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Dr. Avi at the 11th Annual Future of the Pharmaceutical Benefits Scheme Summit 2014

Innovation and Healthcare System Reform

Thanks very much. That’s a little bit of all bio there. Essentially, I’m at a company called Energesse . We’re a consultancy in the healthcare and wellness space. We consult companies mainly in Australia, but also healthcare organizations in the UK and US. A little bit about what we’re going to talk about today, the title is Innovation and Healthcare Reforms. Obviously, with a lot of changes going in, we focus a lot in the last day and a half in the problems and the challenges. I’m really going to take different attack, and talk more about the potential solutions that our organizations can implement.

The takeaway that I want to leave you with, by the end of the day, is that you have 1 or 2 tips that you’re able to implement in your organizations literally tomorrow. This presentation, this come with a warning, because I’m going to be very controversial. Most of you probably disagree with what I have to say, but that’s fine. That’s the nature of a lot of presentations so far, but I’d like to keep it a little bit exciting. If you’re easily offended, probably you’re best to leave, because there some of things I’m going to say are pretty out there.

Moving on, what are we going to cover? Firstly, I’m going to talk a bit about managing the PBS and patient care in the healthcare ecosystem. I call it an ecosystem, because it’s a bit broader, and it’s quite an interdependent system. I’m also going to take the conversation up a level. We really have been focusing on the PBS quite a lot in the last day and that’s the nature of this conference. We really have to look at our pharmaceuticals and the PBS in the context of the boarder healthcare system. I’m really going to talk big picture today.

We’re going to talk a little bit about our systems centricity, how we are focused on creating solutions, and solve problems within the system. Sometimes we forget about the growing patient needs. We’re looking at a lot of patient needs today as a static picture, that’s not actually true. Patient needs and expectations are changing. They want more they want better health care. We’re going to look at how innovation can be used to solve some of these problems. I’m going to give you a few tips on process on how innovating your companies, so that you can go ahead and do this pretty much straight away.

I’m going to talk a little bit about the future trends. That’s not just trends in Australia, but trends globally. When we look at the Australian healthcare system, it really does limit a lot of what’s going in the UK. It takes elements from the US. Certainly when it comes to science, we’re always going to US healthcare conferences, and getting our knowledge from there. Let’s look at some of the trends that are happening there, and what you can do in the organizations today. Finally I’m going to talk about a white paper that Energesse is developing with 20 of the top healthcare leaders in Australia. It’s called Future Solutions in Australian Healthcare. I’ll take about that at the end as well.

Then we’ll have some time for QA, if we’re lucky. I really want to tailor this presentation to what you guys actually want. I just want to get an understanding of which sub-sectors of health care you can’t be working. If you can just get a show of hands. How many people currently work in pharmacy? How many people work in pharmaceutical companies? All right, so we’ve got a few there. We have a few more volunteers that just joined. How many industry bodies?

Research and academia? All right, so we’ve got 2. How many people in other? Quite a lot out there. I know about legal. We’ve got research, market research. What else have we go? Healthcare system.

Audience:        Direct clinical care.

Audience2:      Personal health

Direct clinical care. I think I’ve got some pointers for you guys as well. Let’s see how it goes. Anyone else in the other category?

Broader health, fantastic. I’ve got some for you as well. I think we’ve got it covered. If you don’t mind, just a little bit on my background, because you’ve then understand why I’ve got all these wacky ideas. I started my career as a doctor. I worked as a doctor in the UK. I trained in the medical system over there. Worked for the National Health Service. Then I came to Australia, and I worked for the health system here. I worked in private healthcare syste, and I worked in public as well. I’ve got experience across different healthcare systems in different countries, and also public and private.

I then got to the industry, I did an MBA. I got into industry. I worked initially for a company called Sorono, in medical affairs. Then went on to join a company called Pfizer, as one of the medical directors. I work in research and development, clinical developing, clinical trials. I was involved in registry in products. I was involved in reimbursing products, such as Champix, and marketing products such as Viagra, etcetera, all the hundred million dollar.

At that time Pfizer was turning over a billion dollars a year. It’s not that big anymore. To answer one of the questions earlier, Have we seen a reduction in staff across pharmaceutical industries? Absolutely. At Pfizer I think we had 400 or so plus sales force. I know it’s about 150 people now. In the time that I was there, we completely got rid of the whole clinical research team. We have no clinical research team in house in anymore. Certainly the industry has experienced a world of changes since I left, and that was 2010.

