Health and wellness in the present day day GP practice · Health and wellness in the present day...

Health and wellness in the present

day day GP practice

SAMA Conference: September 2015

Sandton Convention Centre

© 2015 Towers Watson. All rights reserved.

Health and Wellness are generic terms

Health is defined as the overall mental and physical state of a person;

the absence of disease

Wellness refers to the state of being in optimal mental and physical

health:

About living a life full of personal responsibility and therefore taking

proactive steps for one's entire well-being

A person living life very well controls risk factors that can harm them

© 2015 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.

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Types of wellness

Physical wellness The physically well person gets an adequate amount of sleep, eats a balanced

and nutritious diet, engages in exercise for 150 minutes per week, attends regular medical check-ups, and practices safe and healthy sexual relations

Emotional wellness The emotionally well person can identify, express, and manage the entire range

of feelings and would consider seeking assistance to address areas of concern

Career wellness The professionally well person engages in work to gain personal satisfaction and

enrichment, consistent with values, goals, and lifestyle

Social wellness The socially well person has a network of support based on interdependence,

mutual trust, respect and has developed a sensitivity and awareness towards the feelings of others

Spiritual wellness The spiritually well person seeks harmony and balance by openly exploring the

depth of human purpose, meaning, and connection through dialogue and self-reflection

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Types of wellness

Financial wellness

The financially well person is fully aware of financial state and budgets, saves,

and manages finances in order to achieve realistic goals

Intellectual wellness

The intellectually well person values lifelong learning and seeks to foster critical

thinking, develop moral reasoning, expand worldviews, and engage in education

for the pursuit of knowledge

Creative wellness

The creatively well person values and actively participates in a diverse range of

arts and cultural experiences as a means to understand and appreciate the

surrounding world

Environmental wellness

The environmentally well person recognizes the responsibility to preserve,

protect, and improve the environment and appreciates the interconnectedness

of nature and the individual


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Why is health and wellness important?

Personal perspective

Healthy and well people are happier

Society is increasingly becoming health conscious

Employer perspective

Unlocking of full potential

Productivity

Absenteeism

Healthcare financing perspective

Overall sense of wellness prevents illness

Chronic diseases account for ± 75% of healthcare costs

Healthcare inflation is consistently outstripping consumer price inflation and

salaries

Many chronic diseases are preventable


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Employer perspective2015/2016 Staying@Work


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Global Survey

Employers completed the survey between May and July 2015

in North America, Latin America,

Europe and Asia

Countries/

markets

surveyed

34Employer respondents have

more than >10,000 full-time

workers

34%

APAC Participants

582

of the respondents have

their workforces located in

multiple countries and

respondents operate in all

major industry sectors73%

North AmericaParticipants598

1,669

Including

• China

• India

• Philippines

• Singapore

• And 9 others

• Canada • U.S.

242• Argentina

• Brazil

• Chile

• Colombia

• Mexico EMEAParticipants

247

• Germany

• Italy

• Netherlands

• Spain

• U.K.

• And 9 others

LATAM

Participants

51%

70%

40%34%

10%

50% 47%42%

64%

3%

Focus primarily on plandesign

Focus primarily ondirect financial

incentives

Rely primarily onproviders, medicalprofessionals andemerging delivery

system models

Focus primarily onstrategies to build the

health and well-being ofthe workplace and

culture

No strategy toencourage healthy

behaviors

Today

In 2018

Majority of organisations will increase their focus on building

the health and well-being of the workplace


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Source: 2015/2016 Global Staying@Work Survey

How would you characterize your organization’s primary strategy to encourage healthy behaviors, and what do you expect it will be in 2018?

Almost 2/3 of employers expect that building a culture of health will be the primary

strategy to promote healthy behaviour by 2018

Almost 1/2 of employers will be relying on providers and medical professionals


Growth in gross contributions pabpa since 2000

Growth in gross claims pabpa since 2000

Of GDP spent on health

Of health expenditure is in the private sector

55.6%

51.8%

8.9%

55.9%

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Cost and affordability of healthcare is an issue

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0

5

10

15

20

Health spending, % of GDP

Our healthcare expenditure compares to peers

Global Medical Trend 2012 – 2014


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GROSS 2012 medical trend 2013 medical trend 2014* medical trend

All Firms 7.7 7.9 8.3

Americas (ex US) 9.1 9.1 9.7

Asia-Pacific 8.4 8.8 9.3

Europe 5.3 5.2 5.4

Middle East/Africa 8.8 9.8 10.0

7.7%

9.1%8.4%

5.3%

8.8%

7.9%

9.1%8.8%

5.2%

9.8%

8.3%

9.7%9.3%

5.4%

10.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

All Participants Americas Asia-Pacific Europe Middle East /Africa

2012

2013

2014*

*projected

Source: 2013 /2014 Global Health Trends Survey

A substantial proportion of the expected inflationary trends

can be ascribed to chronic conditions

What are the top three conditions that cause the highest prevalence of claims?

