Sturt  EastwoodChief  Executive  Officer

July  2015

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“Sure,  we  cover  diabetes”Health  Insurance  offerings  are  transactional  in  nature  and  reflect  the  shortcomings  of  the  primary  health  system  in  their  response  to  the  management  of  chronic  conditions  such  as  diabetes

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• Diabetes  is  not  episodic• Arguably  front  door  to  chronic  illness• Chronic  illness  hunts  in  packs• Right  approach  delivers  dividends  beyond  the  diabetes  conversation

• Diabetes  101  &  some  thoughts

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Eat  (any  food)

Digest

Glucose  levels   in  

bloodstream  rise

Pancreas  releases  insulin

Cells  accept  glucose

BGLs  fall

Pancreas  stops  insulin  production

Simplified  normal  process

Body  has  a  complex  set  of  mechanisms  and  cross  checks  to  maintain  BGLs  within  a  very  tight  tolerance

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Eat  (any  food)

Digest

Glucose  levels  in  

bloodstream  rise

Pancreas  releases  insulin

Cells  accept  glucose

BGLs  fall

Pancreas  stops  insulin  production

Type  1

• Auto-­‐immune• Pancreas  does  not  

produce  insulin• Genetic  predisposition• No  prevention,  no  cure• Typically  juvenile• Rapid  onset• Acute,  diabetic  coma  etc• Insulin  is  the  only  therapy• Insulin  required  for  life• Pumps  &  CGM  improving  

outcomes• 10%  of  cases• Growing  at  3%

Simplistic  overview

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Eat  (any  food)

Digest

Glucose  levels  in  

bloodstream  rise

Pancreas  releases  insulin

Cells  accept  glucose

BGLs  fall

Pancreas  stops  insulin  production

Type  2

• Insulin  resistance• Pancreas  can’t  cope• Age,  lifestyle,  ethnic,  

parents,  pregnancy• Typically  older  onset• Progressive• Pre-­‐diabetes<-­‐>  Insulin• Multiple  therapies• 85%  of  cases• Growing  at  7%  p.a• 60%  delay  /  prevent

Simplistic  overview

• and  so  what?• High  BGLs  reduces  blood  viscosity  and  attacks  small  and  large  blood  vessels  and  nerve  functionality

– 4x  more  likely  to  have  a  stroke– Australia’s  leading  cause  of  blindness– 4x  more  likely  to  have  a  heart  attack– Leading  cause  of  kidney  dialysis– Leading  cause  of  amputation

• But  condition  can  be  successfully  managed  and  complications  avoided  if  we  work  together

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• Scale

– 3rd largest  country  in  the  world– 1.1m  Australians  diagnosed  (est add.  600k  t2  undiag)– 5%  of  the  population,  280  a  day,  36k  in  NSW  alone  in  2014

– 1  in  4  adults  >25yrs  have  impaired  glucose  management– 4m  Australians  if  pre-­diabetes  included– $6.5b  p.a.  direct  health  costs– Similar  costs  around  productivity  loss– Quality  of  life  impacts– Single  largest  burden  of  disease  by  2019  if  left  unchecked– It’s  real  and  it’s  big  but  there  is  much  we  can  do….

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• Diabetes  is  not  episodic  (feel  ill,  take  a  pill)• Not  all  GPs  comfortable  with  managing  diabetes• Time  between  consultations  critical• Self  assess  and  dynamic  action  adjustment• Est.  up  to  60%  of  t2  able  to  be  prevented  or  delayed

• Once  diagnosed,  good  self  management  key• $1  spent  on  education  saves  $16  in  downstream  costs  (AE/ADEA)

• Annual  cycle  of  care  &  medication  compliance9

TIME

Diabetes  continuum

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Diabetes Primary  Health Health  Insurance Hospitals

Large  base Transactional Transactional Too  late

Increasing $  Driven Complex Turn  away  t2

Longitudinal Time  poor Caveats Blacktown ED

Costly Capability? Shotgun Struggling   to  cope

Patient  Mgmt Paperwork Pumps  /  CGM?

