The rise of the healthcare consumer

Dr Charlotte Middleton (00:15)
The consumer led world we live in today means the role if patient is fast becoming obsolete. A new breed of healthcare consumer is emerging, bringing with them a proactive approach to managing their own health and wellness, as well as a long list of demands for the healthcare system. Increased input in decisions, proactive care and engaging digital experience, and transparency in their pricing and billing. Any service they receive must be highly personalized to their needs and be convenient, enabling them to access healthcare when, where and how they want.

Dr Charlotte Middleton (00:50)
Today’s panel will look at the emergence of the new healthcare consumer. How well is the system meeting the needs of today’s consumer? How does technology fit in and what role should healthcare providers play in this new world order?

Dr Charlotte Middleton (01:04)
Today we are joined by Dr. Rachel David, CEO of Private Healthcare Australia, the peak body for Australian health funds. Hi Rachel.

Dr Rachel David (01:15)
Hi everyone.

Dr Charlotte Middleton (01:17)
Dr. Simon Kos from Next Practice.

Dr Simon Kos (01:19)
Thanks for having me Charlotte.

Dr Charlotte Middleton (01:22)
And associate Professor Michael Greco from the school of medicine at Griffith University, CEO of Care Opinion Australia, and CEO of CFEP Surveys Australia. Hi Michael.

Dr Michael Greco (01:36)
Yeah, hi Charlotte. Great to be here.

Dr Charlotte Middleton (01:39)
Really love to say thank you so much for joining me here today. Look, I think I’m going to start talking about just how proactive people are becoming about their own health and wellness. More connected with devices, sensors, wearables, implantables. They’re all able to track and manage things like their nutrition, their exercise, their sleep, their stress. Do we think that this increased monitoring of patient’s health is translating into increased health literacy? Rachel, I might start with you on this one.

Dr Rachel David (02:09)
Well look, coming from Private Healthcare Australia, we’ve been really fortunate in that we’ve, as an industry, have worked with one market research provider, Ipsos, for over 30 years, so we actually have the most enormous amount of data about direct to consumer research that we’ve been able to track over time. What we’ve seen most recently is particularly for people aged under 40, their ability to be able to have access to not just telehealth, but all of the self-monitoring through devices that you’ve talked about, is actually really important. They actually take it for granted. Whether or not we yet have the evidence about whether this is creating real health improvements, this is something that’s now becoming a minimum expectation of the gen Y and the millennial consumer, that not just will their doctors know about all of the monitoring and all of the online services that they’re able to access, but that their doctors will actually be able to advise them about this and what may or may not be the good services that they can access.

Dr Rachel David (03:24)
We have seen an explosion in different types of techniques and tools in the mental health space. For example, and this is something that I think in particular, particularly given the impact of the pandemic on a lot of people in that age group, it’s something that health professionals really need to keep across.

Dr Charlotte Middleton (03:45)
I find it’s interesting because I myself know that as well, in terms of what patients are coming to me as a GP, but I also know that many, many GPs very much sit on the fence when it comes to those devices, and how we interpret them and what we do with that information, and particularly, I guess, becoming literate ourselves of what are the good apps out there and what aren’t the ones that we should be referring our patients to. It’s certainly an area that we as GPS need to grow in I think as well, and to learn more.

Dr Rachel David (04:18)
Yeah. Including with the quality control with some of these things. Now there are some brilliant, really well established services out there that are providing digital health to consumers, people that haven’t accessed the health system, but there are some that I’m pretty sure that come from the complimentary space that may not be validated as well. I think it’s that degree of awareness and being able to advise patients is becoming more important.

Dr Charlotte Middleton (04:46)
No, couldn’t agree more. Michael, what’s your opinion on this?

Dr Michael Greco (04:50)
Well, I think it raises some interesting things [inaudible 00:04:54], and I want to introduce the concept of activation. We talked about health literacy. Very important and it really addresses the skills of a person in terms of their understanding the knowledge of healthcare. But there are two other important aspects to a person being able to engage with these new devices and technologies, and that is skills and confidence. Knowledge, skills and confidence, those three components is what makes up activation, and I think this where we’re now heading in terms of understanding.

Dr Michael Greco (05:38)
You talked about how to better personalize care or the needs of the patient, and I think to do that, even with things such as medical devices, we need to know where that patient is on that journey of activation because what we find is that people who are lower activated really struggle with the concepts of self-care and self-management of their conditions. No matter what devices you have, they’re not ready for that. Typically, in a population, about 40% of people are lower activated, whereas the more highly activated people, 60% on a typical population would be ready for these devices, and their application, they would vary in terms of how they would work with them.