I then went on to a lead industry for a while, doing things in technology, owning companies in that space. Then coming back to healthcare, because I find that’s really where my heart is. My heart is around helping people with their health and wellbeing, which is why our organization really has a vision of helping a million people in the health and wellbeing around the world. We did spend some time working in the holistic health space, and looking at other areas of healthcare that are assigned to emerge.

What we found is some of these things are traditional Chinese medicine, meditation. There’s a growing evidence based for them. In fact the Australian Heart Association actual cited meditation as one of the solutions for heart disease, or preventing the progression of heart disease. That’s meditation, not medication, which is very interesting. We spend some time in that area as well. If you think I have a bias, yes. I have a bias across the whole lot of healthcare, and looking at various different solutions for various different conditions.

It really helped me redefine what healthcare is all about. Healthcare, medicine alone isn’t necessarily health. I did say that this is going to be controversial. Medicine is not necessarily health. Just law is not necessarily justice. There is a difference. Medicine is a sub-sector of health. Sometimes, when we get focused on medicines alone, we lose sight of the broader picture of the value that we can add back into the healthcare system. We lose sight of the value that we can add back to patients. That’s one of the key points here.

What is healthcare really? Healthcare is the maintenance and restoration of the health of the individual’s body and mind. The maintenance being prevention. We forget a lot about that. We focus on treatment quite a lot. Healthcare really is a combination of both, and is also body and mind. Often we really focus on the physicality, the physical outcomes of healthcare, but we forget about the mind. We forget about the rule of the mind. A lot of this stuff may not relate to your professional point of view, but it may relate to you from a very personal point of view.

What is the healthcare ecosystem actually look like. We talked a lot about PBS, but I just want to give you a broader picture of what the healthcare system actually is. Once you understand what’s going on in the whole system, you’ll then understand why some of the things are happening the PBS, and the nature of some of changes that are actually going on. When we look at the entire healthcare ecosystem … Firstly, we’ve got the biggest funders. We’ve got federal government on one hand. Between federal and state, we spend about $140 billion in the Australian healthcare system.

We’ve got a PBS there which is one way of paying for healthcare. We’ve mentioned that’s about 0.6% of GVP, which got Medicare, which funds a lot of services, the doctors etcetera. State government largely funds hospitals that’s about $42 billing with the spend. Then we’ve got health insurance companies represented on the bank. Again, we’ve got 11 million people in Australia that have private health insurance. Again, that funds a lot of healthcare. We’ve got work cover, which we forget about, which also covers a lot of employee benefits in health care.

Then we’ve got things like exercise and nutrition. We tend to forget about the rule of exercise and nutrition, particularly when we starting talking about medicines. When we talk about clinical outcomes around medicines, we start to forget about how important exercise and nutrition actually plays a role in the results that which is in practice. We’ve got age care, and then we’ve got a research in academia, again, represented here. We’ve got our medical professionals, we’ve got about 70,000 across the GP and specialist in this country. Pharmacist, we talked about that Got about 5,250 pharmacist. Steven, was I correct 5,250?

About that plus and minus 3. And about 65,000 employees. That gives you an idea of scale of the ecosystem. Then we’ve got all the nurses, the allied health professionals, the occupational therapist, the physios, all play a role in the maintenance and prevention. We’ve got the alternative health space. That’s a $4 billion industry in this country. We offered 30,000 employees. Fair size for a country like this. We’ve got complementary medicines, which we’ll talk about. We’ve got the pharmaceutical industry, and medicines in there. Then we’ve got the not for profit sector.

The interesting thing about the not for profit sector is that it very often addresses the gaps. The areas where the not for profit organizations are not able to fill, the not for profit raise money from the public to provide healthcare services in those areas as well. Why am I telling you all this? When we start to talk about that we don’t have enough money to do stuff, and we don’t have enough money to create solutions, the reality is if you look at the entire ecosystem, there’s a lot of money around different areas. We can be creative about how we work with other areas with the healthcare ecosystem. We can find some amazing solutions for this person. 23 million of the Australian population, which is really at the center of this ecosystem.

