The Australian Institute of Health and Welfare estimates that of the 10 million hospitalisations each year – 1.2 million of which Medibank funds – about 6 per cent are unnecessary or preventable. Glenn Hunt
Medibank Private says better management of chronic disease patients is showing early signs of reducing unnecessary hospital visits through tailored care plans, but has found that some measures are as simple as ensuring patients don’t miss their specialist appointments.
The $7 billion health insurer has been running its CareComplete program since mid 2014 in an attempt to take better care of its sickest members and reduce the number of times they visit hospital. After kicking off with a 100 person pilot, the program now covers 5000 of Medibank’s 4 million members and costs about $30 million a year.
Dr Andrew Wilson, Medibank’s group executive, provider networks and integrated care, says investing in chronic disease patients makes strategic sense because “it combines health outcomes and fiscal responsibility”.
The Australian Institute of Health and Welfare estimates that of the 10 million hospitalisations each year –1.2 million of which Medibank funds – about 6 per cent are unnecessary or preventable. Many of these admissions are likely to come from chronic disease patients and could have been prevented “through people receiving better care in the home and in primary care”, Dr Wilson said.
Medibank, like its rivals in the $20 billion industry, is under pressure to reduce the amount it pays out for medical care. Brendon Thorne
Medibank, like its rivals in the $20 billion industry, is under pressure to reduce the amount it pays out for medical care, because this is pushing up premiums and turning people off expensive cover. Alarmingly, the proportion of Australians with hospital cover dropped to 47 per cent from 47.4 per cent a year earlier in the June quarter. This trend goes against about seven years of steady growth of population coverage until late 2014, from which point the rate had remained steady. Members with concerns about affordability and value for money are dumping their policies.
‘Join the dots’
Underpinning Medibank’s CareComplete program is a philosophy of helping patients make sense of the confusing health system and “help them join the dots”, Dr Wilson said.
What that means in practice is appointing a care co-ordinator, a health professional who goes to the patient’s home and spends time getting to know them and their needs. A plan is created in consultation with all of the patient’s healthcare professionals – doctors, specialists and others like physiotherapists – and records are maintained on a digital platform that all parties get access to. Other Medibank staff, known as care navigators, keep in touch with the patient to help with administrative things like booking appointments. There are just over 100 of these employees at Medibank now, a number that has doubled in the past year.
Rebecca Bell, who is the general manager, utilisation management in Dr Wilson’s department, said often the most effective interventions come from the care navigator, who can organise things like a taxi to an appointment or home modifications like handrails. In one case a man suffering from heart failure kept being admitted to hospital because he was having trouble monitoring body fluid levels. Although he had a set of scales that reported those details his poor eyesight meant they were useless, so Medibank bought him a set of talking scales.
Early results from the pilot show marked improvements in measures like weight loss, blood pressure and blood glucose control among participants, along with better lifestyle choices like increased rates of exercise, reduced alcohol intake and fewer smokers.
Ms Bell said the pilot also showed a significant reduction in risk of future hospitalisation, which Medibank will now monitor against a control group of members with similar risk factors. Although she would not provide a specific figure, Ms Bell said the reduction was “enough for us to get excited and believe that this is all heading in the right direction”.
Medibank is now analysing its membership base to identify areas where the programs could be targeted. Ms Bell said Toowoomba turned up in early analysis as an area where Medibank has “a lot of members with chronic and complex conditions”.
Dr Wilson said the annual $30 million cost of the program would sit as part of the $5 billion Medibank paid each year for care. “That’s obviously offset as we reduce unnecessary hospital admissions. That’s where we see the financial return on investment.”