Dr Michael Greco (06:38)
We’ll come back more to that concept because it’s really important in terms of how we tailor our care, whether that be through medical devices or whatever, with people, and there’s now an exact science around activation and how it links to health outcomes and things like healthcare cost reduction. That’s very important too.

Dr Charlotte Middleton (07:02)
Wonderful. Thanks. That’s some really interesting points there that makes us think a bit more of what we need to do to educate our patients. Simon, your work with Next Practice and the GPs, what’s your view and their view on all of this?

Dr Simon Kos (07:17)
Michael’s points around activation really resonated with me. What I think it alludes to is the fact that one size doesn’t fit all, and as our health system evolves, we’ve actually got generational, attitudinal difference between the generations. There used to be a paternalistic style of medicine and doctor knows best, they’ll tell you what to do, how to do it, and very much the gen Y are in the driving seat because they have information and then they have the tools at their disposal to make an informed decision about what they want to do.

Dr Simon Kos (07:50)
It was interesting when they looked at electronic health record data in Sweden, which has had a national electronic health record for the longest period. They found that it wasn’t 100% penetration, there was actually more like 40%, so there were a bunch of people who were very well and they engaged with the health system infrequently. They didn’t have much information, so for them, a comprehensive tool that aggregated their information and put them in control, they didn’t have much to work with and the stakes weren’t high.

Dr Simon Kos (08:26)
At the other end of the scale, there are some people who aren’t able to engage due to the complexity of their condition or mental health factors, so what we’re really talking about is that 40% of people whom have risk factors or a chronic disease where leaning in and managing their condition through tools and their own information can make a real difference.

Dr Simon Kos (08:52)
As we’ve provided some of these capabilities to our patients, it starts the conversation. Even something as simple, and I’ll make a distinction between consumer medical devices and health grade clinical devices, even giving someone consumer medical devices to be able to capture their heart rate, their weight, that sort of stuff, their step count on a daily basis can get them thinking. Once you start the conversation, that’s the first step in putting them back in control of their health and shifting it from this paternalistic sickness conversation into a ongoing wellness conversation. I think that’s got to be good for our patient outcomes.

Dr Charlotte Middleton (09:38)
Yeah. For me it’s about empowering our patients to, in some instances, look, well exactly, take their lead. Take the lead in their own healthcare. I think that’s really important. But it’s about providing the right information isn’t it? Because we all know that so many of our patients head to Dr. Google to try and get their information, so it’s about giving them, I guess, the right resources to enable that.

Dr Charlotte Middleton (10:02)
Look, that actually is a good segway into you mentioned that typically they come to us when they’re unwell, and we know that that typically is the model in the world really, that we practice sick care rather than a lot of preventative care. Typically patients come to us when they’re ill, not when they’re well. Do we think though that this reactive approach to healthcare is effective in managing our consumers today and what do we need to do to start making that shift to proactive and preventative healthcare? What do you think?

Dr Simon Kos (10:36)
My perspective is it is failing our society as the burden of disease shifts. If you have battlefield trauma or an acute and serious infectious disease, great. Hospitals and doctors know best. But if you’re counseling someone through lifestyle induced chronic disease, the moments of truth aren’t there in the doctor’s surgery. Maybe that’s where you have the insight oh, I need to make a change, but the moments of truth and the moments of weaknesses are out there through your daily life. If you have some sort of technology that can help provide that insight to you when you need it, or give you the mirror that allows you to reflect back on what cumulative decisions mean over a period before you go back to the doctor with a decline of your condition, that can make a huge difference.

Dr Simon Kos (11:29)
Something as simple as we do this tracking your medication, so we know that up to 60% of medications that get prescribed aren’t taken as prescribed. What does that mean when you go back to the doctor and you’re treating someone with hypertension, and their blood pressure is poorly controlled? Do you up their dose or so you have a conversation about compliance? Being able to tick that off and actually have a look at your calendar of compliance and say, “Boy, I need to sharpen up on how I take my blood pressure medications,” can make huge difference in terms of patient outcomes down the line.

Dr Charlotte Middleton (12:06)
I couldn’t agree more. You spoke about a medication tracker, do you want to just tell us a little about Next Practice and how it came about, and how you’re trying to change the model of healthcare a little bit there?

