sturt eastwood - diabetes nsw - diabetes & chronic disease management
Post on 12-Aug-2015
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Sturt EastwoodChief Executive Officer
July 2015
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“Sure, we cover diabetes”Health Insurance offerings are transactional in nature and reflect the shortcomings of the primary health system in their response to the management of chronic conditions such as diabetes
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• Diabetes is not episodic• Arguably front door to chronic illness• Chronic illness hunts in packs• Right approach delivers dividends beyond the diabetes conversation
• Diabetes 101 & some thoughts
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Eat (any food)
Digest
Glucose levels in
bloodstream rise
Pancreas releases insulin
Cells accept glucose
BGLs fall
Pancreas stops insulin production
Simplified normal process
Body has a complex set of mechanisms and cross checks to maintain BGLs within a very tight tolerance
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Eat (any food)
Digest
Glucose levels in
bloodstream rise
Pancreas releases insulin
Cells accept glucose
BGLs fall
Pancreas stops insulin production
Type 1
• Auto-‐immune• Pancreas does not
produce insulin• Genetic predisposition• No prevention, no cure• Typically juvenile• Rapid onset• Acute, diabetic coma etc• Insulin is the only therapy• Insulin required for life• Pumps & CGM improving
outcomes• 10% of cases• Growing at 3%
Simplistic overview
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Eat (any food)
Digest
Glucose levels in
bloodstream rise
Pancreas releases insulin
Cells accept glucose
BGLs fall
Pancreas stops insulin production
Type 2
• Insulin resistance• Pancreas can’t cope• Age, lifestyle, ethnic,
parents, pregnancy• Typically older onset• Progressive• Pre-‐diabetes<-‐> Insulin• Multiple therapies• 85% of cases• Growing at 7% p.a• 60% delay / prevent
Simplistic overview
• and so what?• High BGLs reduces blood viscosity and attacks small and large blood vessels and nerve functionality
– 4x more likely to have a stroke– Australia’s leading cause of blindness– 4x more likely to have a heart attack– Leading cause of kidney dialysis– Leading cause of amputation
• But condition can be successfully managed and complications avoided if we work together
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• Scale
– 3rd largest country in the world– 1.1m Australians diagnosed (est add. 600k t2 undiag)– 5% of the population, 280 a day, 36k in NSW alone in 2014
– 1 in 4 adults >25yrs have impaired glucose management– 4m Australians if pre-diabetes included– $6.5b p.a. direct health costs– Similar costs around productivity loss– Quality of life impacts– Single largest burden of disease by 2019 if left unchecked– It’s real and it’s big but there is much we can do….
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• Diabetes is not episodic (feel ill, take a pill)• Not all GPs comfortable with managing diabetes• Time between consultations critical• Self assess and dynamic action adjustment• Est. up to 60% of t2 able to be prevented or delayed
• Once diagnosed, good self management key• $1 spent on education saves $16 in downstream costs (AE/ADEA)
• Annual cycle of care & medication compliance9
TIME
Diabetes continuum
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Diabetes Primary Health Health Insurance Hospitals
Large base Transactional Transactional Too late
Increasing $ Driven Complex Turn away t2
Longitudinal Time poor Caveats Blacktown ED
Costly Capability? Shotgun Struggling to cope
Patient Mgmt Paperwork Pumps / CGM?
30+% undiagnosed Minutes v Months Reactive
Database Reactive
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Mission
Complications
Diabetes
At risk
General Population
• Improve Prevention• Increase Identification• Improve Management• Reduce Complications• ROI – people / $
• Gen Better, Healthier You, NSW Govt -‐ Get Healthy• HBa1C test now covered by Medicare• NDSS, Care Plan, Education, cycle of care, medication compliance• Better that you know and have the ability to appropriately
intervene
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We can be more systemic (and successful) in our response if we empower the customer….
• Screening – Hba1c motivation (across total base)
• Create a diabetes package or extra’s subset– NDSS registration– Care Plan
• Diabetes Education **• Dietician• Exercise Physiologist• Podiatrist• Optical check (retinopathy)
– Annual Hba1c, weight, BP, Med compliance– Membership of diabetes association
• Magazines, newsletters, events, help lines etc– Outbound support / coaching texts or calls?
Best Practice
•Diabetes Portal or other mechanism that enables you to assess customer compliance to:• NDSS registration• Care Plan elements• BGL uploads• Annual Hba1c, weight, BP, Med compliance• Membership• Movement upload• Outbound support / coaching texts or calls?
• Early interventions possible•Compliance discounts to premium
• EG WSDI
Skin in the Game
Weight
BSL
Activity
BP
Food
Or manualdata entry
Patient sharing
information with GP
generated care plan
GP sharing information with hospital Specialistservices
Patient General Practice Hospital Services
‘Powered by Telstra Health’ ‘Enabled by LinkedEHR’
Targeted Smart Multi-‐media Education
Patient Self-‐Management eHealth Enabler Model
Telstra’s Health Gateway – WSDPMI’s Diabetes Gateway
Telstra’s Health Gateway:A platform (web portal & mobile app) enabling customers to access their health data and information, connecting them with their care providers and enabling interaction and transactions across their health care needs. Unlike self-‐management apps disconnected from the broader health ecosystem, theconnected Health Gateway is never empty – once registered, the customer is delivered value instantly
Integration with Linked EHR & GPMP: Goals, Recommendations& Reminders
The core of the collaborative care model – integration across providers and coordination between health events – is dependent on shared information
The approach is to bridge the gaps between existing technologies in order to facilitate information exchange. This will focus more on the behaviours of those interacting with enabling technologies than the enabling technologies themselves.
Integration with Linked EHR & GPMP: Medications & Prescriptions
Gateway delivers a consistent and standardised customer interface, plus supporting clinical and business logic. It has been built with the highest standards of privacy and security (NASH PKI certification & ISM compliance)
It links with:•Medications history from Linked EHR•CMI from GuildLink•ePrescrption fulfilment capability from eRx Express
The Patient Experience: George Institute assessment tools
The Patient Experience: George Institute goal setting tools
• Dealing with chronic conditions requires a longitudinal approach and teamwork
• Issue is big and getting bigger• We have an opportunity to create better outcomes for all involved
• Customer participation & empowerment is key• Best practice chronic care packages required• Attack is the best form of defence….
– (Will leave pumps for another discussion)
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Thank You
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