My name is Avi Ratnanesan. I run a company called Energesse. Energesse is really a healthcare consultancy firm, we really help companies solve strategic and operational problems, usually using a bit of out of box thinking, so more innovative thinking in the way we solve problems.

We’ve got team in the U.S. and the UK as well. One of the things we do is we try and bring practice across the different markets to solve some of the challenges for healthcare organizations. My background personally, I used to be a clinical doctor.  I used to work in the UK and in Australia in clinical medicine, I got into the biotech and pharmaceutical industry. I was working on a lot of the things that John Mattick was talking about, or pharmacogenomics strategy, how to develop drugs to target certain genes. Before I move more into the business side and the business strategy.

Pfizer is a billion dollar company and we are really looking, also to look at where the future of the industry look like and do we penetrate those markets before we go into the consulting side. The aim most today really is to give you one or two tips of pointers that you can use in your organization pretty much tomorrow, in terms of how to solve the challenges that you’re currently facing.

Being a strategist, we’ll start by looking at the big picture of the Australian healthcare Eco-System as I call it. Starting big picture will then we’ll then drill that down into what are some of the major challenges that occur in this healthcare Eco-System.

We’ll drill it down a bit more into what are the challenges for the health industry. A lot of them have already been mentioned, but what I like to do here is just make sure you understand the logic as to why these challenges are currently occurring and why it’s coming from the health system that we currently face.

We’ll then look into what the future trends are in the industry and what is Solution Opportunities. Then finally I’ll talk about a white paper that we’re working on, we’ve interviewed 20 of Australia’s leading healthcare experts and the solutions that they see for the future of healthcare.

What is the healthcare Eco-System?

One of the big challenges that we have in healthcare in Australia and in a lot of modern economies is that, when we think about our members or our patients or our consumers, we really look at it from the lens of our own organization. We tend to forget all the other different elements of healthcare that are currently influencing that member.

If we look at the healthcare Eco-System here, you’ve got federal government, and federal government, and this Eco-System spends about 140 billion dollars a year in this country. Federal government spends about 45% of that through Medicare and PBS, the pharmaceutical benefit scheme.

When you think about that, that’s already a silos structure. We’re already incentivising you, funding you and paying you based on what exist within a Medicare structure and what exist within a pharmaceutical PBS structure and never the two shall meet. Then we’ve got state governments and public hospitals and with state government, this is the fastest growing area of the budget.

When we talk about the growth rates and healthcare spending, this is the fast growing area, this is the problem area. You’ve got not for profits, health insurance, work cover we tend to forget also covers a lot of healthcare or sick care as we call it.

Consumers also spend their own money on exercise personal training and all these things which have a great degree of influence on behavior change, which is really the holy grail of healthcare, behavior change.

Nutrition, a huge part of that. Aged care, research and academia, we heard from Professor John Mattick today. He plays a very big role in advancing healthcare. We’ve got the doctors, over 70,000 doctors in this country. Pharmacists over 6000 pharmacists in this country. Allied health, 120,000 allied health workers in Australia. Traditional medicine. We forget, it’s a 4 billion dollar industry in this country, traditional medicine or alternative health. Then you’ve got your over-the-counter pills, your medical devices and diagnostics, I know we’ve got Medtronic here, a couple of other companies. You’ve got the pharmaceutical industry and then you’ve got the private sector.

In the center of all these is your patient, your consumer, your member. These are all the influencers that currently affect that patient or member. One other things we forget to realize is that this Eco-System is actually interdependent.

Every change you make, whether it’s in the health insurance industry, in the pharmaceutical, whether you change the type of treatment that you’re giving, that has a flow and effect to other sectors of the industry. Why is this important?

When you implement projects in your area, one of the things that we forget to look at is how that affects all the other players in the area. For example, if health insurance were to partner up with primary care networks, that will then influence consumption of the consumer or healthcare, that will then influence the amount of usage particularly of its private care, the usage in private care.