The beautiful thing about the healthcare ecosystem in this country is that the principal of health care is universal health care. We really believe in that. We really want to give everyone in this country very good access. Not just the medicines, but to health care. That’s a wonderful principle, and we forget about the privilege we have working in the system under hat guiding principle.

The other thing that we tend to forget is when changes happen in on par of healthcare, it affects many different parts of healthcare. Brendan talked about this. When we reduced the amount of funding to the PBS, for example, then we reduce the amount of funding available to pharmaceutical companies. The drug industry will reduce the funding available to pharmacy, for example. What happens then, or pharmaceutical companies are not able to fund research. We’ve certain seen that. We know that they fund a degree of education for medical professionals.

What happens then is that those benefits, access to pharmacy, for example. Patients have less access, potentially expertise station have less expertise from the doctors. There is a flaw on impact for whatever change you make in the industry to a stake holder. Very often, we tend to forget the flow on impact. Not only do we forget the flow on impacts to the patients, we also tend to forget the flaw on impacts to all the other stakeholders in the industry. I forgot to mention devices and diagnostic, which is a very important piece.

One thing I want to take from any falsely changing intervention that you’re looking to make in the organization. Think about the flaw and impacts to other stakeholders. When you start thinking that way, you actually start looking at the potential opportunities within the ecosystem to collaborate with other stakeholders to achieve the outcome that you want. We talked a lot about this, a we’ve all talked about the points of trying to have it on cost versus benefits to patient. That’s also about cost centric system versus the patient centric system.

I want to tell you a bit of a story. I recently had an opportunity to go to a specialist consultation with my Dad. My Dad is 69 years old. He’s got a number of illnesses. He’s got diabetes, he’s got asthma, he’s got heart disease. Very rare for me, despite being a doctor, the first time I actually went to the see a specialist with him, and be with him for that consultation. In that consultation … My dad’s a very intelligent man. He’s a dentist. He’s the president of the World Dental Federation. He knows his stuff when it comes to medicines.

In that consultation, he was there sitting with the specialist. The specialist said to him … Asked his history. He was able to relay his history. Then he said, “What medications are you on?” My Dad started rattling off. It became a bit of a challenge, because he was on many medications, he couldn’t actually tell the specialist what was going on. This is a real situation here. An intelligent person, with certain amount of medications, and he was having a real challenge doing that. I felt quite guilty, because.. some preparation for him, and help him with that side of things, but I couldn’t do that.

After we went for that consultation, we came back home. I said, “Look dad, let me help you with this situation. Let’s just look at all the medication that you currently own at the moment.” They said okay. I said, where do you keep it? He said, “Okay, I’ve got some here.” He’s got all his puffers,he’s got his tablets, all this other stuff. I said, “Let’s get all that stuff up.” I said “Okay, we got some there as well in the fridge.” I went to the fridge, searched all the medication. Let’s get all of it out. Then my mom came in. She said there’s medication upstairs as well, in the fridge up stairs. Oh, really?

I go upstairs and collect all those medications and bring it down. Here we’ve got this massive pile of medications. I look at all that stuff. I go, “Wow, there’s a lot of stuff” I went through the medication. The first thing I did. I just checked expiry dates. There was 52 medications in total, more puffers, creams, tablets, all that sort of stuff, accumulated over the years. 26 had already expired. Straight away, that’s half of it. He said, “No, I’d still use that.” I said it’s expired 4 years ago. You got to get rid of it immediately. Then I take the rest of the medicines, there’s 26 left. Out of 26, 13 were not for him anymore, not indicated for him anymore. Their even substituted with some other medication.

He was still mixing the stuff up. This is an intelligent man, who’s got a very good sense of size and knowledge in medication, but that is the real situation of someone who’s 66, 67, 68 in the management of medicines. A very real situation. What I did, I helped him develop a drug chart, and then that was something again that he could take to future consultants, and have a bit more systematic approach to his health. Why am I saying this? The reason is this. When I heard about the home medication review, and before we talked about in John Jackson. I thought, what a fantastic thing.

These are real opportunity for pharmacy can evolve in this area, because not everyone has got a son who’s a doctor, that will come to specialist consultation. That’s not the problem, this is a real world situation. I look at the fact that we’re capping things like home medication review, and things like that. I really don’t see the sense of it. I really see that this huge opportunity for us to, not just increase the funding, but also use it rationally. These are real problems in terms of the quality use of medicines.

