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HealthSystemBenefitsfromImprovedPerformance
ACTASummit2016
GeorgeSavvidesThursday24th November2016
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SuccessrequiresAdaptiveLeadership
ü Asmarketsgo,futuredemandstrong/growingü PrimarycarepatientcomplexitygrowingüHealthcareprofessionalstandardshighü Economycapableofmaintaininghighstd.ü Bewareofendlessdemandwithoutdiscernment
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WeareamongthebestofNationsreportinggoodhealth…butwhataboutwastefulness
Percentageofadultsreportingtobeingoodhealth,2011(ornearestyear)AIHWAustrali’as health2014– inbrief
Source:OECDHealthStatistics2013,http://dx.doi.org/10.1787/health-data-en;WHOGlobalHealthExpenditureDatabase. 3
70% of this group have underlying chronic disease
Chronicdisease:prevalencegrowing
7millionover65by2055
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TheHealthcareChallengeHowtobendthecostcurve?
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STRESS
TheNeedtorebalanceAcutevsPrimaryCareü Healthutilisation hasincreasedsharplyinthepastdecade.üWearenowreceiving41%morehospitalcareperpersonthanFY05.
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…thistranslatesintohighacute use…Theproblemofsilos
Highrelianceonacutecare
Why?
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ForPHI&Publicfunders…thechallengeishowtobendthecostcurve?
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notTeams
Sustainability:Qualityvswastefulcare
§ Healthsystemwasteis2timeshealthCPI§ Reducewastedcare$’s toaddresssystemleakage§ Savingwasted$’s iskeytosustainability§ Adaptiveleadershiprequiresinsight….theroleof
registires.
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Despiteitsgoodreputationourhealthsystemhasthreemajordiscontinuities…itleaks
public/private:federal/state:acute/primary
Source:http://www.aihw.gov.au/australias-health/2014/health-system/. 10
Challenge:complacencyvs change(theenemyofgreat..isgood– JimCollins)
§ Prosthesessuppliersonnoticetorespond§ Registriesbringfactandinsightintohealthsystemperformanceofferingdesigninputforbestpathways,andteambasedintervention.
§ Transformation&renewalisthenewnormal§ EvenPHIinsurershavebecomehealthco’s§ WhowilltransformPrimaryCaresilo’sintoteamplayers?Weneedinsight.
§ AdaptiveLeadershipisacriticalsuccessfactor.
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Identityisthemirrorofpurpose
§ Whenregistriesprovideinsightonclinicalperformancetheyprovidepictureofa desiredfutureforoptimalcare
§ Thisevidencedbasedimageofoptimalpathwayswillinformthenecessaryhealthsystemtransformation
§ Itwillinformtheinvestmentinintegratedprimarycare§ Registriesinformoptimaldesignandultimatelyidentity§ Theemergenceofagecarescalewillrelywillevenmore
oninsightandoptimaltreatment
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Registriescanplayasignificantroleinreducingsystemleakage,theymayholdthekeytosustainability
thequantumofinefficiencyismuchgreaterthanhealthinflation
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TheSourcesofSystemWastemostcanbeaddressesbyregistries
1. Unwarrantedvariation2. Lessthanbestcarepathways3. Carecostsassociatedwithinappropriatetreatment4. Lackofpatientinformationatpointofcare5. Inadequateprimarycareforhighneedspatients6. Lackoftransparencyforpatientdecisionmaking.
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AddressingImbalanceofAcuteCarevs PrimaryCare
§ MixofAcuteCarevs PrimaryCareinAustraliaisanoutliervsEurope,NZ§ PrimaryCaregrowthratepalessthanAcuteCare§ PrimaryCareinvestmentreducesAcuteCaredemand§ Multifactorprevalenceinchronicdiseaseincreasingtheneedfor
integratedprimarycare.