33%

24%

5%

14%

19%

76%

29%

90%

4%

11%

20%

62%

29%

36%

60%

69%

21%

24%

9%

53%

41%

29%

35%

76%

4%

7%

2%

24%

15%

65%

51%

62%

69%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Substance abuse

Other

Mental health

Accident

Musculoskeletal/Back

Gastrointestinal

Respiratory

Cancer

Cardiovascular

Asia-Pacific

Americas

Europe

Middle East/Africa

Source: 2015/2016 Global Staying@Work Survey

South Africa is no exception

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0%

5%

10%

15%

20%

25%

30%

35%

31.4

31.6

31.8

32.0

32.2

32.4

32.6

2010 2011 2012 2013 2014

YE

AR

SChronic Disease Prevalence 2010 - 14

Average Age % ChronicSource: 2015 HQA Annual Report

Almost 1/3 of the population are registered for one or more chronic diseases

The population has aged by 1/3 of a year over a five year period

Chronic disease prevalence has increased by 6.82%

We are also experiencing increasing complexities

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0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 5.0%

Schizophrenia

COPD

Rheumatoid Arthritis

Bipolar

Cardiac Failure

Hypothyroidism

Ischaemic Heart Disease

HIV

Depression

Asthma

Diabetes

Hypertension

Chronic Disease Trends 2012-14

Additional Chronic Disease Prevalence

Source: 2015 HQA Annual Report

15%11% 10% 9%

19% 17%12%

22%

12%

20%

7%

25%

15%9% 7%

17%

49%

46%

30% 30%

63%

42%

38%

26% 46%

40%

33%

25% 47%

34%

31%

17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Basic medical/Outpatient Hospital/Inpatient Pharmacy Maternity

The bulk of medical expense increase is expected to come

from hospital/inpatient services

How do you expect the expenses related to the following service categories to change over the next five years?

Asia Pacific Americas Europe Middle East and Africa

Significant Increase Significant Increase Significant Increase Significant Increase

Moderate Increase Moderate Increase Moderate Increase Moderate Increase


South Africa is no exception

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29

30

31

32

33

34

35

36

37

132

134

136

138

140

142

144

146

148

2010 2011 2012 2013 2014

LIV

ES

PE

R 1

000C

OV

ER

ED

LIV

ES

LIV

ES

PE

R 1

000 C

OV

ER

ED

LIV

ES

Admission Trends 2010-14

# Lives Hospitalised # Hospitalised more than once


The response…

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The top cost management method in 2014 is to limit certain

services, thereby capping maximum claims for some

treatmentsWhat are the most effective tools you employ for managing medical costs?

91%

91%

68%

68%

77%

64%

59%

77%

41%

14%

5%

67%

73%

67%

61%

55%

37%

49%

22%

20%

39%

27%

65%

59%

71%

50%

50%

62%

32%

38%

53%

3%

29%

71%

59%

54%

47%

39%

44%

22%

20%

15%

31%

8%

71%

68%

63%

55%

51%

48%

37%

32%

28%

25%

18%

Limits on certain services

Pre-approval for scheduled inpatient services

Contracted networks of providers for all treatments

Contracted networks for specific care

Pre-approval for diagnostic or advanced tests

Wellness/Wellbeing features

Second medical opinion

Chronic condition or disease management programs

Coverage for catastrophic claims

Alternative cash allowances (for using public facilities instead ofprivate care)

Stop-loss insurance

Middle East/Africa

Europe

Americas

Asia-Pacific

All Firms


As in prior surveys, respondents identified member

coinsurance as the most typical cost-sharing approach in all

regions but EuropeHow typical are the following cost-sharing approaches for the medical products you offer?