We keep talking about access to new medicines, but a lot better ways they can use current medicines, so that patients get the benefit. Normally, as I mentioned, the needs of patients is not static. We’re taking a snapshot right now, and say that the cost of healthcare is this. Let’s just keep it was it is. The needs of patients are changing. We know patients want better service from the doctors. They tell us, “We don’t want better doctors. We want nice doctors.” They’ve said that in medical curriculum are changing.

Even our selection process has changed. They want access to different choice of therapies. $4 billion industry in this country, 30,000 professionals, they’re going that way. They want to prevent this stuff. They want the complementary medicines. They want more information, they are seeking more information. I think I mentioned Dr. Google yesterday. The world’s most famous medical practitioner, Dr. Google.

It’s not only that, what’s really interesting is that patients are actually going to another source of information that they rely very heavily on, and that’s Dr. Blogger. Healthcare bloggers are actually not just influencing the way the information gave about medicines, but also how they use their medicines. Patients actually go into a blogger, seeing what medications they take, and then decided on whether I’m going to continue that medicine or not, based on the information of a stranger that they’ve read about online.

You got to say to yourself, “Well this is absolutely ridiculous. How can I do that?” Why not they listen to me? Why listen to me, I’m the doctor. I’m the pharmacist. I’m the one who’s giving them advise. Why their changing the behavior. We’ve got to understand the relationship and the connection that patients have with that blogger. That blogger is going through a similar condition, a similar illness. The stories that they tell resonates with the patients that have this illness. Ultimately, people want that, you want that. That’s what you want. That’s what you want from your healthcare provider, and you’re not getting that.

It’s only when you don’t get that, you go to someone who’s a stranger online and get that information. This is a very real trend. We talked about patients wanting continued access to medicines, pharmacy. Then one thing, all the other stuff around exercise and nutrition to help them with their wellbeing as well. What are the current challenges? We’ve seen lots of graphs, charts, etcetera. I’ve intentionally taken out all my graphs and charts for the very reason that you have very intelligent people present you with enough numbers, and graphs, and charts. You know the facts.

The way I see it is this. Hear what the challenges are in the current healthcare system. Number 1, we still have a system that does not really give us equitable care. There’s still an inequity of access to healthcare in different parts of this country. That for me, universal healthcare system is still the biggest challenge. Delivery is fragmented. If you go to a hospital, you get cared in the hospital. You can then go to your GP, you get a certain level of care, you get a specialist. There’s still not that great sense of communication and coordination between different parts.

You’ve only experienced this. You got one doctor, one GP, you got to tell your story all over again. You go to another GP, you got to tell your story all over again. We still have a very fragmented healthcare system. I just want to ask a question there. How many people have filled out their eHealth record? Show up hands. Fantastic. Leaders of healthcare, and we haven’t filled out our eHealth record. Here’s the thing. We’ve got to walk the talk. You seriously have to, because it’s all well and good to come up and talk about how bad your government is treating us this day and the other. eHealth records are a very good thing. They absolutely help solve the problem around this fragmented delivery of care.

Enormous amount of efficiencies and a great opportunity for pharmacy as well. I filled out my eHealth record. I did because of… thing is a very good idea. Again, this is an area that patients need helping. They do need help to be reminded, fill out your eHealth record. Come into pharmacy and do it. We’ll help you do that. Huge opportunity to work together with initiative that government is doing, and solved a lot of the issues in healthcare

Rising cost, we talked about it. Don’t spend about $140 billion. Many different figures has been shown. I think this is the only number that I’m putting in this presentation. It’s one of the figure I’ve got with 9.4% of GVP. It seems to be the going rate in an OECD country or developed nation for good healthcare system. If you look at countries like the United States, it’s 17.7%. $3.7 trillion being spent on healthcare. It’s completely unsustainable. Whereas this, as we say, seems to be the going way.

The reason people aren’t going to tell you, and reason governments never going to tell you that things are going okay is this. They want you to continue to find efficiency. They want you to continue to change. They want you to continue to adapt. They want you to continue to improve, so you continue to deliver the best service that you can to patients. While they’re looking for that reassurance, and it’s fantastic that community pharmacy aggrievance exist that 5 year of assurance. I don’t think that’s actually going to happen.