Also they will drive up usage of pharmaceuticals and other treatment options. Every reaction, every single action taken by one part of the Eco-System affects another and that’s something you got to think about when looking at stakeholder management. I’ll talk about the impacts of these in a second on cost. Sorry, and the other point is that they drives up increase usage of allied health as well.

In looking at that, we then start to talk about it, we’ve talked a lot about these the last couple of days. The major challenge is all about the cost being unsustainable.

Well, have we really asked ourselves “What is sustainable?” Does anyone have a clear goal here as to what is the number that we actually want to achieve in terms of healthcare? We are leaders of healthcare. This is a big problem.

We know we spent a 140 billion, it’s about 9.1% of GDP, but the outcome goes are unclear. It’s not very aspiring if we’re talking about a healthcare system that’s really, our goal is really save money. That’s not what people resonate with.

If we look at this and we’ve talked about this already, in terms of what we’re paying for healthcare when we compare it to other modern economies, we sit somewhere in the middle. This is a graph of all the countries in OECD or developed economies. We sit somewhere in the middle. We’re not, actually compared to other countries spending a hell of a lot. We’re spending about, we’re paying about the right price for our healthcare system.

When you look at healthcare outcomes, I only think of two things when I look at healthcare outcomes, there’s two big things. Are we living longer? Are we living better. It’s life expectancy and quality of life, quite simply.

If you look at life expectancy, we’re one of the highest countries in the world. Men live about 80 years here and women 84 years on average. A lot of this is driven by the healthcare system. In that sense you’d say, “Okay, we really have a crisis.” We talked about this the other day, we actually a very good healthcare system. What’s the problem? What’s everyone winging about?

The reason is that when you project out the cost of healthcare as a percentage of GDP, and now we spend about 4% of our healthcare cost comes out of GDP. When we project that out, in this treasury projects into 2050, that’s looking up to 7% Why people say this is unsustainable is because of the rate of growth is going to take a lot away from the nation’s economy. We got to stop the rate of growth.

Currently, we’re okay. As it goes up over the next few years, that rate of growth is the concern. Currently, we’re okay. As it goes up over the next few year, that rate of growth is the concern. Now what’s driving that rate of growth? A lot of people keep talking about the aging population, the aging population, the aging population is driving up consumption. That’s not actually true right now.

What’s actually driving up consumption of healthcare services, is the fact that, if you have a disease right now, you have multiple treatment options, you have multiple procedures, you have many different doctors and specialist that you can visit. Right now, consumption is higher because diseases have been sub-segmented to even niche diseases. You might have a biomarker that you have to get tested for.

For the things that you already have, consumption is very high. If you think about it for a second, over the next 10 years, 20 years, that’s just going to become more and more, even without an ageing population.

If our population did not age, we will increase consumption anyway. This graph here just shows you the effects of that growth rate and how much population aging actually affects and how much is actually driven by increased consumption of services, drugs, therapy, procedures, et cetera and that’s just going to become more and more.

I just wanted to make that distinction so you just don’t get confused when you implement your projects around the reason why you’re doing this projects in terms of cost savings. What are the challenges? Now, ageing population is challenge over the long term. Why is that a challenge?

I did mentioned earlier, hospitalizations is the highest rate of growth. The problem with ageing population is that there is a increase number of hospitalizations, it’s already high now, it will get much higher. When we look at chronic disease, stroke, cancers, COPD, mental health, depression, the hospitalization is really the main driver of cost.

What else is the problem with the healthcare system?

The big principle in this country is that we want an equitable healthcare system, which means we want a fair go for everyone. Right now is it equitable? In urban areas we get very good healthcare, this is excellent healthcare, compared to the U.S., compared to the UK, we get great healthcare here. The problem is, populations like the indigenous populations get very poor healthcare relative to what we’re getting. There is that fragmentation issue where it’s really uncoordinated in this country compared to other countries. You go to one doctor and you go to another doctor, it might even be in the same practice and sometimes those records are difficult to access.

If you changed doctors, getting your medical records from one doctor to another in a different state is virtually impossible, it’s very difficult. Then when you start talking about discharge summaries, so if you went into a hospital, the discharge summaries here don’t necessarily always go back to your doctor.

