The company says, ‘in a genuine spirit of partnership’, that private health insurers are an ‘untapped resource’ for health funding.
Private health giant Bupa is once again rattling the health funding cage, calling for amendments to the Private Health Insurance Act 2007 to allow insurers to fund primary care-based activities like risk assessments and chronic disease management.
Bupa already operates 32 GP clinics and is in the process of acquiring Partnered Health’s 68 GP clinics; if successful, it will become the fifth-largest operator of GP clinics in the country.
While Bupa may be able to own and operate GP clinics, Australia prevents health insurance from covering out-of-hospital medical services that attract a Medicare benefit.
Over recent years, it has made various inroads into the primary care sector. As well as buying GP clinics, it has acquired mental health clinics and introduced free telehealth consults for members (given that Medicare famously does not subsidise telehealth between a doctor and patient who have not met face-to-face).
Today’s reform paper pushes the envelope slightly farther by explicitly proposing that the Private Health Insurance Act ben amended “to permit insurers to fund preventive health programs, early intervention and non-admitted care as substantive benefits, covering risk assessment, screening, health coaching, digital interventions, care coordination and chronic disease management, with eligibility determined by clinical effectiveness and value rather than whether care is delivered in an admitted hospital setting”.
It also recommended that insurers be allowed to “support coordinated care across the full health continuum, from prevention and early detection through to treatment and ongoing management, facilitating referral pathways and information exchange between insurers, GPs, specialists, allied health, pharmacists and hospitals”.
Allowing private health insurers into primary care and prevention, Bupa argued, would be a win for government and for patients.
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“Private Health Insurers are largely an untapped resource, that, if empowered by the right reforms, could help build a stronger prevention system focused on intervening before conditions develop,” the report said.
“Insurers have unique attributes that can help strengthen and expand prevention in the health system.
“Improving health outcomes through better management of chronic disease and reduced hospitalisations is key, and reorienting our healthcare system towards prevention and integrated, person-centred care, delivered by a flexible, multidisciplinary workforce and enabled by technology is a large part of the solution to tackling chronic disease.”
Other recommendations included aligning benefits with quality and recovery outcomes rather than admission or service volume, expanding Hospital in the Home and further streamlining pathways for overseas-trained doctors.
It also discussed, at length, the idea of moving Medicare toward a blended funding model by expanding MyMedicare.
Under Bupa’s plan, MyMedicare would be used to introduce a new, voluntary blended funding model with patient-linked funding for chronic and complex care. This would be of “sufficient scale to support genuine service redesign rather than operating as a marginal incentive layer”.
It would also require participating practices to “align internal remuneration arrangements with the model, including sharing flexible funding with GPs, remunerating clinical oversight and coordination activities, and appropriately supporting multidisciplinary workforce costs and practice infrastructure”.
Following this, it would use the GP Chronic Condition Management framework “as the foundation for progressively expanding blended funding beyond discrete care planning items”.
Bupa did, however, acknowledge that its reform plans were not intended to be prescriptive.
“This paper is … offered in a spirit of partnership and collaboration,” it wrote.
“It represents Bupa’s contribution to a broader conversation about how we can work together to improve health outcomes, strengthen sustainability and build a system that better meets the needs and expectations of Australians.”
Read Building a More Accessible, Modern and Sustainable Health System here.
