Medibank is a leading Australian health insurer established in 1975 as a not-for-profit organization and has since grown through mergers and acquisitions to become a for-profit entity. Healthcare costs in Australia are rising significantly and are projected to exceed revenue by 2050 due to factors like an aging population and increased rates of chronic disease. Medibank aims to address these challenges by focusing on preventative and primary care, improving access to GPs, coordinating care for high-needs patients, and paying providers based on health outcomes rather than activities.

1. 1
The American Chamber of
Commerce in Australia
Business Briefing
George Savvides
Managing Director, Medibank
Friday 5 September 2014

2. A leading health insurer for nearly 40
years
Established by
the Australian
Government
as a not-for-profit
1975
1976:
private
health insurer
1998: Incorporated with
the Commonwealth as
its sole shareholder
2011-2013:
•Health Solutions formed
•ADF Health Services
contract secured
•Medibank and ahm
health funds merge
•Repositioned ahm brand
1980 1985 1990 1995 2000 2005 2010 2014
1990: Merges with
Health Australia
2006-2007:
•Launches Diversified
Insurances (travel,
pet and life insurance
products)
•The Medibank Private
Sale Act 2006 (Cth)
passes
2009:
•Acquires ahm
•Merges with Health
Services Australia
•Converts to for-profit
entity
2010:
McKesson
and Carepoint
acquired
2014:
•New head office
•Reorganisation of
Complementary
Services

3. OBJECTIVES
Medibank on the inside
3

4. We know what our members want
Reduce the
burden on
the public
system
To provide
quicker access
To provide
financial
coverage
To provide
better quality
healthcare
experiences
Quicker
access
Financial
coverage
Better quality
healthcare

5. Value
Simplicity
Flexibility
Relevance

6. OBJECTIVES
Healthcare demand & costs are growing
6
Expenses on health and aged care
are expected to exceed revenue by
2050.

7. AUS HEALTHCARE COSTS AS % OF GDP COST OF A C-SECTION
Actual
9%
2009
COST DRIVERS - 2009
OUT OF POCKET COSTS COMPARISON
Actual
3.8%
1960
Projected
20%
2045
$1.875T cost of
chronic care to the
industry
- % OVER 65
.75 of every
dollar spent
2009
2050
13%
HOSPITAL SPENDING PER DISCHARGE
11%
Hip replacement cost in
Australia 45%
cheaper in
Germany,30% cheaper
in France and Canada.
of Australian
bankruptcies in
2009 were health
or health insurance
related (3153
people)
Australia has the
3rd highest cost
of generic drugs
40% more than
the UK.
CAN AUS FRA NZ GER
$14,896 $9,531 $8,049 $7,856 $5,192
$
$ $
25 - 28%
$7082 $4820 $3732 $5820 $7449
AUS CAN GER FRA USA
$15,198
FRA $291
UK $341
NZ $399
GER $552
OECD $559
AUS $627

8. Medibank outlook on Australian health
expenditure
Medibank forecast of health expenditure to 2025

9. Medibank outlook of Australian health
expenditure
Medibank forecast of health expenditure to 2025

10. Chronic disease is now more prevalent
than ever before
Source: MPL data
Consume 35% of all
hospital and medical
expenditure
70% of this group
have underlying
chronic disease
2% of Medibank
members

11. Are we really looking after Christine?
My needs are forever
changing, which presents
a challenge when it comes
to managing my condition

13. Many insurers are focused here
focus
Long Term Supply Side Options
13

14. Ave # of GP Encounters by Location (2004)
Very
remote
Source: Locality Matters, the influence of Geography on General Practice Activity 1998-2004
Ave. $ per Hospital Separation by Remoteness
(2008)
3,651.6 3,887.5 3,965.1
4,328.6 4,422.3
Major
Cities
Inner
Regional
Outer
Regional
Remote Very
Source: AIHW National Public Hospitals Establishment Database, 2005
Remote
5.5
4.5 4.2
3.6
2.2
Major
Cities
Inner
Regional
Outer
Regional
Remote Not
stated
Expenditure Per Person By Service & Region (2008)
1,311
Source:
753
312
1,428
661
346
1,468
576
318
1,723
409
243
Admitted Patient Medicare PBS Pharmaceuticals
Major City Inner Regional Outer Regional Remote and Very Remote

15. Differentiated
offering for
Medibank
members
Health Assessments
Pre and Post Discharge
programs to mitigate
unplanned readmissions
2
3
Integrated GP
and virtual
health coaching
and disease
management
programs
4
Best practice, evidence
based outpatient
programs delivered
through General
Practice
5
6
Integrated Care
program to
address patients
with complex
conditions
1
Primary care objective
Patient
Centered
Medical
Home
6

16. GP Access - added value for members &
help improve their health
What it offers:
Same-day appointments
Fee-free consultations
After-hours GP home-visits
A range of one-off health assessments.
Key statistics:
26 medical centres in Brisbane, the Gold
Coast, Ipswich and Cairns (Queensland)
145 GPs
More than 30,000 consults
Research shows 35% of respondents more
likely to stay with Medibank with these
additional services

17. integrated care approach
Working with primary care to join the dots to deliver care
coordination and improve health outcomes.
1. Continuity of
care across
secondary and
primary sectors
2. Continuity of
patient information
and support
3. Co-ordination
of providers
“Care Team”

18. 18

19. Reduce hospital admissions by 25%
Improve experience
of care
(patient surveys,
provider feedback)
Improve population
health
(clinical markers,
biometrics,
smoking)
Improve health
system utilisation
(bed days, ED
presentations,
readmissions)
CarePoint

20. GP-led supported by additional services
A primary-care based clinical
coordinator that helps manage the
patients’ holistic care needs
A call-centre based
team that will help
patients navigate
appointments and
logistics
Hospital discharge
services that will
ensure preventative
measures are in
place to mitigate
readmission
Home-based
services to
support patients
managing their
chronic
conditions and
lives at home
Lifestyle
counselling to
improve self-management,
motivation and
adherence to
plans
After hours support for questions
and advice when required

21. A healthcare system for the future
Focus on
primary care as
the central point
Pay for health
outcomes rather
than activities
Co-ordinate care
for high needs
patients
Motivate people
to invest in a
healthy lifestyle

22. 22
Thank you