16%

54%

13%

27%

5%

47%

17%

7%

35%

21%

9%

5%

9%

4%

14%

22%

26%

17%

27%

16%

26%

35%

48%

8%

26%

21%

36%

14%

60%

21%

23%

52%

14%

42%

14%

43%

15%

33%

14%

44%

15%

19%

36%

70%

31%

42%

41%

10%

6%

29%

32%

36%

12%

15%

38%

41%

24%

38%

18%

11%

33%

23%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Member coinsurance

Annual deductible

Annual limit on out-of-pocket expense

Premium cost sharing with employees

Asia Pacific Americas Europe Middle East and Africa

Very Typical Very Typical Very Typical Very Typical

Typical Typical Typical Typical

Occasionally Occasionally Occasionally Occasionally

Never Never Never Never


30%

18%

39%

36%

15%

34%

41%

18%

18%

22%

27%

31%

12%

18%

21%

20%

19%

12%

9%

11%

14%

15%

23%

19%

34%

48%

25%

21%

59%

33%

14%

43%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Personal Health Risk Assessment/Appraisal (HRAQuestionnaire)

Employee Assistance Plan (EAP)

Biometric Screenings (and/or Annual Physical/Check-up)

Second medical opinion

Tobacco Cessation Assistance

Chronic condition or disease management program

Lifestyle and Health Education

Fitness programs/challenges (including pedometer)

Offered through our insurance services

Offered by a partner

Not offered, but plan to offer in next 12 months

Not offered, and no plans to offer in next 12 months

The percentage of respondents that say they offer health

promotion features (either directly or through a partner)

continues to growDo you currently offer any of the following wellness features?


A look at some South African experience

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Approaches to Heath Promotion

Primary prevention

Risk reduction by altering behaviours

Vaccination

Secondary prevention

Screening

Tertiary prevention

Modification of risk factors that are already in existence


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-2.00

-1.50

-1.00

-0.50

0.00

0.50

1.00

2010 2011 2012 2013 2014

Primary Care Maternity HIV Chronic Diseases

The trends pertaining to health promotion are encouraging


In elderly people influenza is a major cause of hospitalisation and

mortality during winter months

Vaccination is highly effective at reducing mortality and morbidity from

influenza

Vaccination can produce a 50% reduction in cases of respiratory

illness, pneumonia, hospitalization and mortality

Immunisation of older people against influenza is likely to be one of the

most cost-effective primary healthcare interventions available

British Journal of General Practice


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Primary Prevention: Flu Vaccinations

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0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

2010 2011 2012 2013 2014

Flu vaccine coverage >= 65years(%)

Primary Prevention: Flu Vaccinations


The USPSTF recommends screening for colorectal cancer using fecal

occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning

at age 50 years and continuing until age 75 years.


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Secondary Prevention: Colorectal cancer screening


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0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

2010 2011 2012 2013 2014

Colorectal cancer screening ≥ 50 yrs in previous year (%)

Secondary Prevention: Colorectal cancer screening



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Source: Screening for Cervical cancer: Clinical Summary of USPSTF recommendation. AHRQ Publication No. 11-05156-EF-3, March 2012

Secondary Prevention: Cervical Cytology

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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2010 2011 2012 2013 2014

Cervical Cytology coverage (previous 3 years)(%)

Secondary Prevention: Cervical Cytology


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The USPSTF recommends biennial screening mammography for

women 50-74 years.

Secondary Prevention: Mammography

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0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

2010 2011 2012 2013 2014

Mammogram coverage ( ages 50-74 years in previous 2 years)(%)

Secondary Prevention: Mammography


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0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

2010 2011 2012 2013 2014

COPD IHD Asthma HIV Cardiac failure

Chronic Disease Management: Flu Vaccinations


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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

2010 2011 2012 2013 2014

COPD IHD Asthma HIV Cardiac Failure

Chronic Conditions: Condition-specific Admissions


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40.0%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%

54.0%

2010 2011 2012 2013 2014

HbA1c coverage for Diabetic patients (%)

Chronic Disease Management: Diabetes


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0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

2010 2011 2012 2013 2014

Diabetes - Once Diabetes - More than once

Diabetes: Condition-specific Admissions


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0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

2010 2011 2012 2013 2014

Diabetes - Once Diabetes - More than once

Diabetes: All-cause admissions


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Delivery mechanisms and systems

Patient related issues

Funding and reimbursement

models

Some food for thought…


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