Dr Simon Kos (12:16)
Yeah. Quite simply, it was an insight from a medical doctor, but experienced business entrepreneur who himself had a brush with the health system and then said, “Wow. Where would I go for the very best primary care in the country? What do I expect? What does it look like?” It started a journey that resulted in him creating a model of care that focuses on principles of compassion with time for the doctor and engagement, connectiveness, so digital technology enabling it, and then also convenience. That convenience comes back to your principle of empowerment which is I want to engage with the system when and where I want it. If I can do that digitally rather than actually coming into the practice, or I’ve been to the practice, what was told to me? Having that information there makes a huge difference.

Dr Simon Kos (13:10)
This is what we do at Next Practice. We try and provide a model of care that digitally empowers the consumer, gives them the tools in the palm of their hand, and then they can start to self-manage when and where it’s appropriate. That’s exciting, and here with are in healthcare, going on the same journey that many other industries have gone down. They’re just a little bit ahead of us, which gives us the chance to look at what works, what doesn’t, what people lean into and engage with, and then try and bring that to healthcare as well.

Dr Charlotte Middleton (13:41)
Fantastic. Wonderful. Thanks very much for that. Rachel, with your experience, is this the way forward?

Dr Rachel David (13:47)
Yeah look, it is, and it’s important to bear in mind that for the most part, when people join a health fund, they’re not sick and that they don’t see themselves as a patient, but they’re concerned that if something happens in the future, I want my kids to have a specialist doctor or I don’t want to be on a waiting list, and that’s why they choose private health. But there’s a huge opportunity there when someone takes that step, to be able to influence some of the choices that they make, and you’ll see that some of the funds have gone down the path of allowing people to get reward points for instance, if they engage in healthy behaviors, whether it be exercise, diet and mindfulness, healthy sleep. One of the funds has partnered with Woolworths to create a reward system where people are diverted to a nudge towards having fresher and healthier food for example.

Dr Rachel David (14:48)
But there’s so much more we can do at that point. Like the boiling frog syndrome, someone gets into a series of bad habits, which over time, they don’t seem like very much, but over time they can end up in something that’s actually retrievable down the track. It’s so sad when someone actually presents in a situation where that’s happened to them and they have diabetes or coronary artery disease, or something that could have been prevented but they hadn’t taken some quite small steps along their life journey to be able to avoid it.

Dr Rachel David (15:23)
Part of the problem is our funding mechanism and the health system that we’re in. Medicare, it was set up with the best of intentions, it’s been fantastic to have a universal health system, but this is a system that was set up in the 1970s where we had 1970s diseases. At that point, brief interventions for acute conditions that resolved themselves, or ultimately the patient died, it was absolutely fine to have that perspective, but now the relationship that we have with people over their life, we have the potential to make that so much deeper. But I think it’s important that the funding actually follows that at some point.

Dr Charlotte Middleton (16:11)
Yeah. We need that funding for those longer, more complex consultations that allow us to give that preventative care to our patients.

Dr Rachel David (16:21)
Yeah. At the risk of perhaps being controversial with a GP audience, the idea that patients form a continuing relationship with one practice and one team of health professionals, I think, begins to become more important as we shift towards chronic diseases really being the norm.

Dr Charlotte Middleton (16:43)
Yeah. No, I absolutely agree. Look Michael, I might bring you in at this point with your website, Care Opinion. I might get you just to tell us a little bit about that because it’s my understanding, obviously when it comes to consumers, they’re now starting to seek more understanding and influence their own treatment and referral decisions. Your website can help facilitate that, is that correct?

Dr Michael Greco (17:06)
Well what it’s really about Charlotte, the website, it’s really about giving a voice to the public 24/7, where they can feel heard by those that have cared for them. Surprisingly, over 50% of the stories on Care Opinion are positive. Purely positive, and nearly every story has something positive in it, but there’s degrees of concerns or issues that they may raise. The purpose of our site is to give them, so that they can feel heard, see that their stories about their health treatment are being listened to by the providers and responded to, and in some cases, changes being made. A partnering in that service improvement process.

Dr Michael Greco (17:59)
This is all happening in realtime, so that’s the beauty about the Care Opinion website is that it allows people to safely, anonymously tell their story. All the stories are moderated by our team here, just to remove any names and anything untoward to keep both the public and the providers safe, so we don’t mention staff names and [inaudible 00:18:21]. It’s not and name and shame site. The site is purely focused on gratitude, but also mainly service improvement. What can we keep doing that we do well and what are the things that we can change where change is needed?

