is that the
endeavours of General Practice, Primary Care more
broadly, and much more recently of the health
insurance industry as well, is to work towards
improved health status for those we touch our
patients and customers.

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Private Health Insurers and Primary Care
naturally aligned

• Continuity (of care or responsibility)
• Prevention
• Primary care has roles in Primary and Secondary
• PHI sense of responsibility is weighted towards
  secondary
• Wellness or Wellbeing
• Alternatives to hospitalisation / Broader Health
  Cover
• Overall health needs beyond the acute episode

... and why does PHI see itself in this space?
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Between 1995 2005, health spending outpaced
economic growth in 29 of 30 OECD economies
6.0
LUX
KOR
IRL
TUR
POL
ISL
AUS
HUN
GRC
OECD
GBR
NZL
USA
SWE
SVK
MEX
NOR
FIN
BEL
NLD
AAGR in Health Spending ()
PRT
ITA
ESP
CHE
CAN
DNK
CZE
JPN
AUT
FRA
DEU
Source OECD, 2007. AAGR Average Annual Growth
Rate.
AAGR in GDP ()
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Health costs are expected to rise rapidly
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Projected health and aged care spending to 2033
Per capita healthcare expenditure (real 2006/7
dollars)1
Total annual healthcare expenditure ( GDP)
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12.4
12
10,000
10.6
8,375
9.3
9.3
10
8,000
6,385
8
6,000
5,026
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4,277
4,000
4
2,000
2
0
0
2022-23
2012-13
2002-03
2032-33
Source Projection of Australian health care
expenditure by disease, 2003 to 2033 (AIHW,
2008). Population Projections, Australia, 2004 to
2101, Series B (ABS Cat. 3222.0) 1. Includes
high-care residential aged care 2. Other sources
include workers compensation and transport
accident schemes, and other private sources (eg
charitable organisations)
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Houston, we have a problem

• The usual suspects
• Rising costs
• Uneven quality
• Declining access to care

• Some looming challenges
• Loss of professional authority of doctors
• Integrity and relevance of academic medicine
• How do you do prevention?

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Private Health Insurers, GP Networks and
Prevention

• National Agendae to Shift the Focus from Acute
  Care
• NHHRC (National Health Hospitals Reform
  Commission)
• National Preventative Health Task Force
• National Primary Health Care Strategy
• Prevention
• For General Practice, a natural undertaking
• For PHI, almost a business imperative if it can
  be done economically ... but
• Fragmented payers in the Australian system
  balance of who spends now against who gains
  later
• Absence of health economic research on
  relationship between prevention / chronic
  disease management strategy, outcomes, effects
  on utilisation and hospitalisation

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Less than 2 of health expenditure is spent on
preventative health
25,000
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Small adjustments to the status quo??
Prescriptions Spend more Train more Focus on
prices
Every system is perfectly designed to get the
results that it achieves Paul Batalden
Insanity doing the same thing day after day and
expecting different results Einstein
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Private Health Insurers, GP Networks and
Prevention

• The National Agenda is reframing General Practice
  
• as providing possible substitution for
  hospitalisation
• as a key source of health information
• as focal in the delivery of public health and
  prevention messaging to individual patients
• as a co-ordinator of disparate health
  professionals outside the hospital sector
• as a solution to the economic threat of chronic
  disease

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Private Health Insurers, GP Networks and
Prevention

• The National Agenda is reframing General Practice
  
• are you ready?
• are you resourced?
• will the structural and MBS rebate solutions
  deliver to expectations?
• what allies can you gather to your cause?
• what else would help?

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Health Funds and preventionthe elephant in the
room?