In my timing, 10 years ago or 7 years ago when I first joined the pharmaceutical industry, we were still stalking about finding certainty. Now, I come back and hear what’s going on, we’re still looking for certainty. You’re not going to get it. The best thing you can do is innovate, and adapt, and create your own business models..Aging population, we talked about the aging population, chronic disease and services, people like my dad. I’m putting a burden on the healthcare system, but with that, we’re actually are victims of our own success.

Let me explain what I mean. Cancer used to be a terminal disease. We had cancer, and many different types of cancer used to die very quickly. It’s now become a chronic disease, because of medications that we provide, we help people stay alive for much longer, and live a better quality of life. As such, in many different conditions, we now have a growing proportion of people with chronic disease. That puts a different kind of burden on the healthcare system.

A very big issues in our healthcare system is the inefficient allocation of resources. We are allocating resources … I’d say we spend on certain amount on state, we spend a certain amount on federal government spent. Again, we don’t have that coordination across the 2. We work in silos. Talking about the PBS, as good as it might be, is stuck in a silo. That’s the reason I decided to bringing up a big picture today, because I’m really very passionate about working across the silos and getting better efficiency across the silos of healthcare. We do have the power to do that.

The other thing that we focus on is very short-term measures. Again, whether some of the other people have talked about . When we’re looking at the healthcare the moment, we’re looking at cost, we’re not looking at value. We’re not looking at overall health outcomes. Can someone tell me what is a good health outcome for Australian Healthcare, what’s our target? What’s the goal of Australian healthcare for the next 5 years? I don’t know one. I don’t think any of you do. If we don’t have a goal, how are we going to get there? If we don’t have a goal for health outcomes in this country, how are going to get there?

That really is a big question. We have a goal for cost, but we don’t have a goal for return on investment, every other organization does. We need a vision, and we need strategy, we need goals. We can work towards them. Every stakeholder have talked to cluster healthcare ecosystem wants to work with better healthcare ecosystem, but we don’t know what the goal is. We focus on very short-term measures. They’re not real world measures. We look at hospital waiting times, for example. When I heard about the hospital waiting time issues, where people wait too long for healthcare services in this country.

What do we do? When you go to emergency,no more long hospital waiting times, now it’s going to be 4 hours max. You’re not going to wait longer than 4 hours in a hospital emergency waiting room. What happens? I know because I’ve talked to emergency doctors. Here’s what happens. Patients come in, within 4 hours, we get you into the emergency department. This time we’re not going to treat you. Before you we actually try to treat … The staff won’t treat you, we’ll just ship you off within 4 hours onto another ward, like a short-stay ward, or something else.

We’re really passing on to fix this short-term measure that we’ve implemented within the system. We really need to be looking at long-term outcomes in the PBS, we have to look at those outcomes, and in other areas of healthcare as well. If we keep training like this, we get some political wins, but we’re actually not getting any real wins in the healthcare system. Then we’ve got a system that’s really focused on disease rather than prevention, and really not looking at rook cause. A lot of people coming with stress.

A doctor, unfortunately, only has a certain amount of time to deal with stress. We’re not really getting to the root cause of it. We know that stress then goes on to cause cardiovascular disease. There’s implications and other sort of diseases as well. We’ve got a system that’s really focusing when people are sick. We’ve got a sick care system. What we need to have is a well care system, address people when people are sick, but also when they’re well. Why is this important? Look at how you manage your car at the moment.

You look at your car engine. Do always fix your car when it has a problem, or do you also take it for regular servicing to prevent it from having the problem? Similar when you to your dentist. Your dentist recommends you got to a dentist every 6 months to prevent any serious issues from happening. That will prevent any serious issues. Whereas in our system, we’re actually fixing the problem after the problem has already occurred, rather than trying to prevent problem. We really need to shift the focus of the system away from just disease alone, but more to the wellbeing and preventive side.

Albert Einstein have said, “Problems cannot be solved by the same level of thinking that created it.” The journey that we’ve got to so far has come from a way of thinking, a way that we’ve thought about our healthcare system. For us to move forward, to advance the healthcare system, we need a completely different way of thinking. Einstein used the word consciousness. In healthcare it would be health consciousness. We need a different way of thinking about our healthcare in order for us to move forward.

