dr. andrew wilson - medibank - we can afford the future of our health system…but we can’t afford...
DESCRIPTION
Dr. Andrew Wilson delivered the presentation at the 2014 Health Insurance Summit. The 2014 Health Insurance Summit focused on how legislative changes affect the future of health insurance in funding, membership and services. For more information about the event, please visit: http://bit.ly/HISummit14TRANSCRIPT
1
HEALTH INSURANCE SUMMIT
Dr Andrew WilsonJuly 2015
2
The Medibank Story
OBJECTIVES
3
Healthcare in Australia is growing at an
unsustainable rateTotal Healthcare expenditure (2011): $130bn (~$6,000 per capita)
Hospital costs represented 38% of expenditure (excl. CapEx)
State and Federal Government was responsible for 70% of expenditure
Healthcare now accounts for ~30% or more of State budgets
Between 2006 and 2011 GDP in Australia grew at ~3.0% CAGR
Between 2006 and 2011 healthcare costs grew at 8.5% CAGR
OBJECTIVES
4
CHRONIC DISEASE IS COSTING
5
HEALTHCARE USAGE
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
BARRIERS TO BETTER HEALTHCARE
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
NAVIGATING A FRAGMENTED
SYSTEM
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
THE NEED FOR CHANGE
9
REGULATORY BARRIERS
Existing Private
Health Insurance
regulations offer no
incentive for PHI to
help manage the
health of their
members.
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
WHAT CAN BE DONE?
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
LEADING POLICY
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
GP ACCESS
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
THE APPROACH
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
involve
assessment
and care
planning
coordinate care
across all parts
of the health
system
address gaps in
care and non-
compliance
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
BENEFITS OF PRIMARY CARE
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
coordinate care
across all parts
of the health
system
address gaps in
care and non-
compliance
Patient and
care team
Individual
care plan Patient has
responsibility for
their own health
5.5
4.5 4.23.6
2.2
MajorCities
InnerRegional
OuterRegional
Remote Notstated
Very
remote
Expenditure Per Person By Service & Region
(2008)
Source: Australia’s Health 2010
1,311
753
312
1,428
661346
1,468
576318
1,723
409243
Admitted Patient Medicare PBS Pharmaceuticals
Major City Inner Regional Outer Regional Remote and Very Remote
Ave. $ per Hospital Separation by Remoteness
(2008)
Source: AIHW National Public Hospitals Establishment Database, 2005
3,651.6 3,887.5 3,965.14,328.6 4,422.3
MajorCities
InnerRegional
OuterRegional
Remote VeryRemote
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
INTEGRATED CARE
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
coordinate care
across all parts
of the health
system
address gaps in
care and non-
compliance
GP Management Plan / Team Care Arrangements
Practice Nurse coaching sessions (face to face)
Allied Health sessions
Telephonic and Online coaching sessions
Integrated content, tools, goals, and evaluation
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
GARRISON HEALTH
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
coordinate care
across all parts
of the health
system
address gaps in
care and non-
compliance
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
HEALTHCARE FOR THE FUTURE
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
coordinate care
across all parts
of the health
system
address gaps in
care and non-
compliance
Patient and
care team
Focus on diet,
exercise and healthy
behaviours
Individual
care plan Patient has
responsibility for
their own health
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KEEPING HEALTHCARE AFFORDABLE
What Medibank is doing:
1. Paying hospitals a fair rate to look after our members
2. Focussing on quality and outcomes
3. Ensuring our members get the right treatment when
they need it
4. Helping eliminate improper payments
5. Working with governments to continually improve the
operation of the healthcare system
Dependency
Mileston
e
Holiday
period
Achieved
Activity
Initiative
FOR BETTER HEALTH
Social
services
collaboration
Chronic
disease
management
Patient
wellbeingImproved patient
outcomes &
reduced hospital
admissions
coordinate care
across all parts
of the health
system
Patient and
care team
Individual
care plan Patient has
responsibility for
their own health
We all have a role to play in working
towards ways to reduce the burden of
chronic disease, and through cross-
sectorial collaboration, we can overcome
regulatory barriers to achieve better
coordinated and integrated care, to
ensure that we really are working towards
the better health of all Australians.
20
Thank You Dr Andrew Wilson Executive General
Manager, Provider
Networks and
Integrated Care