Dr Michael Greco (18:35)
That’s the point about Care Opinion, but Charlotte, I was fascinated by both Simon and Rachel’s responses, sorry, about the new world of disease. As Rachel said, in the 1970s it was, up until then, very acute based. Now we’re moving to more where treatment’s around chronic conditions. The story is chronic conditions are not curable, so the role of the patient has to become more active in their care. What I wanted to say, and I think it very much ties into both Simon and Rachel, is that knowledge alone does not change behavior of the consumer. We know that. That knowledge alone does not change behavior. It’s why, just to be a little bit [inaudible 00:19:25], that’s why doctors still smoke or are overweight, because knowledge doesn’t change behavior. It’s the skills and confidence and journey with those conditions.

Dr Michael Greco (19:35)
The role of the health provider has to change somewhat, as Simon said before. I’m not saying they’re paternalistic today, but it has to change from an information giver, solely that, to one that walks alongside a patient on that journey of self-care and self-management. That brings into a whole new perspective of how important is it for the patient to self-care? We’re assuming that they want to because of the medical devices and whatnot, but as Simon said, there’s quite a large percentage of people who aren’t really interested and feeling like they have a role to manage their condition, or they feel like that’s really left up to, when they are ill, to the health system. We have to somehow change that mentality and we know there are ways we can do that. I think that’s the new edge in our health system is how do we support patients on that journey of self-care? There is, as I said before, a science about that.

Dr Charlotte Middleton (20:37)
Talking about that, how we can better support our patients and a little bit, I guess, about technology, what are some to more personalized healthcare technologies that you’ve seen out there that are doing that? That are supporting our patients?

Dr Michael Greco (20:51)
Well, technology’s something that I’m not the expert on, what I am the expert, oh, I wouldn’t call myself an expert, but what I am very passionate about and understand the science of is how do consumers… Where are they on that journey of engagement from zero, as in I don’t really have much to do with my heath. That’s something that happens out there and happens to me, to an activated patient that says, “I’m up for this. I have a role to play in this,” and the caregiver becomes someone different in that role. They become more of a walk alongside and they become more of supporting them in their problem solving.

Dr Michael Greco (21:41)
But at the lower end of the scale in terms of engaging with the technologies, I think initially it’s really about exploring how important it is for the patient or the consumer to self-care. The issues that providers need to be very aware of in that space are things like trust and relationship. Those are key in terms of building that consumer in starting, I think as Simon said before, starting the conversation around self-care. What kick-starts that, the key component to that is relational care, not information care, and it’s around building trust. There’s so much around that that’s so important. Once they get on that journey of that, then we can start to engage them in those technologies. Absolutely.

Dr Rachel David (22:38)
Charlotte, I think there’s a couple of important things that Michael just said that I’d like to pick up on, and one is that the science of behavioral change is it doesn’t necessarily have to go through a technology channel, but what you do need to do is to find out, even if it seems to be nothing, what is important to that particular person that could be used to motivate them? Then you can start thinking about ways in which they could be nudged to more appropriate behavior, or actually more constructive behavior I think is the word I’m looking for.

Dr Rachel David (23:17)
I’ll give you an example of a young male in their twenties who’s very reluctant to engage with a health system at any level, but is at risk of developing a range of chronic diseases because of poor eating behavior and smoking for example. Well what’s going to be important to him? From our research, and I think it would be very obviously to everybody who listens to this, is that white teeth, for that person means they’re not overlooked for a job, they can go on Tinder and not be embarrassed, and people are not going to make a judgment about their social status every time they open their mouth. From a health funds point of view, because we cover and we interact and we provide allied health, white teeth is the way through to that person to be able to encourage them to not just go for the dental checks, but engage in a lot of other positive behavior as well.

Dr Charlotte Middleton (24:16)
Well that’s really interesting.

Dr Simon Kos (24:18)
Yeah.

Dr Charlotte Middleton (24:19)
Didn’t think the white teeth would be the driver.

Dr Michael Greco (24:23)
Well I think that Rachel, it’s asking [inaudible 00:24:26] what’s important to them. We have a saying at Care Opinion, “It’s about what matters to the patient, rather than what’s the matter.” It’s what matters to you. Asking him that, he’d probably, young 20-year-old would probably tell you that if we can listen to it, that, “Yeah, look, I go on Tinder. I don’t want my teeth to look bad. I go to a job, I don’t want my teeth…” Yeah, absolutely. That’s a really very good point.