What is innovation all about? People get confused about innovation. The thing is, innovation is the next smart phone. It’s not necessarily a new smart phone. Innovation is that … I’ll keep the definition very simple. It’s something that’s new, is different, involves change or a form, and it creates value. You actually get improve health outcomes. You ought to get reduced mobility, reduced mortality, you reduce cost, or you generate revenue if you’re a for profit organization. Who do we doing innovation for? The stakeholders, either patients, or consumers, service providers, or the healthcare users.

At anyways you can involve anything, you can involve services, you can involve products. Often we talk about innovation, we talk about the next thing block buster drug, not necessarily the case. Particularly now that we’re not getting as many as blockbuster drugs that we need to innovate and how we got those drugs paid for but he ecosystem. While processes policies structured in business models.

Here’s a real thing about when we innovate, when we do something different. We tend to forget this side of things. When we innovate, there’s a lot of confusion, that can be anger, that can frustration, because there’s a big change that we’re not used to. We’re going out of our comfort zone. Instead you want to see the tone, and listen to the tone of all the speakers at this conference and a lot of people in healthcare, we see that. We see a little bit of anger, we see some frustration, we see a lot of these things happening amongst the medical practitioners, amongst industry, and so and so forth.

In this state leadership, and very often when you make some very big decisions. Typically, like in US, if I’m going universal healthcare, a lot of mistakes can happen. That happens with innovations, get used to it. What we said is best practice before is no longer best practice in the future. You can just imagine, what you’re currently doing is best practice, and you know for years, and years, and years, this is the best way to do it. Then someone comes along and says to you, “Hey, actually what you’re doing right now is wrong. There’s a better way to do it.” How do you feel about it? That’s the challenge a lot of you are going through right now in the healthcare system.

Ultimately what we’re looking for is a win-win. The win for the industry, win for practitioners, and win for patients. We’ve got to hold that as a guiding principle. Sometimes it’s a win-lose-win. One industry wins, patients win, but one part of the industry loses. That’s the reality of how it’s working today. Ultimately, I only considered the patient needs, everything else then comes out to evolution. What are some of the potential solution going forward? What are some of the things that you can take away, and use it in your organizations? I’m pretty much trained to go out on a limb here, and say here’s what we see as some of the future trends that are happening in the healthcare industry across the western world. He want to adopt some of these things, and think about how these might relate to the organization by all means.

First things is, first look within. If you’re now looking for a solution to some of the challenges you’re having, payment models. How do convince government better? How do we look at faster registration processes? The first thing I’d say is first look within. Very often, and studies have shown that the best ideas often come from our own customers. That’s one potential solution. Our suppliers, so people within the value chain. The shareholders within our organization as well as our employees.

Here’s a very strong source of ideas for solution. What is it I’m going to see happening? We’re going to see a huge expansion of integrated care models. I talked about a bit eHealth system. Any system that’s going to allow greater coordination of access between hospitals patients. This might be pharmaceutical companies. It might be medical practitioners as well. We’re going to see an expansion there. Government’s investing in that. They’re going to invest more in that space. We’re going to look at how specialist can get access to patients in the community. We’re going to look at how GPs can get that access to patients, and so on and so forth.

Integrated care is definitely going to be the way forward. We’re also going to see greater localized community care. We’ve already heard and think about how Medicare locals may not be around much longer. I think that probably will be true. I see a great amount of merit in having very localize systems of provisioned, of care that cater to local communities. You might have seen an area where higher levels of aboriginal population, then they had different sorts of needs, to areas in Eastern suburbs of Sydney.

When we have localized care, we have better quality of care. However, having said that, government have said they’re going to change the structure around how they deliver it. The great opportunity here is that, here’s a place that pharmacy can interact with, here’s a place where we can interact within healthcare systems better with community. I think the idea or the principle of a localized unicare system is the definitely the way we want to go. We want to push more services out of busy hospitals and more into the community, absolutely.

We’re going to see a lot of workforce innovation. If we look at the running cost of hospital’s about $25 billion, while 70% of that is starting cost. We’re really going to see how we can change staffing cost within the healthcare system, so we got to see a few things. Devolution, we talked about. The federal government, moving responsibilities away from fed government over to state government. That’s to remove duplication, and so state government have more flexibility. I believe that’s going to help it.

