dr avnesh ratnanesan - energesse - future solutions for australian healthcare reform
Post on 14-Sep-2014
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Dr Avnesh Ratnanesan 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
Future Solutions for Australian Healthcare Health Insurance Summit 2014
Dr Avnesh Ratnanesan (Avi)
Founder & CEO, Energesse
Agenda
1. Understanding the Australian Healthcare ‘Eco-System’
2. Major System Challenges and Need for Reform
3. Specific Industry Challenges for PHI
4. Future trends and Solution Opportunities for PHI
5. ‘Future Solutions in Australian Healthcare’ White Paper
Understanding the Healthcare ‘Ecosystem’
Federal Government State Government
& Public Hospitals
Patient/Consumer
Not-for-
profit
Aged Care
Research &
Academia
Private Sector – PC & Hospitals
‘Ecosystem’ is interdependent
Federal Government State Government
& Hospitals
Aged Care
Research &
Academia
Patient/Consumer
Private Sector – PC & Hospitals
Major Challenges with Healthcare System
1. Growth in healthcare costs are ‘unsustainable’ - $140bil at 9.1% of GDP and outcome goals unclear
OECD Health Expenditure
Australia Health Outcomes
Health Growth Rate vs GDP
Actual Govt Health expenditure
Grattan Institute Report, adapted from The Conversation 24 April 2013
Major Challenges with Healthcare System
1. Rising costs are ‘unsustainable’ - $140bil at 9.1% of GDP and outcomes goals unclear
2. Ageing population – managing chronic disease and services
Chronic disease service load
Major Challenges with Healthcare System
1. Rising costs are ‘unsustainable’ - $140bil at 9.1% of GDP and outcomes goals unclear
2. Ageing population – managing chronic disease and services
3. Inequitable care – fragmented & uncoordinated delivery
4. Inefficient resource allocation – silo structures and culture
5. System driven by short term activity and measures, rather than outcomes
6. Significant portion of health outcomes is influenced outside the system
Dynamic consumer needs and expectations
Specific Challenges for Health Insurers
1. Rising costs of claims with stagnating traditional funding models
2. Regulatory restrictions prevent efficient management of member health pathways
3. Information asymmetry in clinical practice – variable protocols and moral barriers
4. Consumer disempowerment and complex behavioural drivers
5. Protectionism & lack of trust amongst healthcare stakeholders
Future Trends and
Solution Opportunities for PHI
Develop new innovative funding sources
Population Health Management, Changing Incentives and Integrated Care
Valuing Service Outcomes: Cost-Effectiveness & Risk-Share Agreements
Leverage partnerships & bridge silos
Facilitate best practice peer-sharing & community think-tanks
Enhance trust with stakeholders
Empower Consumers (Community rating)
Empowering Prevention amongst Consumers AIA Vitality Program
70%
75%
80%
85%
90%
95%
100%
Source: “Participation in an Incentive-based Wellness Program and health care costs: Results of the
Discovery Vitality Insured Persons Study”. Reproduced with permission from AIA Vitality Program
Not Engaged
Benchmark
Cancers Cardiovascular
Diseases Endocrine and
metabolic disease
Musculoskeletal
Engaged members experienced lower
costs per patient
Cancers Cardiovascular
Diseases Endocrine and
metabolic disease
Musculoskeletal
Engaged members had lower
admission rates
Get your strategy right with prevention: PepsiCo Study
Source: “Do Workplace Wellness programs save employees money . Evidence from a Fortune
500 company Liu et al. Diagram adapted from www.engagingleader.com/6-lessons-from-pepsi/
Personalised health and Behavioural profiling to improve adherence
Reproduced with permission from Akumen
Future Solutions for Australian Healthcare 1. Michael Armitage, Private Healthcare Australia 2. George Savvides, CEO, Medibank 3. Dwayne Crombie, MD, BUPA Health Insurance 4. Mark Fitzgibbon, CEO, NIB 5. Prof Ian Frazer, AC, CEO TRI 6. Prof Stephen Leeder, AO, Chief Editor, MJA 7. Gavin Fox-Smith, CEO Johnson & Johnson 8. Michael Ackland, GE Healthcare 9. John Bronger, Pharmaceutical Society of
Australia 10. Dr Martin Cross, Chairman, Medicines Australia 11. Alison Verhoeven, CEO, AHHA 12. Dr Mal Washer, Doctor & former MP 13. Michelle Bridges, Wellness expert and ‘The
Biggest Loser’ host .... And 7 other healthcare experts
Summary
1. Understanding the broader Australian Healthcare ‘Eco-System’
2. Major Challenges within the System and Need for Reform
3. Specific challenges for the Health Insurance Industry
4. Future trends and Opportunities for PHI
5. Future Solutions in Australian Healthcare White Paper