Dr Charlotte Middleton (24:58)
I think it’s coming back to that embracing that personalize healthcare. That’s it’s not just that stock, standard answers that we’re giving our patients, “You must stop smoking. You must do this for this reason.” It’s about that personalize healthcare. Asking them what is important to them. No, that’s really, really interesting points. Simon, your experience with that?

Dr Simon Kos (25:21)
As I think about it, there’s probably two related but different industries. There’s the sick care industry and then the health and wellness industry. Maybe health is the crossover between sickness and wellness, but those two industries operate under different dynamics. In healthcare it’s science based, regulated and we’ve been doing it for a long time. This new space of wellness of burgeoning. There’s a lot of innovation going through there. Not all of the claims are substantiated, but if we could bring those two together we could engage on the wellness journey that people obviously want to do with the added credibility of coming from the medical space of credible informational sources.

Dr Simon Kos (26:14)
I think there’s a lot of learning to do from a general practice perspective. I think about how I was trained as a clinician and no one said to me, “Behavior change.” There is a science around behavior change, but that’s what I learnt. I learnt diagnostics and therapeutics. To be able to counsel someone, it does, it starts with a relationship. It works on trust. It’s generating influence, but then handing that over in a way that they can understand and start to manage their own care. That’s really important. Yes, technology is one channel that works for a subset of people, but this is an evolving role of general practice as we combat chronic disease and moving into this fear of behavioral management and behavioral modification.

Dr Charlotte Middleton (27:08)
I couldn’t agree more. Couldn’t agree more. Rachel, the other way that the health funds, I know, support patients through their wellness journeys I guess, there’s a lot of support programs aren’t there, for them, through the health funds now? Because I’m constantly getting patients coming to me saying, “Oh yes, I’ve joined this weight loss one,” or, “I’ve joined this osteopetrosis one,” or, “I’ve joined this,” and it’s all through the health funds.

Dr Rachel David (27:31)
Yes. Look, there are various things that are available starting at the primary prevention level and moving right through to people in the frail aged bracket where the dialysis at home, home assistance for a variety of things including the allied health component of frail aging for hospital prevention, but also the care of chronic organ failure, palliative care and so forth. It is something that the fund offer throughout life. I think we’re at the beginning of this journey at the moment and there is so much more that can and will be done in this space, but bringing some people from marketing and behavioral change in other industries into the health funds has been a really useful exercise here.

Dr Rachel David (28:33)
We now have people who’ve worked for the food industry, in allied health in psychiatry, in airlines. Through all of these different spheres are now working in health funds and are putting together programs which inform how we do this. It’s different for different age groups, so a loyalty program which puts a big emphasis on measurement from a motivated younger person around weight loss and are you using our sleep app and so forth? Then I can get retail reward points. That can be incredibly popular and encourage people to make some lasting changes. But as you get into older age groups, so people might be less confident and actually be reliant on a particular medical specialists, non-GP medical specialist or GP, then I needs to follow the complexity of their situation. That’s where I think we’re just in the infancy. I think that the development of the sector is really in its infancy, but it can play a much bigger role.

Dr Michael Greco (29:52)
One of the things I was thinking about is that the importance of risk stratification. In other words, what segments of the population are going to better respond to treatment or wellness messages? More importantly, what proportion of or what segment of the population won’t respond to those wellness messages and self-care? That’s why when we talk about patient activation or consumer activation, in an ideal world, actually the traditional risk stratification method has missed about 50% of lower activated patients because we think it’s to do with acuity or medical complexity that those with medical complexity won’t really do the things or haven’t been doing the things we’ve asked them. But that’s not the case actually. There is a slight correlation or relationship between those two, activation and medical complexity, but it’s not that strong.

Dr Michael Greco (30:58)
It’s important to know where a person is on that journey because once we do that, then we can target our population better. If we want to target wellness messages and to do things more about yourself, you probably wouldn’t target the lower activated initially. You’d go for the more higher activated patients because they’ll do it. They’re the worried well in a sense, that we talk about, that they’ll do things, they’ll go to a website, they’ll look things up. But the lower activated won’t necessarily do that, so to know where people are on that journey, and it is a diagnostic in a sense, yes, and we call it a vital sign now just like other vital signs in terms of blood pressure, weight, age, patient activation is now a vital sign. Knowing whether a patient will engage, it’s a measure of engagement, but it’s more than that.

