Jun 20, 2015
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THE PROBLEM
2
Small proportion of customers consume a large percentage of overall benefit
outlays …we call them our “frequent flyers”
Distribution of hospital benefits amongst nib insured customers (incurred CY13)
0%
20%
40%
60%
80%
100%
120%
$0
$100
$200
$300
$400
$500
$600
$700
0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12%
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($
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Proportion of Total Insured Hospital Customers
1% of our hospital customers account
for more than 50% of hospital benefits
(pre risk equalisation)
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THE SOLUTION
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Coordinated care trial (Brisbane North)
Team Care II Coordinated Care Trial
• 3 year controlled trial, randomised by patient
• Participants were over the age of 50 with at least 1 chronic condition, recruited
by their GP for their complexity
• Approximately 3000 patients (2000 intervention, 1000 controls)
• Over 100 general practices, 175 GPs
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THE EVIDENCE
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▼ Hospital utilisation for intervention participants ‐ 19% fewer hospital
admissions at 20% lower cost than control participants (after 12 months
of service coordination)
▼ Hospital utilisation for intervention participants ‐ 25% fewer hospital
admissions at 26% lower cost than control participants (after 18 months
of service coordination)
▲ MBS utilisation for intervention participants increased when
compared to control participants
► PBS utilisation similar between both groups
▼ Overall cost impact ‐ 8% lower cost for intervention versus control
participants
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THE RISE OF CHRONIC DISEASE
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Chronic health problems account for ~30% of presentations to GP
• Ischaemic heart disease (also known as coronary heart disease)
• Stroke
• Lung cancer
• Colorectal cancer
• Depression
• Type 2 diabetes
• Arthritis
• Osteoporosis
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Chronic kidney disease
• Oral disease
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PREVENTION
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Primary and secondary
• Smoking
• Physical activity
• Alcohol
• Poor diet
• Obesity
• Hypertension
• High blood fats
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GP MANAGEMENT PLAN
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• Patient education
• Evidence based
prescribing
• Disease monitoring
• Action plan
• Immunisation
• Risk factors
• Medication reviews
• Falls prevention
• Advance care plan
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DIABETES
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• Fastest growing chronic illness
• Approximately 100,000 new diagnoses each year
• Annual cycle of care
o BP, weight, BMI
o HbAlc
o Lipid management
o Diet, smoking and exercise advice
o Eye care
o Foot care
o Screening for kidney disease
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GP DEMOGRAPHICS
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• 75,653 registered medical practitioners currently
working (AIHW 2012)
• 34.5% GPs = 26,100
• 40.8% GPs female
• Average age 50
• 35% GPs overseas trained
• 1,200 GP training positions per year
• 24,000 specialists,12,500 in training (AIHW 2011)
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SPECIALISATION
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• Unrestrained growth specialist services
• Subspecialisation, narrowing scope of practice
• Increased fragmentation
• Supply induced demand
• Over diagnosis and over treatment
• Not matched to community need
• Cluster in urban areas
• Driven by income differential
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ARE ALL GPs THE SAME?
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• VR vs non-VR
• Accreditation (67%: 2010)
• Home visits, after hours cover
• Practice nurses
• Corporatisation (15-20% DOHA 2012)
• Rapid turnover practices
• IT
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THE VISION – THE MEDICAL HOME
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• Comprehensive whole person, whole of life care
• Patient registration
• Preventive care
• Chronic disease management
• Patient registers, recall systems
• Multi-disciplinary care
• Discharge planning
• Palliative care
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HOW?
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• Divisions of general practice
• Medicare locals
• Primary health care networks
• Coordinated Veteran’s Care Program
• COACH
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ENABLERS
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• PCEHR
• Electronic health fund identification
• Product restriction information
• Pathways
• Alliancing
• Consumer engagement and empowerment (eg Whitecoat)
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PATHWAYS
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Rapid access to information about specialist services as a
key tool to help them care more effectively for patients
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CONSUMER ENGAGEMENT & EMPOWERMENT
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Whitecoat allows users to search (by specialty, by location) and
compare (cost and consumer reviews) ancillary providers
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DO
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• Reward quality, not quantity
• Incentivise best practice
• Support discharge planning, advance care planning
• Share information re costs
• Expect accountability
• Provide information for customers
• Support eHealth
• Contribute to research
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DON’T
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• Disrupt quality care models
• Further fragment health care
• Introduce single disease programs
• Confuse patients
• Under-estimate complexity
• Reward rapid turnover
• Remove price signals
• Reduce access for disadvantaged