Doctor are sitting there asking patients what happened to you in the hospital, expecting the patient to know exactly what procedures they went through. This is a huge problem in terms of coordination.

That then results in inefficient resource allocation, because we are all working in silos, we got private hospitals, we got public hospitals, we got general practice, we’re having to duplicate lots of test, we’re having to duplicate medical reports. It’s a very inefficient resource allocation.

There’s very few partnerships, true partnerships that really occur across networks. We have this culture that is, I have to say, slightly territorial as I would say, because we all got this patch protection going on.

I will give a bit of warning here that some of the things I will say are a little bit provocative, but they’re really some of the things that, I speak to a lot of CEO’s in healthcare and these are the things that they are thinking. The system is also driven by short term activity. We’re really driven by activity measures.

If you think about what goes on in the media when they complain about the healthcare system. What do they complain about? Almost often it’s waiting times in emergency, it could be waiting times for elective procedures. We’re really talking about activity, what are we driving towards? We’re really driving to towards making sure that churn is much faster than it used to be. Is that really the best thing that we should be asking for from our healthcare system?

I’ll tell you a story. A friend of mine works in emergency medicine in an emergency medicine department and in that area they’re driving towards four hour waiting times maximum in emergency. We talk about four hour waiting times. I use to work in emergency medicine, a lot of patients can’t be treated in four hours in terms of the emergency and so what do they do?

They create another ward that becomes an interim ward where people just come into emergency, you don’t really treat them and you just pass them onto another ward where it’s not recorded as emergency and then shipped them off to a different hospital. That’s what they do to beat the system.

The reality is, when you try and drive this sort of activity measures, you really don’t get the best health outcomes for the patient and really we need to look at that very seriously. Another part about the health system when we look about this cause and Dr. Ann Carruthers has mentioned it as well. Your health outcomes often influence outside of the healthcare system.

When we talk about smoking and smoking bans, those were the things that really drove smoking rates down significantly. A lot of our healthcare is driven by the Department of Agriculture in terms of nutrition, the Department of Transport in terms of the stress levels that we experience.

All of these other departments, the departments that really affect a lot of public health issues but not in the healthcare system. That’s something to be aware when we implement projects in healthcare. When we do things in healthcare and particularly with health insurance you always trying to create products for consumers.

The challenge is that you’re trying to create products for consumers today. The reality is that consumers’ expectations are changing. By the time you get your new product out there, they would have changed their mind. If you look at Apple and the way they create products, they create products for what consumers want in five years’ time.

We tend to create products based on the market research we’ve just obtained. That’s the challenge. Consumers want better relationship with the doctors, they want more options in their healthcare, they want to use vitamins and things like that even when they don’t work. They want to see Dr. Google. Most of the time, the patients already gone through Dr. Google and Dr. Google is the world’s most famous medical practitioner. Let’s admit that. We’ve got to know how to work with Dr. Google and how to get credible information up there online. They want the latest pharmaceutical treatment. As we know, we talked about this and John Mattick talked about this as well. Pharmaceutical treatments for niche diseases are credibly expensive, up to tens of thousands of dollars per dose. The reason for that is because they have to, the cost of developing a drug is over a billion dollars, but you got to make back that cost in a various niche population of people.

These patients want that because they can find out about these drugs online. They want to use their wearable technology and this has becoming a consumer driven revolution, rather than a health system driven revolution. Consumers are the one that are using this, not our healthcare system, and then they want to do things like exercise and wellness programs. What does that mean for health insurance, and I’ll skim through this very quickly because we’ve heard about this a lot.

There’s a rising cost of claims because of the increase utilization but, we’ve got our funding models are still stuck on that traditional funding models which is let’s increase the number of members. It’s a volume game. We got to find new ways of obtaining more funding into the healthcare system.

We want to manage those health pathways, those healthcare pathways don’t, we want to influence primary care, we’ve talked about it. Every single health insurance company here is going to go away and find out how to penetrate primary care. We still got those regulatory restrictions.