Dr Michael Greco (31:56)
We can stratify our population, whether in a GP practice, knowing who should we target more, and who do we need to just to get on with things because we know they will? In terms of health funds, in an ideal world you would know where to better target people based on their level of activation because we know that’s what drives them. We know it’s the knowledge, skills and confidence within them that leads them to their decisions around healthcare, and other decisions as well in terms of wellness.

Dr Charlotte Middleton (32:28)
I can see some changes coming to GP training. With all this behavior modification. But it’s absolutely needed, so some wonderful points there. Look, I’m going to the, for instance, in the US where on demand healthcare is been growing. A number of apps have been developed to help people to view available clinics, schedule visits, pay and even access their own reports. I guess is that where Next Practice are engaging patients?

Dr Simon Kos (32:59)
I think there are some exemplar models in the US, but the US healthcare system is fundamentally different, so they’re actually solving some different challenges. But you’re right. There’s an incredible amount of investment in digital health in the US. It’s a hotbed of innovation and it’s wonderful to be able to see some of the integrated models work over there.

Dr Simon Kos (33:19)
I think one of the journeys that the US is on, and other places like parts of Europe, the Nordics especially, is value based care. Here in Australia we’re squarely stuck in fee for service. The whole model of value based care is meant to be anchored in outcomes, and when you actually have the same organization responsible for care provision as care payment, you can start to bring it together and the right intervention, regardless of the cost, that focuses on the outcome is appropriate. If you can do it over text or you can do it via an email and it doesn’t require bring someone into the face-to-face into the clinic or a telehealth call that then triggers the consultation, that’s the way to go get things done.

Dr Simon Kos (34:04)
When I look to the US, I actually do see some other things. They’re a very individualistic society and the trends of consumerism are more marked than we see over here. The concept of concierge medicine came out of the US where arguable they see themselves as more time poor and there’s a higher proclivity to go pay for some of these services, whether they’re paying it out of their own pocket or it’s paid for by their employer because it’s funded different. There are different funding models to enable access to care.

Dr Simon Kos (34:40)
When I look at those exemplar models I think about One Medical or Forward Medical or ChenMed, they’re really doing some great things in terms of activation, empowering people with the digital tools to self-manage and addressing the power balance. This asymmetry of information where once upon a time the healthcare organization not only held all the data, but knew what it meant. To the greatest extent possible we can shift that onto the patient, give them the information, give them the tools and help them understand how to use it, and then finally give them choice. That’s ultimately where I think we want to move it to. The empowered health consumer who understands their condition, with the right tools to be able to self-manage and then they make the choice about when and how they engage with the health system to get the help they need.

Dr Charlotte Middleton (35:32)
Yeah, fantastic. Rachel, Michael, what are your thoughts on that?

Dr Rachel David (35:36)
Look, in terms of, again, I think the US is quite a different system, but we do need the Medicare system and private health which is bolted onto Medicare the way that it works in Australia, to evolve beyond where it is at the moment. I think we talk about information asymmetry and it is still present in so many ways, despite the best efforts of many good GP specialists out there at informing people. There is still a lot of snake oil salesmen and people that will get into people’s heads and offer simple solutions to what are really complex problems, and I think we do need to guard against that a little bit and see if we can somehow use this amazing network of GPs that we’ve got to better steer people towards treatments and a system of care that can actually help them.

Dr Rachel David (36:42)
Some of the saddest things that we see are people that do have conditions that are not treatable or are treatable only to a certain extent, who go out, they get into the hands of someone who’s going to charge them a lot of money, who probably won’t be able to help them, but they put a lot of belief in this person. They go out and either mortgage their home or Crowdfund or draw down on their super that really, if they’d had a good relationship with a primary care provider to start with, they would have been able to get at least a countervailing opinion that this was highly unlikely to help them.

Dr Rachel David (37:22)
The ChenMed model also interests me about how we can better help the 2% of people in the health fund world that probably generate 60, 70% of the claims. These are the people who have four or more chronic conditions, but who are very passive, heavy users of the health system, but very passive users of the health system and really don’t have, unless they have a motivated family member, they really don’t have that guide with them who can help bring all of the fragmented bits together so that their time is well used in the health system and they’re not traveling around to lots of different locations. There isn’t duplication in the tests they receive. That they have a single source of truth and a single medical record and so forth, and perhaps from a health fund point of view, more important than ever, they’re not landing in hospital because a particular aspect of their treatment was neglected.

