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Dr Avnesh Ratnanesan - Energesse - Future solutions for Australian Healthcare Reform
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Dr Avnesh Ratnanesan - Energesse - Future solutions for Australian Healthcare Reform

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Dr Avnesh Ratnanesan delivered the presentation at the 2014 Health Insurance Summit. …

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/HISummit14


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  • 1. Future Solutions for Australian Healthcare Health Insurance Summit 2014 Dr Avnesh Ratnanesan (Avi) Founder & CEO, Energesse
  • 2. 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
  • 3. Understanding the Healthcare ‘Ecosystem’ Federal Government State Government & Public Hospitals Patient/Consumer Not- for- profit Aged Care Research & Academia Private Sector – PC & Hospitals
  • 4. ‘Ecosystem’ is interdependent Federal Government State Government & Hospitals Aged Care Research & Academia Patient/Consumer Private Sector – PC & Hospitals
  • 5. Major Challenges with Healthcare System 1. Growth in healthcare costs are ‘unsustainable’ - $140bil at 9.1% of GDP and outcome goals unclear
  • 6. OECD Health Expenditure
  • 7. Australia Health Outcomes
  • 8. Health Growth Rate vs GDP
  • 9. Actual Govt Health expenditure Grattan Institute Report, adapted from The Conversation 24 April 2013
  • 10. 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
  • 11. Chronic disease service load
  • 12. 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
  • 13. Dynamic consumer needs and expectations
  • 14. 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
  • 15. Future Trends and Solution Opportunities for PHI
  • 16. Develop new innovative funding sources
  • 17. Population Health Management, Changing Incentives and Integrated Care
  • 18. Valuing Service Outcomes: Cost-Effectiveness & Risk-Share Agreements
  • 19. Leverage partnerships & bridge silos
  • 20. Facilitate best practice peer- sharing & community think-tanks
  • 21. Enhance trust with stakeholders
  • 22. Empower Consumers (Community rating)
  • 23. 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 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
  • 24. 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/
  • 25. Personalised health and Behavioural profiling to improve adherence Reproduced with permission from Akumen
  • 26. 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
  • 27. For complimentary copy Call +612 8091 0918 OR Email avnesh@energesse.com
  • 28. 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
  • 29. For complimentary copy Call +612 8091 0918 OR Email avnesh@energesse.com