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Better than a cure: Insurers and data driven early intervention

   21/08/2018        Articles

Too often patients receive treatment for preventable diseases, many of them chronic, long-lasting conditions with persistent effects.

An estimated 31% of Australia’s burden of disease is preventable, with reduced exposure to some risk factors, according to the Australian Institute of Health and Welfare. In 2015-16 the nation spent $170 billion on health or approximately 10% of GDP.  With Australians living longer, pressure on our healthcare system is steadily mounting.

Both government and healthcare insurers are looking for ways to ease the burden.  For government, this includes encouraging Australians to take up private health insurance. For insurers, the challenge is to demonstrate real value to customers, offer meaningful and affordable products and stay relevant to their needs.

Chronic numbers

Chronic conditions are the leading cause of illness, disability and death in Australia.  For an affluent country, the figures are startling.

An estimated 50 percent of Australians have at least one common chronic condition.

Nearly one in four are coping with two or more, according to Australia’s Health 2018 report.

In a submission to government regarding best practice in chronic disease prevention and management in primary healthcare, the Pharmacy Guild of Australia reflected that a health system geared towards “expensive episodic acute medical care is inefficient at dealing with the changing demographics and disease patterns that we’re now experiencing in Australia”.

Prevention is better than a cure.  Early intervention must certainly be better than a lifetime of management.

Insurers are placed well to help

In primary healthcare, getting information to flow is challenging.  In 2016-17, one in six people (17%) aged 15 years and over saw three or more health professionals for the same condition with a lack of communication part of the problem, according to the Australian Bureau of Statistics.

Meanwhile, data within healthcare has historically existed in siloes with poor visibility between systems.  Finding ways to allow medical professionals to access important data when and where it is needed remains challenging.

Health insurers, however have a comparatively privileged position – with a more complete picture of their customers’ health, assisted by claims information for allied health services, such as acupuncture or healthy lifestyle incentives such as gym memberships.

In fact, consumer health forum Painaustralia urges private health insurers to do a better job of matching the allied health treatments required by members to align with best-practice prevention and management strategies.

The challenge for insurers is to uncover the relevant insights within their customer data, to help them to provide the right products at the right time.

A recent PwC report Reimagining Healthcare discusses the importance of digitising healthcare generally and using data analytics to deliver more affordable, convenient and personalised prevention and care.

The PwC report suggests greater collaboration across the board, between public and private organisations, state and federal governments, adding “even competitors can benefit by partnering to deliver consumer centred health services”.

Why collaborate?

Harnessed properly, any organisation can use their data to help personalise and tailor products to customer needs.  With secure data collaboration, they can also connect to multiple data sources to extrapolate further, whilst ensuring complete data privacy and control.

In the healthcare context, there is potential for using data analysis to help identify groups at risk of chronic disease, particularly if organisations are willing to work together on such an important, far-reaching outcome.

Secure data collaboration is not ‘sharing’ data, and therefore does not expose customer details, jeopardise patient privacy or create compliance risk.  With secure data collaboration, even sensitive data sources can be involved in the work – importantly, without being depersonalised.

For example, software developed by Australian technology provider IXUP encrypts data at the cell level, so the collaboration occurs by matching the encrypted values only.  When completed, the analysis can be applied without having lost the important detail for personalisation.

Insurers want to do more

Health insurers have long had preventative personal coaching programs, helping members quit smoking, lose weight or get fit.  Many run chronic disease management programs, such as HCF’s phone line support and Bupa which has another for those with cardiovascular and stroke-related illness.

Many health insurers also support widely-available intervention programs such as Healthy Weight for Life.  Some have their own apps for encouraging healthy habits or partner with developers, for example, nib’s multi-year trial with mindfulness app Smiling Mind.

Generally speaking, health insurers have indicated an interest in doing more to assist in the early intervention of chronic disease.  Ahead of the most recent federal budget, Bupa even proposed relaxing regulations so that it could pay GPs on behalf of patients as one way, it argued, of encouraging early intervention.

Meanwhile, the Members Health Fund Alliance made a similar submission: “stronger patient outcomes can be achieved by the creation of closer relationships between GPs and insurers in the area of primary health”.

There are of course strong business incentives for playing a bigger role in early intervention, paying less for healthcare costs being the most obvious.

Insurers are also increasingly looking for ways to show the value they contribute to their customers, focusing on better customer experiences or more enticing extras and rewards, lest they be pulled into competing on price alone.

In order to head off this competition, insurers need maintain a trusted relationship with their customers and patients, finding ways to provide more compelling, affordable, relevant products, tailored to their needs, including those not yet faced, but likely around the corner.

More than almost any other health issue in Australia right now, chronic disease needs to be addressed most urgently.  Health insurers are well placed to provide the data-driven early intervention that will make a difference and lead to living healthier lives.

Contact us to take your first step towards unlocking the true value of your data with IXUP’s secure data collaboration environment.