Dr Rachel David (38:29)
That often doesn’t happen on purpose, but once someone is into specialist care, the cardiologist doesn’t notice that someone’s arthritis has flared up to the point where they can barely walk and then they fall over at home. It’s that sort of situation. It’s having that coordination role, which may or my not be the GP, and how that’s best, how we can use automation to make that as effective as possible is something that I think is of enormous interest to us at the moment.

Dr Charlotte Middleton (39:06)
Part of that, I would say, as a GP is that we need that improvement in interoperability to support that, where we are all talking to each other, and there’s a massive downfall in our system with that at the moment in terms of the connection between hospitals and GPs and specialists and GPs, and we need to improve on that in order for that messaging and communication, I think, to be effective around patient care as well. It’s very fragmented still at the moment.

Dr Simon Kos (39:38)
Yes it is.

Dr Charlotte Middleton (39:39)
[crosstalk 00:39:39]. I can see that you’re agreeing with that.

Dr Simon Kos (39:42)
It’s not a quick fix. We have so many legacy systems that are entrenched in our health system, and sometimes those systems don’t get replaced quickly. Some of the big hospital based information systems are operating 30 years after they’ve been implemented, so the opportunity to create data liquidity and bring it all together is challenging, but I do see us on the cusp of a Cloud revolution in healthcare that has made a dramatic difference elsewhere. That’s actually really exciting because once we start to bring that data up, using appropriate security so that we safeguard the confidentiality of that important information, then we can start to do really interesting things with it.

Dr Simon Kos (40:28)
When you’re able to start to correlate some of those consumer informational sources with your clinical data sources, and even mash it up with other personal lifestyle information, then you can get really powerful insights. I guess that’s the basis of personalized care. They talk about precision medicine and often that’s a shortcut to thinking about genomics, but this concept of personalization, what’s your position and what’s your context and what therapy is going to work best for you? I think we can start to get precise about anticipating what that might be for any given patient.

Dr Charlotte Middleton (41:05)
Yeah, I agree. I agree. You spoke about there aren’t a lot of quick fixes here, but are there any quick wins? Do we have some quick wins that we could implement now?

Dr Simon Kos (41:16)
If there was one thing that I could wave my magic wand and see it happen, it would be to hasten the move to Cloud based systems. I just see the security of being up in the Cloud, the potential to share information around, the interoperability to be able to support Cloud enabled data with complimentary systems to provide additive benefit beyond what one individual provider might be able to do, that’s being powerful. Then to be able to take that and then translate it out into form factors that make sense, so mobile devices for patients or care at home for providers, so that they’re able to do their job out of the clinic as well. Enormously powerful, especially when we’re talking about interventions that sometimes time is really important.

Dr Charlotte Middleton (42:09)
Yeah. Absolutely. Michael, did you have anything to add to that?

Dr Michael Greco (42:13)
Yeah, I do. The importance in integrated care, as Simon eluded to, is tough in a fragmented system. How we bring funding models together? Who’s responsible for the [inaudible 00:42:28]? Where do the benefits lay? The concept of value based care was raised and I think we’re heading towards that in Australia as well. I was impressed by the AMA’s recent document on the 10 year plan for primary care, and I know we have a primary care taskforce now in Australia that’s trying to look at these issues around value based care.

Dr Michael Greco (42:53)
It picks up on what the concept of the quadruple aim of care, and the quadruple aim of care is to improve health outcomes, reduce cost, and the other two arms of it are [inaudible 00:43:04] to improve staff experience and improve patient experience. They are the four arms of the quadruple aim of care, which are all striving to do is, as I said, is improve those outcomes, reduce those costs, moving care outside of hospitals into the community where we can because it’s going to be cheaper and we know that patient experience generally is better, but also the staff experience, that’s a whole new world and making sure that’s okay, because if our staff aren’t happy, then I can guarantee you our patients won’t be happy generally. They’re north very connected those two worlds.

Dr Michael Greco (43:46)
But look, just something a little bit lighthearted, but that whole concept that was used, I think both by Rachel and Simon, around asymmetrical, and we often talk about this in GP training. When I was training back in the 90s, helping GP registrars through their training around those supporting patients. To give providers an idea what it’s like for a patient in terms of that asymmetrical power relationship, I often used to say, “Look, you can tell patients to take their clothes off, but they can’t tell you to take your clothes off.” They look at me in shock, but that’s what it’s like. That’s the power that you have. To neutralize that or to share that power is quite empowering for patients, and it often starts with simple things and it’s building that trust. But that’s going back again to the bringing people on that journey of self-care with you. It’s another story. A funny one.