We still want to look at how we can influence the entire health pathway for the best outcomes. There is that information asymmetry as we talked about. What does that actually mean? Some doctors think that some procedures are better than other procedures. How does that translate to the health insurance industry?

Some of you are having to pay lots of money for lots of procedures in certain geographies, where it’s very little in other geographies. Why is that? It’s because the surgeons, the doctors et cetera are getting a certain kind of information in that area, saying that this is the best procedure and others are going in another area are saying that is the best procedure.

One thing I learned about this whole Eco-System working across many different industries, is that everyone really believes they’re doing the right thing for the patient. I know that’s hard to buy, when you talk to the pharmaceutical industry, doctors, nurses, health insurance, everyone really believes they’re doing the right thing for the patient.

When you get into that issue of trying to argue with other sectors of healthcare and you’re wondering why they don’t agree with you. Let me tell you this, they’re really believe they are doing the right thing. If you want to win that argument, you got to show how you’re trying to do the right thing as well.

The other thing is, if health insurance want to influence clinical protocols, there is that moral barrier. The AMA president talked about this the last couple of days, we shouldn’t interfere with the doctor patient relationship. The reality is health system is becoming more, we’re becoming more resource conscious in the healthcare system.

I’ve trained in the UK, I worked in the UK. The mentality of doctors over there certainly is around, if I give this patient some treatment, how many patients am I actually taking care away from? There is that mentality of I’m trading off the individual versus society. Whereas here, that mentality isn’t quite there.

The other challenge that we have in the health insurance industry is the consumer disempowerment. What do I mean by that? In other industries and in another products, consumers get to choose they type of care that they want.

The problem with the healthcare industry is, if you go to a GP you can’t actually choose a GP all of the time. You might choose your practice but you might not get the GP that you want and particularly when you’re choosing a specialist, you really have no idea what you’re buying. The other point about this is you’re not actually buying because you’re not paying for the services.

In a sense, you’re almost bit of a victim in terms of the services that are provided to you and therefore that means you can’t actually influence it and it also means you don’t really care about your health that much because you’re pretty disempowered.

This is one of the challenges in this system. If you want to change my behavior, I’m a very complex human being and so are you. There’s multiple factors involve if you want to change my behavior to become healthy.

I talked a bit about this, is that protectionism and let’s face it, there is a lack of trust between different silos in healthcare and that is the fundamental issue behind why negotiations, cooperation and collaborations are very difficult to implement in the system.

It was Einstein that said, “Problems cannot be solved by the same level of thinking that created them.” It was our level of thinking that brought us here now, in order to change and develop solutions, we really have to change the way we think.

What are some of the future trends and some of the solution opportunities for the health insurance industry?

This is quite a big picture sort of representation of what the solutions are but if you want to talk specifics, I’m happy to chat about it further and some of the speakers in the last two days already talked about specific solutions.

But here’s how I see them. One of the ways is, the government had already said, “We’re going to cap the amount of money that’s going to come into the system, we’re not going to allow it to grow.” If we need to increase healthcare and we need more funding, we need to find new innovative models to funding.

We know that consumers pay about 20% of out of pocket cost, so in this country, consumers pay quite a lot from their pockets for healthcare. There’s other ways to bring money in going to the market, maybe banks are going to be privatized, other companies could still opt to do that and you could also spin off companies to bring more money in through shareholders. Another way to look at it is through wealth management.

Currently, we all pay super annuation and we all spend a lot of money on super annuation and we’re only allowed to take it out when we’re 60, 65. This is a big area where we invest a lot of funds very early on in our life. Some people even use these funds to buy property, boats, all sorts of things with self managed superfunds.

Why can’t we use the funds from here for our own health? You can certainly see there’s lots of synergies between private health insurance and superannuation and I certainly see that as an area that’s going to be explored further over the next five years. The other issue that we have as I mentioned is around the short term activity measures.

We’re now incentivizing hospitals, GP’s on seeing high volume. It’s not so much about the quality of care, it’s get them through quickly when it comes to financial incentive. Obviously doctors want to care for patients as best as possible, but they’re often given these targets to achieve. In the UK it’s quite different. They really look at long term health outcomes. I’ll recite two stories.

