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2 THE PROBLEM 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) $ % Cumulative Hospital Benefits ($m) $600 $500 $400 $300 $200 $100 1% of our hospital customers account for more than 50% of hospital benefits (pre risk equalisation) $0 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% Proportion of Total Insured Hospital Customers 100% 80% 60% 40% 20% 0% Cumulative Proportion of Hospital Benefits 2

3 THE SOLUTION 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 3

4 THE EVIDENCE 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 4

5 THE RISE OF CHRONIC DISEASE 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 5

6 PREVENTION Primary and secondary Smoking Physical activity Alcohol Poor diet Obesity Hypertension High blood fats 6

7 GP MANAGEMENT PLAN Patient education Evidence based prescribing Disease monitoring Action plan Immunisation Risk factors Medication reviews Falls prevention Advance care plan 7

8 DIABETES Fastest growing chronic illness Approximately 100,000 new diagnoses each year Annual cycle of care o o o o o o o BP, weight, BMI HbAlc Lipid management Diet, smoking and exercise advice Eye care Foot care Screening for kidney disease 8

9 GP DEMOGRAPHICS 75,653 registered medical practitioners currently working (AIHW 2012) 34.5% GPs = 26, % 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) 9

10 SPECIALISATION 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 10

11 ARE ALL GPs THE SAME? VR vs non-vr Accreditation (67%: 2010) Home visits, after hours cover Practice nurses Corporatisation (15-20% DOHA 2012) Rapid turnover practices IT 11

12 THE VISION THE MEDICAL HOME 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 12

13 HOW? Divisions of general practice Medicare locals Primary health care networks Coordinated Veteran s Care Program COACH 13

14 ENABLERS PCEHR Electronic health fund identification Product restriction information Pathways Alliancing Consumer engagement and empowerment (eg Whitecoat) 14

15 PATHWAYS Rapid access to information about specialist services as a key tool to help them care more effectively for patients 15

16 CONSUMER ENGAGEMENT & EMPOWERMENT Whitecoat allows users to search (by specialty, by location) and compare (cost and consumer reviews) ancillary providers 16

17 DO 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 17

18 DON T 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 18

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