Dr Charlotte Middleton (44:53)
Rachel, did you have anything to add there?

Dr Rachel David (44:56)
Look, I think I really agree. I agree with all of those points. The need to integrate the patient experience more would come up a lot for health fund members because by the very nature of the way that health funds are set up, they find specialist care and allied health, so often the GP is one step removed from what’s going on. But if someone has a bad experience as a result of fragmented care, it will either land back on the GP or back in hospital, so this is something that we see a lot of as a considerable gap in the system.

Dr Rachel David (45:44)
But the more we can encourage participants in the system on the provider side not to be threatened by sharing information, reviewing outcomes and receiving feedback, I think the better off we’ll all be, and it can be done in a context that doesn’t cause harm. Of course if a patient is so delighted that they go off and they make a statement like, “Oh, Dr. So And So cured my cancer. I think you all should go and see him or her,” or, “Dr So And So is great because he gives out opiates without asking any questions,” to makes some other outrageous statement, then of course it needs to be moderated and removed from any kind of meaningful feedback, but I think there are ways in which that can be done. Most of us actually benefit from it, including health funds and the doctors who work in health funds.

Dr Simon Kos (46:43)
We do that ourselves. I think you go and eat out in a restaurant, you’re able to leave a review and that’s your voice. That’s empowering. We’ve done the same thing and it’s really simple. Just rate your care experience. Rate how cared for you felt by the person who looked after you, not the doctor. We rate the actual patient advocate, the person that greets you in the front area, and then rate your care experience today. Just being able to give people a voice allows us to actually manage some of those negative conversations in a productive way or actually capture and celebrate some of the good that we’re able to do. It’s just one of those common things that happen in every other industry, but we don’t really do here in medicine. I think picking and choosing some of those innovations we see that have taken legs, that could make a big difference here, I’m excited to see them to come to general practice.

Dr Charlotte Middleton (47:41)
So am I.

Dr Michael Greco (47:42)
[inaudible 00:47:42]. It’s a new world too Simon. The Medical Board of Australia are introducing a new CPD for all doctors across Australia, so that their continuing professional development is going to change enormously in the sense of what they choose to professionally develop will now be structured into three areas around the traditional educational aspect of CPB. But now there’s being a call for peer, or sorry, reviewing performance data back from doctors, and measuring outcomes. Those two streams are something a little bit different for doctors. Part of the measuring outcomes is patient feedback around my communication skills, around my interpersonal competencies, so doctors will be seeking that sort of feedback from their patients to satisfy some CPD requirements.

Dr Michael Greco (48:46)
On the reviewing performance steam, that’s around peers commenting on your professionalism, so not only other doctors but other colleagues and coworkers that work with you. We call that multi-source feedback. That’s something in this new world of CPD that’s very [inaudible 00:49:07]. A lot of the colleges now are adapting their CPD systems to align with what the Medical Board of Australia is asking for.

Dr Michael Greco (49:18)
But I guess the reason I make that point is the concept of feedback to the profession. To individuals within the profession. The doctors. They’ll be getting feedback from patients and getting about their communication skills, and getting feedback from their peers and coworkers about their professional skills aligned with what makes a good doctor. The Medical Board’s document.

Dr Michael Greco (49:44)
That’s a bit of a cultural shift because whilst those on this panel would more than likely agree that’s a good thing, I think it’s a little bit threatening for a proportion of doctors, getting patient feedback, or even peer feedback. Some have said to me, “That’s even more threatening than getting patient feedback,” in a structured way that’s benchmarked. I think the planets are aligning in this new world, not only from consumer perspective and going from passive to active, but I think there’s going to be more asked of the medical profession in terms of being reflective practitioners, and really looking at becoming a reflective practitioner. Not to say they haven’t been, but I think that’s going to be more formalized.

Dr Charlotte Middleton (50:37)
Well as you said Michael, I think it’s going to be a whole new world that we’re going to move into. On that note, that is all that we have time for tonight. I just wanted to thank each and every one of you for being here. It’s definitely a ever-evolving landscape and I guess we’ll see where the future heads with this. Thanks again.

Dr Simon Kos (50:55)
Thanks everybody.

Dr Rachel David (50:56)
Thanks Charlotte. Thanks everyone.

Dr Simon Kos (50:57)
Thanks Charlotte.