Chronic Disease and Chronic Disease Management in Bupa - Dr Andrew Vallance-Owen Global Medical Director
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Chronic Disease
and
Chronic Disease Management in Bupa
Dr Andrew Vallance-Owen
Global Medical Director
Prague Presentation June 2010
Bupa is an international healthcare group
United Kingdom Bupa Wellness France Insurance businesses
Bupa UK Membership UK Care Services Health Dialog CNAMTS
Provision businesses
Bupa Health Assurance Bupa Home Healthcare
Bupa Health Dialog Cromwell Hospital Integrated health services
US China
Health Dialog Representative
Office Beijing
Hong Kong
Bupa Hong Kong
Thailand
Spain Bupa Thailand
Sanitas
Australia
Sanitas Hospitals
Bupa Australia / MBF
Sanitas Residencial
Bupa Care Services
Health Dialog Espana
Australia
Latin America
Bupa Latin America
(Offices in Miami, USA;
Mexico; Ecuador; Bolivia;
Dominican Republic)
International India New Zealand
Bupa International Max Bupa Bupa Care Services NZ
(Offices in Brighton, England;
Copenhagen, Denmark;
Dubai, UAE; Cairo, Egypt; and Denmark Saudi Arabia
Hong Kong, China) Bupa Scandinavia Bupa ArabiaSome facts about Bupa We commenced operations in 1947 and our founding principles remain core to our success and growth over 60 years and into the future Bupa’s core purpose is to prevent, relieve and cure sickness and ill health of every kind, across all of Bupa’s businesses and geographies. Our aim is to provide our customers with high quality health and care products and services We are a private company with no shareholders – our primary concern is for our customers. All our profits are reinvested in the company to provide more and better health and care to our increasing number of customers around the world We are in ~190 countries and employ more than 50,000 people worldwide Our businesses include: private medical insurance, hospitals, aged care, wellness, occupational health, chronic disease management, home nursing, primary care, commissioning, health data analytics
Chronic disease management has been identified as a priority for Bupa • Customer needs and wants • Impact on health fund costs • Opportunities in public sectors • Acquisition of Health Dialog in the USA
The burden of chronic diseases is increasing and
driving healthcare spend
• Non-communicable diseases, principally cardiovascular diseases, diabetes,
cancers, and chronic respiratory diseases, caused an estimated 35 million
deaths in 2005
• Total deaths from non-communicable diseases are projected to
increase by a further 17% over the next 10 years
• Roughly 70% of healthcare spend in Bupa’s core markets is currently
attributable to this chronic disease burden
% GDP spent o n
healt hcare - 2 0 0 9
Healt hcare spend on chronic disease This spend is disproportionate
– for example in the UK
% o f t o t al GDP
spent o n chro nic 20.0 roughly 25% (15.4 million) of the
care 15.0 population
have a long term condition,
% GDP
10.0
but account for 70% of healthcare spend
5.0
0.0
Aust r alia Spain UK US
Sources available on request80% of chronic disease deaths occur in low & middle
income countries
• Predictions for the next 2 decades see a near tripling of ischaemic heart disease &
stroke mortality in Latin America, Middle East & sub-Saharan Africa1
• The global number of individuals with diabetes in 2030 is projected to rise to 366
million, (or 6.5% of the world’s population) – 298 million of whom will be in
developing countries 1
• The costs associated with heart disease, stroke & diabetes are large across the
globe, but most significant in the developing world2:
Impact on nat ional income of premat ure deat hs from heart The response to the challenge in
disease, st roke & diabet es bet ween 2 0 0 5 -2 0 1 5
China
developing countries may differ
Russia
India Developed countries have health
600 Brazil systems designed to deal with
500 UK
acute illness
400 Pakist an
Lost $ (billions)
Canada
be t we e n 2 0 0 5 - 300
2015 Nigeria Developing countries often have an
200
Tanzania emerging healthcare system which
100
offers real opportunity to trial
0
Count ry
different approaches to healthcare
delivery
1. Derek Yach – The Global Burden of Chronic Diseases: Overcoming impediments to
prevention & control (JAMA – 2004, Vol 291, No 21)
2. http://www.who.int/chp/chronic_disease_report/media/impact/en/index.htmlAgeing populations and the rise in chronic disease
The proportion of the Project ed increases in t he percent age of regional
population that will populat ions aged over 6 0
World Medical advances
be over 60 is 40 also mean people
increasing globally 35
Nort h America
liver longer with
% populat ion aged over 6 0
30 Europe
- With this, the level more conditions also
25
of multiple 20
Lat in America & adding to healthcare
Caribbean
morbidities & 15 Africa
costs
treatment costs 10
Asia
escalate 5
0
Aust ralasia
2005 2050
Average per person annual cost of t reat ment for Percent age of t he populat ion wit h more t han one
an individual wit h one or more chronic condit ions chronic condit ion by age group
(USA) (USA)
7000
6000
$ per person per year
5000
Aged over 65
4000
3000 Aged over 65
2000 Aged 18-34
1000
Aged 18-34
0
1 chronic condit ion >1 chronic condit ion >1 chronic condit ion
and over 65
0 20 40 60 80 100
Sources on requestBut this doesn’t just affect the elderly …
Of all deaths attributable to chronic conditions the proportion
that occur before the age of 60 are (2003):
Low income Lower middle Upper-middle High income
countries income income countries
countries countries
44% 33% 34% 19%
This is as much of an issue for the working population as for
older retired populations
Oxford Health Alliance: Chronic disease: an economic perspectiveRising obesity
morbidly obese, Approximately 1 billion
300 million adults are obese globally1
40% increase in obesity
surgery in England in
20083
obese,
1 billion
The number of adolescents
In 2005 the cost of obesity in Australia
that are overweight has
was calculated as Aus $873million2*
trebled since 19801
Raised BMI is a risk factor for:
Cardiovascular disease (mainly heart disease and stroke) - already the world's number one cause of death, killing 17 million
people each year.
