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Dr. Annette Carruthers - nib - PHI working with general practice

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Dr. Annette Carruthers delivered the presentation at the 2014 Health Insurance Summit. …

Dr. Annette Carruthers 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/HISummit14

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  • 1. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. THE PROBLEM 2 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) 0% 20% 40% 60% 80% 100% 120% $0 $100 $200 $300 $400 $500 $600 $700 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% CumulativeProportionofHospitalBenefits CumulativeHospitalBenefits($m) Proportion ofTotalInsured Hospital Customers 1% of our hospital customers account for more than 50% of hospital benefits (pre risk equalisation)
  • 2. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. THE SOLUTION 3 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. THE EVIDENCE 4 ▼ 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. THE RISE OF CHRONIC DISEASE 5 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. PREVENTION 6 Primary and secondary • Smoking • Physical activity • Alcohol • Poor diet • Obesity • Hypertension • High blood fats
  • 6. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. GP MANAGEMENT PLAN 7 • Patient education • Evidence based prescribing • Disease monitoring • Action plan • Immunisation • Risk factors • Medication reviews • Falls prevention • Advance care plan
  • 7. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. DIABETES 8 • Fastest growing chronic illness • Approximately 100,000 new diagnoses each year • Annual cycle of care o BP, weight, BMI o HbAlc o Lipid management o Diet, smoking and exercise advice o Eye care o Foot care o Screening for kidney disease
  • 8. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. GP DEMOGRAPHICS 9 • 75,653 registered medical practitioners currently working (AIHW 2012) • 34.5% GPs = 26,100 • 40.8% 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. SPECIALISATION 10 • 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. ARE ALL GPs THE SAME? 11 • VR vs non-VR • Accreditation (67%: 2010) • Home visits, after hours cover • Practice nurses • Corporatisation (15-20% DOHA 2012) • Rapid turnover practices • IT
  • 11. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. THE VISION – THE MEDICAL HOME 12 • 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. HOW? 13 • Divisions of general practice • Medicare locals • Primary health care networks • Coordinated Veteran’s Care Program • COACH
  • 13. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. ENABLERS 14 • PCEHR • Electronic health fund identification • Product restriction information • Pathways • Alliancing • Consumer engagement and empowerment (eg Whitecoat)
  • 14. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. PATHWAYS 15 Rapid access to information about specialist services as a key tool to help them care more effectively for patients
  • 15. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. CONSUMER ENGAGEMENT & EMPOWERMENT 16 Whitecoat allows users to search (by specialty, by location) and compare (cost and consumer reviews) ancillary providers
  • 16. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. DO 17 • 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. MAINHEADINGGOESHERE INUPPERCASEPLEASE Put a footer here if you need to. DON’T 18 • 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