The other thing we’ve got to see is delegation. If you don’t get force delegation, I suggest you look at delegation. That is moving roles from the highly paid workers to lower paid workers. You might have specialist that… institute talk about moving endoscopies from specialist getting paid $250,000 to nurse practitioners that are paid about $60-70,00. That is a reality that could happen. I think really we are going to look at moving the workforce away from busy general practices or into pharmacies, such as task like vaccination for example, preventive health checks. I think a lot of that can be moved away from the more higher paid areas into the more lower paid areas within those efficiencies.

Outsourcing can be very controversial when you talk about government jobs, but absolutely necessary. What do I mean by outsourcing? There’s almost selling work over agencies or sending it over overseas, where you get lower cost and efficiencies. Is that even possible? Absolutely. Already happening now. A lot of your x-rays, when you go to a private sector are being outsourced and being read by specialist in India that cost maybe 20%-30% if what specialist would it for here. They’re even being done after hours, so you get greater access there.

These processes of an outsourcing are actually being done. If we live in a globalized world, which we do, you really want to be looking at how you can do that, particularly for your back end processes, such as accounting, IT , etcetera, a lot of ways of which you can do that in the organization. I’m really keen to see, and I think we will see greater concept to collaboration. We do a lot of work in the pharmaceutical industry, or in clinical research still. We do a lot of work around advocacy. We do a lot of work within the community. Same with health insurance, same pharmacy, that even pharmacy reserves $10 million in research funding.

I think the precious of a tightened healthcare budget is actually going to force us to look outside, and look in other sub-sectors of healthcare economies of scale. That’s really going to happen. I think it’s going to be a very strong thing. I think it’s going to be very positive thing, because we’re going to have much better ideas working with other sub-sectors of healthcare. I don’t think we do it enough at the moment. I think there’s real opportunities for health insurance companies, pharmaceutical companies, pharmacy, and other stakeholders work outside of each other to gain those efficiencies. I think that’s going to be a real thing, we’re going to see more of that.

I think the titling of budgets in this space is a good thing, because it’s actually going force for this to happen. How many of you are on Facebook? Show of hands? How many people are on LinkedIn? Great, okay. We’ve got a handful of percentage of people that are on social media platforms. It’s not just social media platforms, it’s just the whole digital revolution. Healthcare is particularly bad at utilizing the digital technology. We keep talking about how we don’t have enough funds to do a lot of these things, marketing space. A lot of this stuff is of a tiny fraction of what we’re standing on right now. We just haven’t been forced to look that way.

There’s a great degree of adoption. There’s a great degree of adoption by professionals in phase. We’re not using these platforms as well as we can be. Absolutely not. There’s a lot of opportunity for your organization, to do your current jobs, and do what is needed. Patient sector engagement, they look for healthcare information here, and they’re not getting enough from credible sources like you guys. There’s a lot of opportunity to spend more time investing in how to use this more effectively.

The other key thing about social media platforms is that we know that public health education works. The biggest healthcare challenge in this country, obesity related conditions, alcohol related conditions, and smoking related conditions. Costs are about $70 billion, those three things alone. They’re all behavioral in way, if you look at the essence of what they are. We know how public information works, or we looked at things like melanoma skin cancer. The rates have dropped by 10%. The Slip Slop Slap has all been working over the last 10 years or so. Again, here’s this huge opportunity, use this platforms now and adapt for the future.

We looked at personalized health information technology as well. People want to get more personalized with their healthcare. We’re seeing a lot more wearable tech. These things are like wristbands. How many people heard of the Fuel Wristband by Nike? It measure the amount of steps that you take. It get very effective, can be used for conditions like obesity. Apps that we can have on our smart phones measure food calorie intake, etcetera. A lot of these things are really coming to the full.

We talked about personalized medicines. I won’t cover that anymore, because personalized medicines really talk about genetics and how we can target some genes that predispose as certain diseases in order to influence health and wellbeing. We don’t talk so much about personalized health. What do I mean by personalized health? Where technology starting to come out and we’re inviting some companies in the states around the area of personalized health. Then these technologies that actually going to look at epigenetics.

