physiotherapy uk 2015 #physio15 · 6. ey; the future of health insurance –a roadmap through...
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Does Private Healthcare Have A Role in Public Health?
Physiotherapy UK 2015
#physio15
Martin Docherty
Rose Arnott
Aviva UK Health
Learning Outcomes
• To understand the role of the Private Healthcare Information
Network (PHIN) in delivering meaningful, comparative
information for patients.
• To consider the strategic developments within the PMI sector &
their impact on physiotherapy service provision.
• To consider how we improve the management of chronic MSK
conditions within private healthcare.
PMI Market – Headline Statistics
PMI = 10.5% UK Population
10% ↓ in last 6 years
↑ popularity low-cost employer funded cash plans / self insured.
Long-term cost containment priority for purchasers & providers.
↑ in IPT from 6% to 9.5% Nov 2015
Market Share
Controlling Costs & Promoting Clinical Best Practice
Networks & Open Referral
Clinical Pre-auth & Case Management
Cover RestrictionsClaims Analysis &
Monitoring
Cost Containment
PHIN – www.phin.org.uk
• CMA’s Private Healthcare Market Investigation - Final Report
2014.
• Lack of sufficient publically available performance information on;
- private healthcare facilities
- consultant fees & clinical outcomes.
• PHIN approved as independent “Information Organisation”
• Close working with CQC & other health / professional regulators.
• Mandate & 11 performance measures specified by CMA.
• Publication Timeline – data by Sept 2016; publication April 2017.
• New website due for soft launch 2015; full launch March 2016.
• Public Health Implications
Big Data, Outcomes & Digital Healthcare
Risk
Education
Long-term needs
Outcomes based
payments
mHealth / wearable
tech
Big Data
Digital Physio
PMI vs chronic conditions
Chronic exclusion
A disease, illness or injury that has one or more of the following
characteristics:
• it needs ongoing or long-term monitoring through consultations,
examinations, check-ups and / or tests, it needs ongoing or long term
control or relief of symptoms,
• it requires your rehabilitation or for you to be specially trained to cope
with it,
• it continues indefinitely,
• it has no known cure,
• it comes back or is likely to come back.
The current healthcare approach is reactive and addresses
musculoskeletal problems when they arise, usually through the
provision of medical care
Health beliefs are an important predictor of health outcomes for
people with musculoskeletal conditions
Over-medicalisation is a concern. Excessive focus on medical
solutions can result in an unrewarding cycle of investigations to
identify the cause of the pain and an endless search for a simple
cure
People should be empowered with knowledge about how to
maintain good musculoskeletal health
(Arthritis Research UK, 2014)
Musculoskeletal Health: A Public Health Approach
Recurrent conditions in BacktoBetter
Over-medicalisation
The compulsion to “do something” at every consultation has led to
over diagnosis and resultant over-treatment (Malhotra, A et al 2015)
The NICE guidelines for both Osteoarthritis and low back pain
recommend limiting the use of diagnostics
Evidence suggests that patients with low back pain who have
investigations are more satisfied with the care they’ve received, but
have poorer clinical outcomes (Kendrick et al 2001)
60% referred to a
consultantBacktoBetter
25% referred to a
consultant
Chronic management during treatment
Identify
Educate
Support
Good
musculoskeletal
health
Empowering patients
References
1. Aviva Commercial UK – Analysis of Laing Buisson Health Cover Report 2015
2. Competition & Markets Authority; Private Healthcare Market Investigation 2014.
3. Kings Fund July 2015; Better Value in the NHS – The Role of Changes in Clinical
Practice.
4. PHIN; www.phin.org.uk
5. NHS Right Care (www.rightcare.nhs.uk)
6. EY; The Future of Health Insurance – a roadmap through change. 2015
7. Arthritis Research UK (2014) Musculoskeletal health: a public health approach
8. Kendrick, D et al (2001) Radiography of the lumbar spine in primary care patients
with low back pain: randomised controlled trial. BMJ, 322: 400-405
9. Malhotra, A et al (2015) Choosing Wisely in the UK: the Academy of Medical Royal
Colleges’ initiative to reduce the harms of too much medicine. BMJ, 350
10. NICE (2015) Osteoarthritis NICE quality standard
11. NICE (2009) Low back pain: Early management of persistent non-specific low back
pain