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What is 'a PHInsight'?

A PHInsight is a series of data-derived perspectives that reveal opportunities to enhance health fund performance or to reduce likelihood of adverse performance. Each PHInsight has application that can aid a health fund to either (1) reduce benefit outlays; (2) reduce management expenses; or (3) raise policyholder retention and amplify marketing return on investment. The perspectives we provide support fund leaders to make the right decisions for their specific fund. If you work with a subscribing fund you can access all PHInsights but we recommend investing quality-time ONLY on the ones topical to your domain. Those are the ones that save you the most time and help you get your Fund to the best outcome more seamlessly.

We say this because we want to ensure PHInsights gives you back maximal times savings.

  • Outlay savings available right now

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    Data-derived views on benefit outlay savings and return on investment available today, without us needing to wait for any latent innovation. We review the landscape of OHSI Providers and walk through the merits, challenges and risks associated with the programs and point to what is required to reap cost savings and enhance policyholder health outcomes with OHSIs today. With support from our Clinical Panel.    

    How you might use the report


    • Ensure you are across the service provision options
    • Start thinking about changing your current OHSI settings 
    • Familiarise yourself with our OHSI Data Tools and the OHSI PHInsights we will deliver later in FY25
  • ME Composition Secrets

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    Findings from our inaugural anonymised ME Composition survey. As part of this we investigate the range of expenditures across call centres, claims processing centres, marketing and other fund functions. We look for patterns on absolute expense in those domains as well as per policyholder indicators. We expect to uncover large variations in compositional expense of different functions even in relatively similar sized funds (whilst keeping everything anonymised).

    How you might use the report


    • Get familiar with our ME Composition Benchmark 
    • Think about how you might want to use it and who to engage with in your Fund
    • Back of mind consideration on future functional changes as sufficient data comes to light
  • Most Trusted Funds

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    Most Trusted Funds - Building on our ‘Policyholder Trust in Fund’ Data Tool (which is based on 1,000 telephone survey every week) we explore trust levels across health funds. The goal is to uncover underlying factors that contribute to trust, offering health funds clear direction on how to adjust their services and strategies to better meet policyholder expectations and enhance satisfaction. These insights will support funds aiming to understand and improve their standing among policyholders.

    How you might use the report


    • Cross-refer our Policyholder Trust in Fund Data Tool for context specific to your Fund and see if Trust findings for your Fund apply elsewhere 
    • Start contemplating what you can do to enhance trust setting in your Fund, noting that we will publish more on this in future
  • Clinical and economic efficacy of OHSI Programs

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    We uncover results of our expert, independent clinicians’ views of the OHSI programs available today including what health benefits are delivered and whether those health benefits may translate into avoided health problems / hospital admissions. To the extent possible our Commercial Panel then translates those findings into a sectoral evaluation of cost savings presently being realised, both on a per policyholder basis, a per Fund basis and at the sectoral level. Remember these are very early days in our journey into OHSI delivery. In future we expect to find many more OSHI opportunities which will add to the savings – and we will initiate the dialogue on those outlook innovations here.

    How you might use the report?


    • Deepen your understanding of what you can be offering to policyholders
    • Feedback to us how helpful was our review and whether you want to guide our approach to OHSIs exploration in future.
    • Start thinking about your long term OHSI strategy - albeit there is still a lot of research / data coming from us yet, so nothing need be set in concrete
  • Management Expense - Take 2

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    We delve into the 2nd ME Composition benchmark findings, examining cost pressures across different functions within health funds. This analysis seeks to identify not just the areas under financial strain but also potential efficiencies emerging from the data. By comparing current findings with initial benchmarks, we aim to spotlight trends and opportunities for cost optimization, providing actionable insights for funds looking to enhance operational efficiency and financial health.

    Curiously, some of the smallest funds have proven themselves to be the most efficient managers of the policyholder proposition. This paradox is all the more intriguing given there should be considerable economies of scale - in some instances, leading entities are 20 times larger than their peers, yet incur greater costs pr policyholder to manage their business.

    How could this be?

