The uncertain future of Medicare

As Medicare turned 30 earlier this year, it was becoming increasingly obvious that cracks in the system could no longer be ignored. We were joined by Dr. Avnesh Ratnanesan (Dr. Avi), Founder & CEO of Energesse recently, where he talked to us about the challenges in the reform of Australian healthcare and the difficulty of envisioning a future of Medicare.

Dr. Avi will be launching a whitepaper, titled “The Future solutions for Australian Healthcare reform” at the Future of Medicare Conference, taking place on the 13th and 14th August at the Sydney Harbour Marriott Hotel.

Dr. Avi, in your opinion, what are some of the biggest challenges in the reform of Australian healthcare?

Dr. Avi: The first challenge is addressing where we want to go as a nation – what are our healthcare goals? When I speak at various healthcare conferences as ask the question to healthcare leaders in the audience as to what is the vision for Australian healthcare over the next 5-10 years, most people don’t know and neither do I. There is a lot of talk around cost maintenance and reduction, ‘sustainable health system’, etc, but no one really knows what that is apart from projections on rising healthcare costs. Issues like patient co-payments are merely a ‘symptom’ of this much deeper issue.

The second challenge that everyone in healthcare is aware of but rarely speak about is addressing the State V.S. Federal management of healthcare and the associated funding models. Whilst there is no such thing as a perfect funding model, most would agree that a greater degree of certainty in healthcare budgets would help the planning process for many healthcare organisations. The challenge we have with reforms is that it often follows 3 year political cycles when the healthcare needs of the nation are mostly predictable for the next 20-30 years. Whilst I am a strong believer of adapting strategies regularly, expecting major changes to 12 monthly budget cycles often significantly detract from effective long term programmes being implemented.

The third biggest challenge follows on from the first two and that is addressing the needs of an ageing population, which includes how we manage chronic disease. There is a lot of discussion around prevention and wellbeing but most sectors don’t really know how to implement these strategies effectively or even what the objectives should be. In order to reform our system to deliver better health outcomes, we need a clear understanding of what benefits we are looking for from prevention strategies before we implement them.

In the next five years, what would be the biggest improvement you’d like to see in Medicare?

Dr. Avi: I have to say that I love the fact that we have a Medicare system and one that is principled on egalitarianism and universal healthcare for all Australians. This is a fantastic proposition and we should continue to uphold this principle in all our dealings with healthcare.

At the same time, the needs of the population have evolved and so have technologies. Despite, many solutions in healthcare can be simple ones that we just have not implemented due to a lack of focus on what we really want to achieve.

Over the next 5 years, I would like to see continued localisation of resources for the needs of local communities. As we are a large country that is spread out geographically with great cultural diversity, the better we can do this, the better we serve the needs of the nation. I’m not sure that Medicare Locals was given enough time to deliver its outcomes, but some form of this should be maintained.

I would also like to see Medicare continue to engage with industry more as well as the PBS. As I mentioned, a big issue is that we deal with silos in healthcare, that often don’t talk to each other. We are also incentivising in silos which results in a lot of waste. So we need more openness and collaborations between government and industry, public organisations and private enterprise to ensure resources are better managed. It also means working with clinicians and healthcare professionals to understand their role as resource managers.

Finally, like many other leaders in the healthcare space, I would like to see Medicare try and test new models to incentivise integrated care and link better with technologies that allow it to happen. Our e-health initiative has a long way to go and is a perfect example of one of the projects we just need to persevere it and not allow politics or short-term thinking to deviate its true course.

You began your career as a medical doctor in the UK and Australia, and have now successfully founded 3 companies as CEO. Could you tell us a bit about your career journey?

Dr. Avi:  In my time as a medical practitioner, I worked across the medical systems of the National Health Service in the UK as well as the public and private health care system in Australia. Now as the CEO of Energesse, I also work with healthcare institutions in the US, and as a result, my team and I have developed a broad understanding of various healthcare systems in developed economies as well as some of their major challenges and opportunities.

After my time in clinical practice, I completed an MBA with Honours from the University of Queensland and spent 5 years in the biotech and pharmaceutical industry. Initially I managed Research and Development as well as marketing activities. However, in my last 2 years in industry I become more responsible for Innovation and Corporate Strategy with industry leader Pfizer Australia, with over $1 billion in annual revenue.

I then took a brief exodus from healthcare and spent several years as CEO of companies in the video and technology space, which gave me great insights into how innovation occurs in the creative industries and how quickly the speed of technology can move. I eventually sold one company to return to healthcare and initially managed a holistic wellness practice and supported a consumer-led Dr.ive for prevention in healthcare. The company then grew and evolved into a healthcare consultancy firm for larger health and wellness related organisations.

Energesse consults exclusively to healthcare and wellness CEOs, entrepreneurs, business owners, and leading practitioners on solving their greatest challenges, improving health outcomes and delivering superior financial results.  How does your experience solidify the quality of service you provide to the healthcare sector? 

Dr. Avi: I have over 15 years’ experience in healthcare and my team combined has over 80 years’ experience across different sub-sectors and geographic markets. My team and I also have real world experience across other industries which we bring ideas and insights back into healthcare.

The reality is that many areas of healthcare work in silos and are often looking for best practices within their own silo e.g. hospitals look for best practices from other hospitals or pharmaceutical companies look for innovation from other pharma companies. However, to be leading edge and to produce dramatic improvements in results (which is something the healthcare system in Australia really needs), we need to make some breakthrough progress and try new things – many of these ideas some from other markets or other industries, which is what we provide at Energesse.

Quality of service is also ultimately determined by results delivered. And results are determined by what you measure. One of the biggest challenges in healthcare, particularly in this information age is that we are swamped by measurements and data, and we are often measuring the wrong thing and patting ourselves on the back for it, but not really delivering what is needed to truly improve health outcomes. So a big thing that we need to ensure quality is firstly ensure we have objectives tied to true health outcomes for patients and employees, as well as for internal financial results.

You will be speaking at the Future of Medicare conference, what would be your key message to the conference audience? Is there anything else you are looking forward to at the event?

Dr. Avi: I have conveyed many of the personal ideas I will be covering at the conference, however at the event I will be presenting a White Paper called Future Solutions in Australian Healthcare, where we interviewed 20 of Australia’s leading healthcare CEO’s and Thought leaders on what they see as the challenges and opportunities for healthcare in the future. It is a deeply insightful piece of work that will really help shape where we need to go as a nation. We have some very big names involved across research and academia, hospitals, health insurance, medical devices, pharmaceuticals, aged care and many more. It is going to be very exciting.

I’m also looking forward to connecting with other industry leaders at the conference and bouncing off new ideas, it should be a great event.

Joining Dr. Avi at the upcoming The Future of Medicare Conference are the Honourable Catherine King, MP, Shadow Minister for Health and many other leading healthcare professionals including: Terry Barnes, Principal at Cormorant Policy Advice and Dr. Paul Bates, Chief Medical Officer – Australia and New Zealand at Bupa. For the detailed conference program and to register, please visit The Future of Medicare Conference website.

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