Epigenetic is how the environment is currently affecting your healthcare. What do I mean by environment? That sis the food that you eat, the light exposure that you get, the people that you’re around, the amount of stress that you have, and how much you, as an individual, can actually experience before you produce disease. That comes from measuring things like arm length, leg length. The don’t even have to do your DNA sample anymore. They can just take a bit of a history, look at your cultural origin, and measure some things about you, before coming to personalize heath. This is what we’re going to see moving forward.

I’ll run through it rest of it.. We’re going to see more on the space of integrated I’ve talked a bit about that, traditional Chinese medicine are better. Countries like India, and China, and 2 billion people can’t be wrong. There could be something in it. The reason is, particularly in western countries have all these data in English. We discount the fact that they actually work. We really need to look at that. Again, do a multi practitioner consultations. The system really needs to adjust so that you can see your doctor, your pharmacist all at the same time, and get reimbursed for it as well.

We talked about pricing and value of healthcare. They key important here is how do we measure success? If we don’t have a goal, how do we know which way we’re going? We talked about innovative payment models. I do have an opinion on this about free healthcare systems, and that comes from really talking to a lot of doctors. When I say to them, “who are your best patients?” They said private patients. I said why. “Because they’re paying for the service”

When we think about end game, what the end game here? The end game for us is we want to help people get the best healthcare and value your own healthcare. They get that, and they feel like that. We know a lot of psychology comes from that when they pay for something. I’m not saying everybody should pay. People who can’t afford, they shouldn’t pay. We should have those protection they just in place. I don’t think that paying a little bit for your healthcare is necessarily a bad thing.

We talked about leadership thinking for the future. I think we all got to change the way we think, particularly in leaders. We’re all leaders in this room. I really do think we’ve got to stop looking at it from a patch protection way. How can I protect may patch more? Look at the best patient outcomes, and how can it work with other sectors of healthcare to deliver those outcome. I think that’s the big thing. Very important, the soft stuff and relationships to a degree would lost the trust. Some sectors of healthcare have lost the trust of public.

I think that relationship with the public really needs to be restored. Great transparency is required. One of the reasons we’re recording tonight is so we could put it out there and just have that conversation with people about what we discussed in these rooms, so people are actually aware of what’s going on. I think the public needs to know what we do in these sectors of industry. They don’t know enough. They’re not educated enough in this space. Particularly, we need to rebuild that culture of trust.

It sounds like a soft thing. Trust, a bit airy-fairy, it’s a big kumbaya, but we know the economics of trust is this. When you have greater trust in the system, you increase fee and you reduced cost. When you have 2 parties doing business together, transacting together, and there’s a high degree of trust, that transaction appears much faster, and the cost of that transaction also is reduced. There’s a lot of things that you can do to improve trust. I suggest you read a book by Stephen Covey, called the Speed of Trust. It’s a very good powerful book. It’s a global best-seller. It really talks about active things that you can just increase trust in the organization.

Finally, I’ll just cut short on the future solutions for Australian healthcare. We’re involved in developing a whitepaper for all the future solutions for Australian healthcare which interviews 20 of the top leaders, CEO of Australian healthcare. We expect that this can be launched at the future of Medicare Summit in August. In order to get updates for that, all you have to do is just go to this website, and subscribe to that to get an update for when the paper will be released.

Currently we’ve got Professor Ian Frazer, these are people who have committed. Professor Ian Frazer, Professor Stephen Leeder, Dr. Martin Cross, Chairman, Medicines Australia, a few pharmaceutical CEOs, a couple of health insurance. Mr. George Savvides, John Bronger form the pharmaceutical society, Dwayne Crombie from Medibank BUPA, and also for not for profit. And we’re continuing to get that data. That’s really going to give us, one-on-one interviews with all these leaders who said to us “Here’s what we think needs to happen moving forward.”

That’s pretty much it from me. I just want to need some of the contact details if you want to get in touch. If you’d like to find out exactly when is white paper comes, just send and sms with your email address to that number and you we’ll let you know when that happens. That’s pretty much it for me. I hope that was useful for you. I hope that you were able to take just 1 or 2 things that you’d be able to implement in your organization tomorrow. Thank you.



About the Author: Dr Avnesh Ratnanesan

Dr Avi is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organisations and governments.