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					The broader alliance – primary care,
  wellness and health insurance

     Australian General Practice Network
             National Forum 2009

                          Dr Stan Goldstein
                          Head of Clinical Advisory
                          Bupa Australia
                          6 November 2009

Bupa Group


  • A Global Health and Care company

  • Mission Driven Organisation

  • No Shareholders (provident society)

  • Invests all profit globally in in growth and
         servicing its customers

Bupa Australia

Health Insurance
• Over 3 million Australian lives covered
• Largest privately owned health insurer
• Over 2000 employees
• Strong brands and reputation (HBA, MBF and Mutual Community)
• Over 200,000 life insurance, wealth management & travel, home and car
  insurance customers

Aged Care
• Bupa Care Services ( Aus/NZ)
• Over 7,200 employees
• Leading operator of residential aged care facilities
• 96 aged care homes provide care for almost 7,000 people in Australia and NZ

Building Our Healthcare Reputation, Credibility And Impact

              Online                        MBF
Private Health Insurers and Primary Care –
naturally aligned

   Actually ... there is a natural alliance between
   primary care and health insurers, the most difficult
   aspect of which is that at least until now there
   hasn’t been a financial arrangement connecting us.

   The common thread is that the endeavours of
   General Practice, Primary Care more broadly, and
   much more recently of the health insurance
   industry as well, is to work towards improved health
   status for those we touch – our patients and

Private Health Insurers and Primary Care –
naturally aligned

  • Continuity (of care or responsibility)

  • Prevention

      • Primary care has roles in Primary and Secondary
      • PHI sense of responsibility is weighted towards secondary

  • Wellness or Wellbeing

  • Alternatives to hospitalisation / Broader Health Cover

  • Overall health needs – beyond the acute episode

... and why does PHI see itself in this space?

Between 1995 & 2005, health spending outpaced economic growth in
29 of 30 OECD economies

                                                                                   LUX KOR

   AAGR in Health Spending (%)

                                                            AUS                                    HUN
                                                                      OECD             GRC
                                              NZL               USA
                                                    MEX                    SWE         SVK
                                                    BEL NLD                      FIN
                                   ITA       PRT
                                 CHE                       CAN
                                 JPN                             CZE
                                             FRA    AUT

Source: OECD, 2007. AAGR = Average Annual Growth Rate.     AAGR in GDP (%)

    Health costs are expected to rise rapidly
                                            Projected health and aged care spending to 2033
   Per capita healthcare expenditure                                                                                                                   Total annual healthcare
         (real 2006/7 dollars)1                                                                                                                         expenditure (% GDP)
                                                                                                                                             12.4%                         14%
$10,000                                                                                                 10.6%                                                              12%
                             9.3%                                   9.3%                                                                     $8,375
$8,000                                                                                                                                                                     10%
$6,000                                                              $5,026
                            $4,277                                                                                                                                         6%
$2,000                                                                                                                                                                     2%
            0                                                                                                                                                              0
                              2002-03                               2012-13                              2022-23                              2032-33
       out-of-                  $876                                 $1,015                               $1,258                                 $1,616
                                                          PHI and other sources2                 State, territory & local governments

                                                          Individual out-of-pocket              Australian government

                                                              % GDP
Source: Projection of Australian health care expenditure by disease, 2003 to 2033 (AIHW, 2008). Population Projections, Australia, 2004 to 2101, Series B (ABS Cat. 3222.0)
1. Includes high-care residential aged care 2. Other sources include workers compensation and transport accident schemes, and other private sources (eg charitable organisations)

               Houston, we have a problem…

The usual suspects:
   •   Rising costs
       •   Uneven quality
       •   Declining access to care

Some looming challenges

   •       Loss of professional
           authority of doctors
   •       Integrity and relevance
           of academic medicine
   •       How do you do
Private Health Insurers, GP Networks and Prevention

National Agendae to Shift the Focus from Acute Care

    •   NHHRC (National Health & Hospitals Reform Commission)
    •   National Preventative Health Task Force
    •   National Primary Health Care Strategy

• Prevention

    •   For General Practice, a natural undertaking
    •   For PHI, almost a business imperative if it can be done
        economically ... but
            •    Fragmented payers in the Australian system –
                 balance of who spends now against who gains later
            •    Absence of health economic research on
                 relationship between prevention / chronic disease
                 management strategy, outcomes, effects on
                 utilisation and hospitalisation

Less than 2% of health expenditure is spent on preventative health

Small adjustments to the status quo??

                                 Spend more
Every system is perfectly designed to get the
                                 Train more
results that it achieves         Focus on prices

                         Paul Batalden

Insanity: doing the same thing day after day
and expecting different results
Private Health Insurers, GP Networks and Prevention

The National Agenda is reframing General Practice

    •   as providing possible substitution for hospitalisation

    •   as a key source of health information

    •   as focal in the delivery of public health and prevention
        messaging to individual patients
    •   as a co-ordinator of disparate health professionals
        outside the hospital sector
    •   as a solution to the economic threat of chronic disease

Private Health Insurers, GP Networks and Prevention

The National Agenda is reframing General Practice

    •   are you ready?

    •   are you resourced?

    •   will the structural and MBS rebate solutions
        deliver to expectations?
    •   what allies can you gather to your cause?

    •   what else would help?