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UnderstandingHealthInsurance:eg MedibankClaimsmanagementhasdeliveredtoptierindustrymarginsearlierthan
expected;focusonimprovingtoplineperformancetoincrease
§ Premiumrevenuegrowthreflects:o Slowmarketgrowthamidongoing
affordabilitychallengeso Belowmarketperformanceinboth
acquisitionandlapse§ Grossmarginimprovementfrom:
o Productoptimisationo Medibank’sleadershipinhealth
claimsmanagemento Lowergrowthinindustry-wide
hospitalutilisation rates§ Decreaseinmanagementexpenseratio
duetoongoingcostdisciplineandoperationalimprovement
insidePHIHealthClaimsContinuedmarginimprovementdrivenbyproductmanagement
andpaymentintegrityprogram
PHIManagementExpensesNotthemaingame
§ MER down20bpsto8.4%
§ Furtheroperationalimprovements
§ Somereinvestingofimprovementsfromhealthclaimsmanagementinto:
o Customerserviceandengagement
o Retentionteam
o FurthercapabilityenhancedbyPNIC
o Medibankbrandrelaunch
PrimaryCareCostvs. HospitalCost
Costofhealthcaretoprevent acutehospitaladmissions
Costofhealthcareforacutehospitaladmissions
<
Silothinkinginhealthcare
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Ø Silothinking leadstohealthprofessionalsfocusingonmakingtheirowncareaseffectiveaspossible,withoutmuchregardtowhatisgoingoninother“silos”
§ Theprimarycarehealthsystemisdividedintoseveraldifferenthealthservices.Thereasonforthisisobvious- itoffersahighlevelofspecialisation.
§ High-userpatientsinAustralia’shealthcaresystemrequiretheinputofmultiplehealthservices.Theseservicescanworkinanintegrated,coordinatedandpurposefulway,or,ina“silo”uncoordinatedway.
§ The“silo”wayistothedetrimentofthepatientandthehealthcaresystem.
Gene
ralPractition
er
Physiotherapy
Ortho
paed
ic
Radiology
TheCanterburyShoulderInitiativeShoulderpain,aconditionthatistoocomplexforGPs toaccuratelydiagnose,ismanagedinastructuredinandevidencebasedmanner
ü Goal:improveaccesstoorthopaedicshoulderassessmentinthecommunity
ü OrthopaedicshouldersurgeonrecruitedandtrainedaPhysiotherapisttoperformorthopaedicassessments
ü Allpatientsreferredareeitherseenbytheorthopaedicspecialistorbythespecialistphysiotherapist
ü Physiotherapistassessespatientanddecidesifthetreatmentinterventionistobeconservativeorsurgical
ü Thecapacityforassessmentisincreasedandtheorthopod spendslesstimeinoutpatientstriagingpatients
Overcomingsilo:TheOrthopaedicsiloisconsideringwhatisgoingoninothersilos.IntheGPsilomanyGPsdonothaveamusculoskeletalinterest.ThePhysio silodoeshavemusculoskeletalinterest.
Evidenceofintegratedcare:publiclyfundedMedicareprograms
§ Careprogramsdependonunderstandingtheneedsofthehighest-costmembersandcapabilityinmanagingtheprovidernetwork
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Sweden– oneofthefirstadoptersofIntegratedtotalcare
§ Sincethe1960shaveprovidedserviceswithcoordinatednetworkswithaclearpatientfocus.
§ Resourcesarepooledintoacommonbudget.§ 80%oftheSwedishpopulationare
coveredbyintegratedcare.§ Theno.ofhospitalbedsinSwedenreduced
by45%,thru1990s,whileotherEuropeancountrieshadareductionby10–20%
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NewfundingsourcesofPrimaryCare
§ HealthFundsareinvestinginintegratedprimarycare...Itreduceshospitalclaims
§ Integratedprimarycaremodelswillattractnewfunders,couldredefineroleofpharmacist
§ AgeCaresettingsgrowinginscaleandsophistication,moreadaptiveopportunities
§ MBS,PHN’s,PHI’sarethenewteamcarefunders
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IntegratedCarevs RandomCare
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MeetingtheChallenge…
§ Integrated Primary Care reduces Silo waste to bend cost curve toward sustainable future.
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Internationalevidenceconfirmscoordinatedprimarycarereduceshospitaladmissions
Source:ScottI.2010,Publichospitalbedcrisis:toofewortoomisused,AustralianHealthReview,34pp.317-32422
Insight>>Innovation>>removessystemSiloseveninhousebuilding
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