Does Private Healthcare Have A Role in Public Health?

Physiotherapy UK 2015

#physio15

Martin Docherty

Rose Arnott

Aviva UK Health

Learning Outcomes

• To understand the role of the Private Healthcare Information

Network (PHIN) in delivering meaningful, comparative

information for patients.

• To consider the strategic developments within the PMI sector &

their impact on physiotherapy service provision.

• To consider how we improve the management of chronic MSK

conditions within private healthcare.

PMI Market – Headline Statistics

PMI = 10.5% UK Population

10% ↓ in last 6 years

↑ popularity low-cost employer funded cash plans / self insured.

Long-term cost containment priority for purchasers & providers.

↑ in IPT from 6% to 9.5% Nov 2015

Market Share

Controlling Costs & Promoting Clinical Best Practice

Networks & Open Referral

Clinical Pre-auth & Case Management

Cover RestrictionsClaims Analysis &

Monitoring

Cost Containment

PHIN – www.phin.org.uk

• CMA’s Private Healthcare Market Investigation - Final Report

2014.

• Lack of sufficient publically available performance information on;

- private healthcare facilities

- consultant fees & clinical outcomes.

• PHIN approved as independent “Information Organisation”

• Close working with CQC & other health / professional regulators.

• Mandate & 11 performance measures specified by CMA.

• Publication Timeline – data by Sept 2016; publication April 2017.

• New website due for soft launch 2015; full launch March 2016.

• Public Health Implications

Big Data, Outcomes & Digital Healthcare

Risk

Education

Long-term needs

Outcomes based

payments

mHealth / wearable

tech

Big Data

Digital Physio

PMI vs chronic conditions

Chronic exclusion

A disease, illness or injury that has one or more of the following

characteristics:

• it needs ongoing or long-term monitoring through consultations,

examinations, check-ups and / or tests, it needs ongoing or long term

control or relief of symptoms,

• it requires your rehabilitation or for you to be specially trained to cope

with it,

• it continues indefinitely,

• it has no known cure,

• it comes back or is likely to come back.

The current healthcare approach is reactive and addresses

musculoskeletal problems when they arise, usually through the

provision of medical care

Health beliefs are an important predictor of health outcomes for

people with musculoskeletal conditions

Over-medicalisation is a concern. Excessive focus on medical

solutions can result in an unrewarding cycle of investigations to

identify the cause of the pain and an endless search for a simple

cure

People should be empowered with knowledge about how to

maintain good musculoskeletal health

(Arthritis Research UK, 2014)

Musculoskeletal Health: A Public Health Approach

Recurrent conditions in BacktoBetter

Over-medicalisation

The compulsion to “do something” at every consultation has led to

over diagnosis and resultant over-treatment (Malhotra, A et al 2015)

The NICE guidelines for both Osteoarthritis and low back pain

recommend limiting the use of diagnostics

Evidence suggests that patients with low back pain who have

investigations are more satisfied with the care they’ve received, but

have poorer clinical outcomes (Kendrick et al 2001)

60% referred to a

consultantBacktoBetter

25% referred to a

consultant

Chronic management during treatment

Identify

Educate

Support

Good

musculoskeletal

health

Empowering patients

References

1. Aviva Commercial UK – Analysis of Laing Buisson Health Cover Report 2015

2. Competition & Markets Authority; Private Healthcare Market Investigation 2014.

3. Kings Fund July 2015; Better Value in the NHS – The Role of Changes in Clinical

Practice.

4. PHIN; www.phin.org.uk

5. NHS Right Care (www.rightcare.nhs.uk)

6. EY; The Future of Health Insurance – a roadmap through change. 2015

7. Arthritis Research UK (2014) Musculoskeletal health: a public health approach

8. Kendrick, D et al (2001) Radiography of the lumbar spine in primary care patients

with low back pain: randomised controlled trial. BMJ, 322: 400-405

9. Malhotra, A et al (2015) Choosing Wisely in the UK: the Academy of Medical Royal

Colleges’ initiative to reduce the harms of too much medicine. BMJ, 350

10. NICE (2015) Osteoarthritis NICE quality standard

11. NICE (2009) Low back pain: Early management of persistent non-specific low back

pain