One I spoke to a CEO of a hospital network in this country. He said to me “Avi, my job is to try to get through as many patients as possible in this hospital. I really have no incentive to try and improve the long term health outcomes of the community, because it’s all about churn. In fact the most sick people the come through my hospital, the more we get paid. That’s just reality of the system.” The other converse is that I spoke to a CEO of a hospital network overseas and I won’t mention the country but over there he said “I was given a fund, a capped fund where I was in charge of an entire region for 15 years. I had to spend that money across 15 years, but I was given the hospitals, primary care, the occupational therapists, the physios.” Every single area of the healthcare system was under his control. Guess what he did? “I spent every dollar possible on prevention. My focus was entirely on prevention because I had to prevent people coming into those hospitals, because that’s where the big cost is.”

Based on the current incentive structure, it’s hard to imagine that although prevention sounds sexy, it sounds trendy, it’s the thing that we all want to do. It’s hard to imagine that we really can make that change without going into a more population health management approach where we really focus on the outcomes and long term outcomes.

It’s incredibly hard to imagine that happening when we’re changing hospital budgets every 12 months as well. You really need that certainty of funding in order to put strategic plans in place in three years, five years at least. The other thing around that certainty of funding is tying it with the incentives and tying it with integrated care, integrating it with other sectors of the community.

The pharmaceutical industry is probably the most advance in our health system around cost effectiveness. The reason is this, every drug that gets listed in this country, has to go through rigorous cost-effectiveness analysis. What does that mean? It’s tested for safety, how effective it is, but also the cost of that drug versus existing therapies.

Before you introduce a new treatment, a new drug in this country, you’ve got to compare the cost versus other drugs that already exist on the market. This does not exist for surgeries, this does not exist for medical devices, this does not exist for most of the rest of the healthcare system.

As we become a more cost constraint system, we’re going to start to see a lot of this happening. Looking at cost-effectiveness of treatments. Not just safety and efficacy in quality but how costly are these treatments. We’re going start to look at risk share agreements.

I have to congratulate Cooper for doing the deal with House Corp. and looking at Never Events but we all know that outcome is really what we’re looking for. Risk share agreements means I won’t pay you unless you achieve those outcomes.

As an industry this is a huge opportunity for the health insurance industry to drive some of those negotiations. However, if you do drive those negotiations, what I would urge is not to ask them for cost savings but rather to work with those organizations and say, “What’s your big goal? How are you trying to improve your strategic objectives? Where do you want to go in five years and how can we partner with you in five years to achieve that? For the benefit of the patients. All too often, the argument comes from a cost perspective, where you really need to start the higher level and how do we partner as a joint strategic objective?

Which leads me to the next point which is leveraging partnerships. There’s this big trend now as we heard in the last couple of days that health insurance wants to enter primary care.

This is an area, and these group of companies know primary care very well, they’ve been working in that space for a long time, those are the pharmaceutical industry that I use to work. When I look at a lot of disease management programs that health insurance industry is trying to introduce.

These programs are being run by companies like these and spending literally billions of dollars. There’s huge opportunity to not duplicate but partner up on that. Same with medical devices as well as partnerships with pharmacies.

Pharmacies are incredibly underutilized in terms of their, the ability to connect with patients. In a lot of cases pharmacies have a lot more time to connect with patients than doctors do. There’s a lot of prevention work that pharmacies are open to doing and want to do with patients

There’s a big opportunity in terms of in the challenge that I talked about is that information asymmetry, where doctors in different parts of this country are getting different information as to what is the best treatment. A way to fix that is to facilitate that practice sharing. I’m actually encouraging those forums where the top doctors interact with each other, I really support the fact that you need to work with colleges around this but I think the health insurance industry can do a lot more in terms of working with the colleges because there really is a need to facilitate this best practice sharing, not just across specialist but GP’s as well.