• Characteristics of Health Insurance
•  
• Long term association with an individual that
  extends beyond intermittent or even chronic
  periods of illness
• Relationship with family
•  
• Potential relationship with workplace
•  
• Financial stake in an individuals wellness and
  the risk of doing nothing

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Health Funds and prevention

• Prevention Focus for Health Funds
•  
• Primary - limited
• Secondary and Tertiary
• Health Information
• Navigation
• Disease Management
• Health Coaching
• Case Management
•  

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Bupas approach to the future allied values
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Encourage and support customers to achieve best
health future model
Health Improvement Services
Corporate Wellness Services
Preventive Services
Why

• Sales Growth
• Customer Value Proposition
• Customer Retention

• Customer Value Proposition
• Broader Health Cover Compliance
• Benefits Risk Management

• Sales Growth
• Corporate Client Relationships
• Income Generation

• Online health information tools - Health
  Navigator / Using your insurance
• Positive Health Programs
• Chronic Disease Management Programs
• Primary Care / GP Support
• Health Dialog

• Corporate in2life
• Outsourced workplace screening and wellness
  services e.g. Good Health Solutions Peak Health

How

• Online health information tools in2life
• Other low cost channels DM call centres
  partners

• Health Dialog
• Health coaching
• Shared Decision-Making tools

• Health Risk Assessment
• Corporate wellness report

Corporate
What

• Health information

• Health Risk Assessment
• Health fitness programs
• Quizzes
• Targeted messages
• in2life partners

• Health checks
• Health and wellbeing solutions
• Remedial lifestyle program design
• Minor clinical services
• Health coaching services
• Yoga, massage and pilates
• Absence and productivity Management

• Chronic Disease Management Programs
• COACH
• Post Natal Depression (PIRI)
• McKesson
• Mental health services

• Personal Health Record

• Offline capabilities
• Health support
• Fitness lifestyle offerings

Positive Health Programs
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Bupa big issues evidence, cost, amenable to
change
Current Initiatives
Heart Health
Bone and Joint Health
Mental Health

• The COACH program
• Young_at_Heart
• Online Cardiac Rehab Program
• Brain Natriuretic Peptide study
• RoCAD Coronary CT Trial
• Retinal Imaging - CERA

• KicStart
• Partnership with with AHIA, Joint Research Pty
  Ltd and other funds
• Osteoporosis Treatment
• Optimising Prostheses Selection

• McKessons telephonic psychiatric customer
  support
• PIRI Post Natal Program
• Ante Natal depression intervention trial
• Mental Health Research Institute Bipolar program

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Healthy ageing The goal now is not just to live
longer but to make those extra years as enjoyable
as possible. With foresight and planning, ageing
can emerge as an opportunity rather than a
problem. The Foundation supports a range of
initiatives that aim to develop evidence-based
knowledge that will help realise the potential of
healthy ageing.
MBF Foundation initiatives 2008 snapshot
Correct as at June 2009
Funding committed by strategic priorities
New initiatives Centre for Eye Research Early
prediction of cardiovascular disease using novel
retinal image-analysis. Pain Management Research
Institute - Pain After Breast Surgery . The
Childrens Hospital at Westmead - The role of
dietary protein and exercise in pre-diabetic
adolescents .
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Private Health Insurers, GP Networks and
Prevention

• How will Bupa work with General Practice?
• not JUST a cash cow
• improving the evidence - implementation
• engaging and motivating patients
• self-management and compliance
• making services and programs available-
• - direct provision and benefits
• decision support

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Wellness and obesity Building a strong base for
better health and wellbeing should be a routine
part of our everyday lives, not just a response
to a health crisis. The Foundation is supporting
programs to encourage people to take up and
maintain healthy behaviours at home, at school
and in the workplace.
Keeping healthcare affordable MBF Foundation is
exploring health policy initiatives that may
assist in easing the financial burden on
healthcare services and strengthen the
sustainability of Australias mixed public and
private health system.
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The next initiatives

• How will Bupa work with General Practice?
• Decision Support
• Services available
• Benefits available
• Eligibility
• No Gap specialists
• Producing information on quality
• Chronic Disease Management
• Health coaching (Health Dialog)
• COACH
• Mental Health
• Weight loss to avoid joint replacement
• Member Information
• Corporate Wellness

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Decision Support we need to ensure that
improvements work for patients
doctors practices
outcomes
25,000
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Bupa Australia Corporate Arrangement
with AGPN Ask us! Come see us at the stand
25,000