Diabetes – which has rapidly become a global epidemic. WHO projects that diabetes deaths will increase by more than 50% worldwide
in the next 10 years.
Musculoskeletal disorders – especially osteoarthritis.
Some cancers (endometrial, breast, and colon).Chronic disease management – Bupa definition
• Chronic disease management as a term is used loosely and can encompass a
variety of activities, all centred around supporting the health of an individual with a
chronic disease
• Clarity is required on why activity is being undertaken in this sector – to improve
health outcome of the patient or ensure cost-effective utilisation of healthcare
resources
• Therefore, in Bupa we are describing chronic disease management as:
“co-ordinated, pro-active, patient-centred, healthcare interventions and
communications for people with long term conditions to optimise the
quality of patient care & health outcome while minimising overall
healthcare costs”
(long term conditions are those conditions that are permanent and require
ongoing supervision, observation or care)”Tackling the issue of chronic disease requires both
prevention & management
• With the issue of chronic disease growing across the globe, there is a need to
ensure that chronic disease is prevented wherever possible and people with chronic
conditions achieve the best possible health outcomes:
Reduce emergence of Restore function/
symptoms reduce complications
Primary Early diagnosis Secondary Tertiary
Prevention Prevention Prevention
Chronic disease
We know that there a small
number of risk factors that management
cause the majority
of the chronic disease Once a condition has been
burden1 and that primary diagnosed, it is crucial that
prevention health outcome
& health promotion for the person is optimised
could prevent up to 70% of
the
disease burden2
1. WHO: http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/index.html
- high cholesterol, high blood pressure, obesity, smoking and alcohol
2. World Health Report 2008: Primary Health Care – Now More Than EverObjectives for managing chronic disease
• The hypothesis: it is possible to implement strategies that help people live
with and manage their chronic disease(s) that both:
• Optimise the health outcome for the patient
- In terms of ameliorating progression, preserving functionality &
reducing suffering
• Reduce or minimise associated healthcare cost
– Reduction in acute emergency interventions
– Reduction in overall hospital admissions related to poor management
of the disease (e.g. diabetic retinopathy)
– More pertinent use of primary care services
• The time period required to see effect could well be considerable
– Short term cost for long-term gain often a challengeExpectations of health
• Who pays if the government needs to control its costs? Less public money for health
will mean individuals will need to pay more for services or new forms or rationing may
be imposed.
• Uncertainty surrounds the level of care an individual should expect to be publicly
provided
“silver power” : older populations have increasing
economic and/or political power for two reasons:
• there are more of them numerically (e.g. more
votes)
• they are wealthier than previous silver generations
attributable to the long period of prosperity in the
post-war years
• An emphasis on personal responsibility, lifestyle and behaviour may become important
with the onus of responsibility on individuals.
– With more responsibility placed on individuals, access by individuals to the right
information to manage their lifestyle, health and behaviour would become more
important and a business opportunity for the provider and manager of that
information
• The economic and financial crisis from 2008 onwards has introduced financial as well
as attitudinal factors into the question of regulation and responsibilityChanging location of healthcare delivery
With increased
Technology as a disrupter formal care
Technology has the capacity to erode borders in In 2008, there were 410,000
healthcare and alter the provision of healthcare people in in nursing and
residential care.2 This figure is
Geographical location less fundamental; expected to increase to 493,0003
Provision of care outside clinic (home; by 2020
work; gym; pharmacy)
cross-border healthcare Population ageing is expected to lead to a burgeoning
Movement towards a less physician centred demand for aged care services over the coming decades
model of care: super-specialised medics and across all of our key markets
lower cost healthcare professionals Demand will be heavily influenced by care needs
which are reflective of the changing pattern of disease
Technological barriers a challenge: interoperability, associated with increased longevity, including an increase
data privacy, robustness etc in the prevalence of co-morbidity
Analytics
With healthcare spend spiralling and the electronic capture of clinical data, robust analytics are now
undertaken to:
Monitor health trends and needs Healthcare providers should expect increased scrutiny
Prove cost efficiency of interventions on the outcomes of care & cost efficiency of their services
Advise on most appropriate provision of careTelehealth can transform healthcare delivery
Remote healthcare On-line assistance and Condition monitoring Medication compliance
consultation information for self-
management
Delivery of healthcare Programmes and websites Mobile/fixed devices to monitor Devices that either remind
consultations remotely – that motivate and help key physiological markers patients to take medication
eg via webcam, email etc patients to manage their own (weight, blood pressure etc) or directly dispense to
health (eg diabetic diary) and send alert to physician if improve compliance
values fall outside defined values
All with the shared aim of minimising healthcare costs and improving patient outcome
Most activity is still at the pilot stage with this hypothesis still being tested.