This is a book that I highly encourage everyone to read. It’s called The Speed of Trust and someone mentioned Stephen Covey earlier. This book is by Stephen M.R. Covey, his son. In fact there’s four generations of Stephen Covey’s, they just have different middle names. The real big thing about this book in The Speed of Trust is that it really gets down to the core of the issue here. Why is the relationship between the different silos, private healthcare, pharmaceuticals, medical advice is combative, it’s because there is a lack of trust. This book actually tells you, it gives you 13 trust behaviors that as a corporation you can introduce in your organization. Stephen and I are actually working on writing a book together along with several other healthcare experts around how we change global healthcare systems, what sort of behaviors organizations need to implement in global healthcare to move things forward.Definitely a book I highly recommend.

We talked about the empowering consumers. I talked about consumer disempowerment, there are several areas in which consumers are disempowerment. One is “How do I choose my practitioner?” I have to applaud NIB for this white code initiative, it’s a great model. There are other crowdsourcing type initiatives to helping healthcare.

Another interesting one CrowdMed.com. How many people have heard of CrowdMed. No. Fantastic. This is truly cutting edge. Launch in the last few months. CrowdMed really looks at patients who have not a proper diagnosis for the illness.

I’ve been going years and years and years through medical system. Have still not been able to diagnose and they put their case up online. Medical detectives, many of which are from the medical profession, actually can offer advice on what that diagnosis is along with evidence for why that diagnosis is likely.

The medical detectives which are the doctors and experts in healthcare also get rated by the community as to how good the diagnosis is. The patient then takes that all those recommendations and then discusses it with their own doctor to see …

A lot of patients that have had diagnosis that haven’t been solve, are now getting solutions through CrowdMed. This is all about the trend of empowering the community and giving them power back in the health decisions. Another really interesting program which is here in Australia is in life insurance.

We talked about prevention and the reason I really like the AIA Vitality program is I feel it is one of the more advance wellness programs of prevention programs out there. Why do I say that? This is a study, the parent company that developed this program Discovery Health base in South Africa did a study with Harvard with 900,000 people enrolled in this program.

What they found, because this is real evidence. What they found was that people who engage with this wellness program actually had lower cost per patient as well as lower admission rates. That is for condition such as cancer, cardiovascular disease, endocrine and metabolic disease and musculoskeletal disease, so a lot of the chronic conditions.

This program has already running in Australia, I find it very interesting, and why I find it interesting is because, they’re incentivized , so behaviors are incentivized in a much cleverer way than I see a lot of other programs. If you eat the right food, if you purchase the right food, if you had screenings done, you get points.

The more healthy behavior you apply on a daily basis, your points accumulate. Those points can be traded off for premium discounts, but they can also be traded off for things like movie tickets and other sorts of gifts and prizes.

The reason this is really successful, it really comes down to a thing called behavioral economics. How many people know behavioral economics? Great. The reason this is very successful is it plays into immediate gratification.

We’re all driven by immediate gratification, we want things now, we want prizes now. In a program like this, if you do your exercise today, you can redeem your points for movie tickets very quickly. People need to see that quick reward. The problem with prevention is that it’s very long term.

This is a great way to solve that problem and they’ve done a great job with this program. The other thing about implementing prevention and wellness programs, I think Anne already reiterated this. It really get your strategy right when you’re doing a prevention and wellness program.

I certainly echo what Anne was saying, if you’re talking about preventing a disease from occurring, which is primary prevention, you have to spend a lot of money on screening to get a return on investment. You guys know about return on investment, the area that you really want to spend money on is your high risk patients.

This is a study done by Pepsi on over 10,000 employees, where they implemented the wellness programs for the employees. What they found was that for every dollar spent on the wellness program, for the general population, lifestyle and management, they only got 50 cents back, it’s a massive cost.

For the disease management program where they spend it on the high risk patients, they got $3.80 back in lower claims. When you’re implementing wellness programs and prevention programs, really get to know your objective for the program before you implement.

I want to talk a bit about the future of wellness programs and where it’s going to go. This is a technology from Akumen, which is one of our partner companies, and it’s around behavioral profiling. When you look at wellness programs you’ll see this tale of people start, they’re very excited at three months, a whole bunch will drop off, in six months at least half of people would drop off.