                      Health Funds and prevention:
                      the elephant in the room?

Characteristics of Health Insurance

   Long term association with an individual
     that extends beyond intermittent or
     even chronic periods of illness

   Relationship with family

   Potential relationship with workplace

   Financial stake in an individual’s
      wellness and the risk of doing nothing
                       Health Funds and prevention

Prevention Focus for Health Funds

   Primary - limited

   Secondary and Tertiary –

   •   Health Information
   •   Navigation
   •   Disease Management
   •   Health Coaching
   •   Case Management
Bupa’s approach to the future – allied values

   Encourage and support customers to achieve best health – future model

           Preventive Services                            Health Improvement                           Corporate Wellness
                                                               Services                                    Services


        • Sales Growth                             • Customer Value Proposition                      • Sales Growth
        • Customer Value Proposition               • Broader Health Cover Compliance                 • Corporate Client Relationships
        • Customer Retention                       • Benefits Risk Management                        • Income Generation

                                                   • Online health information & tools - Health      • Corporate in2life
How     • Online health information &
                                                     Navigator / Using your insurance                • Outsourced workplace screening
          tools in2life
                                                   • Positive Health Programs                          and wellness services e.g. Good
        • Other low cost channels: DM;
                                                   • Chronic Disease Management Programs               Health Solutions; Peak Health
          call centres; partners
                                                   • Primary Care / GP Support
                                                   • Health Dialog

                                                                Health Dialog                      Corporate • Health Risk Assessment
What                    • Health information
                                                                • Health coaching                            • Corporate wellness
                        • Health Risk Assessment                • Shared Decision-Making                       report
                        • Health & fitness                        tools
                                                                                                             • Health checks
                          programs                                Chronic Disease Management
                                                                                                             • Health and wellbeing
                        • Quizzes                                 Programs
                        • Targeted messages                       • COACH
                                                                                                             • Remedial lifestyle
                        • in2life partners                        • Post Natal Depression (PIRI)
                                                                                                               program design
                                                                  • McKesson
                        • Personal Health Record                                                             • Minor clinical services
                                                                    Mental health services
                                                                                                             • Health coaching services
                        • Offline capabilities
                                                                                                             • Yoga, massage and
                        • Health support
                        • Fitness & lifestyle                   Positive Health Programs                     • Absence and productivity
                        offerings                            19                                                Management
Bupa – big issues: evidence, cost, amenable to change
                                         Current Initiatives

     Heart Health                         Bone and Joint Health                    Mental Health
• The COACH program
                                    • KicStart                            • McKessons telephonic psychiatric
• Young@Heart
                                    • Partnership with with AHIA, Joint     customer support
• Online Cardiac Rehab Program
                                      Research Pty Ltd and other funds    • PIRI Post Natal Program
• Brain Natriuretic Peptide study
                                    • Osteoporosis Treatment              • Ante Natal depression intervention trial
• RoCAD – Coronary CT Trial
                                    • Optimising Prostheses Selection     • Mental Health Research Institute Bipolar
• Retinal Imaging - CERA

MBF                                 Funding $ committed by strategic priorities*   Healthy ageing
Foundation                                                                         The goal now is not just to live longer but
initiatives:                                                                       to make those extra years as enjoyable as
2008 snapshot                                                                      possible. With foresight and planning,
* Correct as at June 2009                                                          ageing can emerge as an opportunity
    Total of all initiatives           $9,152,144                                  rather than a problem. The Foundation
    Healthy ageing                     $2,841,467      31%                         supports a range of initiatives that aim to
    Keeping healthcare affordable      $3,105,733      34%                         develop evidence-based knowledge that
                                                                                   will help realise the potential of healthy
    Wellness and obesity               $3,204,944      35%
New initiatives

Centre for Eye Research – Early prediction
of cardiovascular disease using novel
retinal image-analysis.

Pain Management Research Institute - Pain
After Breast Surgery .

The Children’s Hospital at Westmead - The
role of dietary protein and exercise in pre-
diabetic adolescents .

Private Health Insurers, GP Networks and Prevention

How will Bupa work with General Practice?

   •   not JUST a cash cow

   •   improving the evidence - implementation

   •   engaging and motivating patients –
       self-management and compliance

   •   making services and programs available-
       - direct provision and benefits

   •   decision support

                                          Wellness and obesity

                                          Building a strong base for better
                                          health and wellbeing should be a
                                          routine part of our everyday lives, not
                                          just a response to a health crisis. The
                                          Foundation is supporting programs to
                                          encourage people to take up and
                                          maintain healthy behaviours – at
                                          home, at school and in the workplace.
Keeping healthcare

MBF Foundation is exploring
health policy initiatives that may
assist in easing the financial
burden on healthcare services
and strengthen the sustainability
of Australia’s mixed public and
private health system.

The next initiatives
How will Bupa work with General Practice?
   •   Decision Support
       • Services available
       • Benefits available
       • Eligibility
       • No Gap specialists
       • Producing information on quality
   •   Chronic Disease Management
       • Health coaching (Health Dialog)
       • COACH
       • Mental Health
       • Weight loss to avoid joint replacement
   •   Member Information
   •   Corporate Wellness

Decision Support: we need to ensure that improvements work for





Bupa Australia

    Corporate Arrangement with AGPN – Ask us!

    Come see us at the stand