30+%  undiagnosed Minutes v  Months Reactive

Database Reactive

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Mission

Complications

Diabetes

At  risk

General  Population

• Improve  Prevention• Increase  Identification• Improve  Management• Reduce  Complications• ROI  – people  /  $

• Gen  Better,  Healthier  You,  NSW  Govt -­‐ Get  Healthy• HBa1C  test  now  covered  by  Medicare• NDSS,  Care  Plan,  Education,   cycle  of  care,  medication  compliance• Better  that  you  know  and  have  the  ability  to  appropriately  

intervene

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We  can  be  more  systemic  (and  successful) in  our  response  if  we  empower  the  customer….

• Screening  – Hba1c  motivation  (across  total  base)

• Create  a  diabetes  package  or  extra’s  subset– NDSS  registration– Care  Plan

• Diabetes  Education  **• Dietician• Exercise  Physiologist• Podiatrist• Optical  check  (retinopathy)

– Annual  Hba1c,  weight,  BP,  Med  compliance– Membership  of  diabetes  association  

• Magazines,  newsletters,  events,  help  lines  etc– Outbound  support  /  coaching  texts  or  calls?

Best  Practice

•Diabetes  Portal  or  other  mechanism  that  enables  you  to  assess  customer  compliance  to:• NDSS  registration• Care  Plan  elements• BGL  uploads• Annual  Hba1c,  weight,  BP,  Med  compliance• Membership• Movement  upload• Outbound  support  /  coaching  texts  or  calls?

• Early  interventions  possible•Compliance  discounts  to  premium

• EG  WSDI

Skin  in  the  Game

Weight

BSL

Activity

BP

Food

Or  manualdata  entry

Patient  sharing  

information  with  GP  

generated  care  plan

GP  sharing  information  with  hospital  Specialistservices  

Patient General  Practice Hospital  Services

‘Powered  by  Telstra  Health’ ‘Enabled    by  LinkedEHR’

Targeted  Smart  Multi-­‐media  Education  

Patient  Self-­‐Management  eHealth Enabler  Model

Telstra’s  Health  Gateway  – WSDPMI’s  Diabetes  Gateway

Telstra’s  Health  Gateway:A  platform  (web  portal  &  mobile  app) enabling  customers  to  access  their  health  data  and  information,  connecting  them  with  their  care  providers  and  enabling  interaction  and  transactions  across  their  health  care  needs.  Unlike  self-­‐management  apps  disconnected  from  the  broader  health  ecosystem,  theconnected Health  Gateway  is  never  empty  – once  registered,  the  customer  is  delivered  value  instantly

Integration  with  Linked  EHR  &  GPMP:  Goals,  Recommendations&  Reminders

The  core  of  the  collaborative  care  model  – integration  across  providers  and  coordination  between  health  events  – is  dependent  on  shared  information  

The  approach  is  to  bridge  the  gaps  between  existing  technologies  in  order  to  facilitate  information  exchange.  This  will  focus  more  on  the  behaviours  of  those  interacting  with  enabling  technologies  than  the  enabling  technologies  themselves.  

Integration  with  Linked  EHR  &  GPMP:  Medications  &  Prescriptions

Gateway  delivers  a  consistent  and  standardised  customer  interface,  plus  supporting  clinical  and  business  logic.  It  has  been  built  with  the  highest  standards  of  privacy  and  security  (NASH  PKI  certification  &  ISM  compliance)

It  links  with:•Medications  history  from  Linked  EHR•CMI  from  GuildLink•ePrescrption fulfilment  capability  from  eRx Express

The  Patient  Experience:  George  Institute  assessment  tools

The  Patient  Experience:  George  Institute  goal  setting  tools

• Dealing  with  chronic  conditions  requires  a  longitudinal  approach  and  teamwork  

• Issue  is  big  and  getting  bigger• We  have  an  opportunity  to  create  better  outcomes  for  all  involved

• Customer  participation  &  empowerment  is  key• Best  practice  chronic  care  packages  required• Attack  is  the  best  form  of  defence….

– (Will  leave  pumps  for  another  discussion)

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Thank  You