The reason is this, whenever we implement or create this behavior profile, these wellness programs, it’s a mass program, one message for everybody, one solution for everybody or a choice of solutions for everybody and we’re surprised at why things dropped off. The future of healthcare is personalization, no doubt about that.

Two elements around that, personalised medicine and personalised health. What’s the difference? Personalised medicine is what John Mattick was talking about where you understand the genetics of a particular disease and you developed treatments towards those genes. Those treatments, personalised medicine. Personalised health is when you tailor the program or tailor the treatment to you as a person, to your behavior patterns. This technology here developed by Akumen really looks at the personality profile of an individual by analyzing text.

This the personality profile of Richard Branson from one of his speeches. This technology was developed through the fast moving consumer goods industry, where billions of dollars was spent on market research and as this fast moving consumer goods like companies like Nestle et cetera got back the market research and they look at it and they developed products to match that, they say “Hang on a second. People ask for this product, but once we created it, it never got solved. People aren’t actually buying this product.”

The reason is this, what people answer in market research isn’t necessarily what they want. What people answer in market research is often what they think you want to hear. In order to fix that problem, what this company did, was it actually pulled the keywords and the metaphors that underpin that text to really define that persons personality profile.

This technology has been used for the National Health Service in the UK, it’s been used with many major corporations around the world. We’re starting to use that as well. If you look at Richard Branson’s personality type here. What’s his dominant thinking pattern? Well order is very high, scientific is very high and communitarian is probably the third. What does that mean? Order is around structure processes. If you’re going to develop a wellness program for someone like Richard Branson, you’d give him step by step guides, you’d give him tools, you’d give him processes and he’s more likely to enjoy that. The scientific side of him also wants to see the scientific evidence, the research, the numbers. A guy like him is probably going to like things like Fitbit where he can see the numbers and the little bit of that communitarian side of him wants him to be a bit more social.

Now for somebody else who is more communitarian or had a high a communitarian score for their wellness program, you’d encourage group activities, you’d talk to them about why improving the health is good for society. You talk to them about how they can engage and work with community through and health and fitness goals.

Really it comes down to, the problem that we have is a lot of programs actually mass programs, and in order to remove that waste of people dropping off from programs, we need to customize it to the individual and understand their behaviors and their mental archetypes.

A lot of questions, a lot of big trends going on. How do we find the real answers? One of the things that we did was, as a company we went out and developed a white paper called Future Solutions in Australian Healthcare, and that paper will be launching on the 14th of August at the Future of Medicare conference we’ll be speaking about that.

In this paper we’ve interviewed 20 leading health care experts in Australia, the health insurance industry is well represented so we’ve interviewed Michael Armitage, he’s the head of the industry body, George Savvides, who we all know, Dwayne was in the paper, Mark Fitzgibbon from NIB. We also got Professor Ian Frazer, he’s the Australian of the Year and head of the Translational Research Institute, Stephen Leeder, you might all know from the Medical Journal of Australia. We got the CEO of Johnson & Johnson and GE. The Pharmaceutical Society. Martin Cross from Medicines of Australia. Alison from the Australian Healthcare and Hospitals Association, Dr. Mal Washer, some might have know him a former parliamentarian doctor. We also got Michelle Bridges from the Biggest Loser because one of the things around healthcare and wellness is that often the sick care system isn’t quite the expert on behavioral change, really some of the leaders of community that really know how to get people motivated and change behavior and we got seven other healthcare experts in that paper as well.

That paper will be released in the next couple of weeks. If you would like a complimentary copy, you can just pull out your mobile phones and just text this phone number. We just need your name and email, so we know where to send it to, or you can email directly and we’ll send you a copy of that paper.

In summary, what I’d like to say is, we looked at the big picture, we understand what major challenges are in the system, what the specific challenges are for the health insurance industry as a result, what the future trends and opportunities for solutions are and also the white paper which will hopefully provide a bit more granularity around some of this solutions as well. That’s it, that’s it for me. Thank you very much.