This is an area of innovation with the evidence base being developed
Many bodies are funding research in this area (eg. WSD in UK, AAL across the EU, ARRA bill, NIH etc.)
The marketplace is fragmented with many emerging competitors.
It is expected to become increasingly crowded in the next 5 years.
Integration of services (and therefore different providers) is likely to be essential for successBupa’s approach to chronic disease is defined by 5
principles
1. Maximising the use of data, analytics & knowledge in all
activity
• Insight and outcome are both crucial
2. Utilising and demonstrating our healthcare expertise
• Both in healthcare & healthcare systems
3. Creating advantage for customers through our scale &
diversity
• Both frequency & geography
4. Building ongoing consumer engagement through
individualised outreach and empowering people to help
themselves
• This can be remote
• Create a symbiotic relationship throughout life
5. Treating the whole person, not the disease.
• Tailor to the individual – personalised interactionFuture trends
There are a number of factors that are likely to affect the future
of chronic diseases & their management
Funding
“New” chronic diseases & •Who will fill gap between need &
Genetics/evolution of medical ability to pay?
changing disease profile •Role of government, particularly in
technology •With medical advances, fatal prevention likely to increase
•Advances may require healthcare conditions may become chronic •Evidence of effectiveness – how will
systems to change •Huge anticipated increases in this evolve?
•Individual responsibility issues raised obesity & diabetes •Role of the employer likely to
•How might environment & lifestyle increase as the workforce becomes
be adapted? older
Location of provision &
consumer empowerment
•Increased transparency & Pharmaceutical company
consistency in the sector
interest
•Changing relationship with
•How will innovation be funded?
professionals & ways of interaction
•Role of the developing world in
(importance of both physical & virtual
developing new pharmaceutical
facilities)
products
•Different skill sets required in
healthcare professionals
•Management of information will be
criticalHealth Dialog Introduction
• Mission : To reduce unwarranted variation.
TM
SMHealth Dialog
• Unwarranted variation
Effective Care: “Proven effectiveness, no
significant trade-offs”
Beta blocker use among patients post heart
attack varies from 5% - 92%,
when it should be ~100%
Preference-Sensitive Care: “Involves trade-
offs, (at least) two valid alternative
treatments are available”
In Southern California, a patient is 6 times
more likely to have back surgery for a
herniated disk than in New York City
Supply Sensitive Care: “If they build it, you
will come”
Per-capita spending per Medicare enrollee
in Miami, Florida is almost 2.5 times as
great as in Minneapolis, MinnesotaHealth Dialog
• Solutions based on client need
> 25,000,000
Members
> 30,000,000
IndividualsAnalytics: finding and reaching the right person at the right time
A unique “Patient Profile” is created for each member from a
variety of raw data and derived data
Over 1,500 FACTS are maintained for each member on topics
ranging from up-to-date contact details to chronic gap scores.
35000 700
600
Predictive modeling is used to identify members with high
30000
Average Cost
25000 500
Admit Rate
20000 400
300
expected utilization and costs
15000
10000
5000
200
100
High risk and costly members are identified for specific outreach
0
0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-95 96-100
0 campaigns aimed at helping them better manage their health
Predicted Financial Risk Percentile
Enage Model: Cumulative Gains Rate
100%
90%
Claims, outreach activity, lifestyle and geo-census data, are used
80%
in models to help predict reach & engagement likelihood
Cumulative Response
70%
60%
50%
40%
30%
20%
10%
0%
Employing specific models allow Health Dialog to identify
0 10 20 30 40 50
Percentile
60 70 80 90 100
members most likely to engage self management supportWhole person health coaching
Summary
• Chronic diseases are a significant and growing issue across the globe
• There are a number of key factors driving the increase in chronic disease -
lifestyle & the ageing demographic are 2 key drivers
• With chronic diseases accounting roughly 70% of healthcare spend,
competencies in managing chronic disease will be needed by any
organisation responsible for health of communities or populations
• CDM is still an area of innovation: the evidence base is patchy (both in terms
of quality improvement & cost effectiveness) & still under development
• Tackling chronic disease requires both prevention and management
strategies - chronic disease management cannot be viewed in isolation
from prevention
• Bupa’s approach is patient centred and aims to improve health status and
reduce costs using analytics to define servicesYou can also read