    Could the co-operatives within PHI – namely the Australian Health Service Alliance (AHSA), the Australian Regional Health Group (ARHG) and HAMBS fully explain the paradox? Or are there additional factors at play? As we probe further, we spotlight a few funds who've long reigned as paragons of efficiency – we dissect those Funds’ financials to conjecture their successful strategies.

    How you might use the report?


    • Know how your Fund is travelling on administrative expense and, if desired, share it with your Board.
    • Join our anonymised management expense benchmark to ensure you have the best available intelligence on your Fund compared to peers. 
  • OHSI Savings in five years

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    In 2012, 0.8% of hospital treatment outlays were in the form of OHSIs. Today, twelve years later, 0.9% of hospital treatment outlays in in the form of OHSIs. Have we really been that slow? And what do we have to do to realise the 11% potential that Private Healthcare Australia's May-2023 Report 'There's no Place Like Home' found is realisable? For this one, our Clinical and Commercial Panel once again join forces to identify gaps in the service proposition and what we need to do to rectify the situation. In this PHInsight we will consider the the future potential of the following programs:

    • Integrated care co-ordination for patients with co-morbidities;
    • In home patient monitoring and wearable technology; 
    • More hospital substitution and inpatient rehab substitution;
    • Population health based hospital avoidance flags; 
    • Post cardiac event rehabilitation;
    • Group psychological services;
    • Home based mental health admissions;
    • Aged care admissions avoidance;
    • Clinician-directed chronic disease management programs;
    • Capitated funding for GPs to manage complex patients;

    We then model the deceleration in premium inflation that some of those initiatives could realise pre and post risk equalisation. We also stress the advantages of collective efforts, where many funds work in concert to realise scale and minimise complexity. We believe that only collective and co-ordinated efforts will propel significant advancements in the decade ahead. 

    How you might use the report?


    • Strategically time your OHSI campaigns based on market readiness
    • Optimise your Fund's OHSI Business Case & OHSI Plan
    • Use our models to determine whether your Fund's preferred initiative for reducing benefit outlay makes a solid Business Case
  • Lapse attacks!

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    What have we learned ten months hence our 'Lapse Projector' Data Tool and consumer market surveys (1,000 people surveyed weekly).

    Firstly, does the Data Tool actually work? Meaning if our data sets predict elevated lapse rates then do they translate into elevated lapse rates once the real results roll in? Projections are almost always wrong and we're sure the early projections we make on Lapse outlook based on our weekly consumer surveys will be wrong initially - but what have we got right?

    What does this deep data set tell us about actual lapse experience and therefore what does it tell us about next year? Moreover can we reliably tell you what types of policyholders are looking vulnerable and provide actionable insights to help you minimise leakage?

    At time of writing (April-24) we don't know. But when this PHInsight hits the press we will know a lot more and, almost certainly, there will be take-outs your Fund can use to help it hold onto more policyholders. The earlier you get onto this (before other funds do) the greater the benefit ill be for your Fund and your own personal marketing insights.

    How you might use the report?


    • Get across these insights before other funds do to ensure you can maximise value from it and hold onto the greatest possible share of your policyholders
    • Identify novel marketing strategies to help you gain policyholders
  • Valuing Lifetime Policyholder Relationships: Unveiling the Bigger Picture!

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    In this report, we focus on the compelling advantages of adopting lifetime policyholder valuation models. Understanding the long-term value of policyholders provides a holistic perspective, helping Funds to make informed strategic decisions. By quantifying the total projected revenue from a policyholder over the entire relationship tenure, these models provide critical insights that go beyond short-term financial metrics. They guide Funds in identifying key policyholder segments, prioritising customer retention strategies, and shaping personalized products and services.
    We've constructed these models with versatility in mind, enabling you to compare the relative merits of acquiring policyholders through (a) organic channels, (b) intermediary channels, and (c) merger and acquisition activity. These tools offer clarity in decision-making, helping you ascertain the circumstances under which it would be most beneficial for your Fund to pursue each of these avenues. Utilize them to strategize your policyholder acquisition methods effectively and optimally.

    How you might use the report?


    • Undergird you marketing strategy with quantitative evidence that either endorses or helps fine-tune your plans.
    • Strategize your policyholder acquisition methods effectively and optimally
  • Embrace Risk Sharing - can you minimise outlays with targeted incentives to OHSI providers?

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    Offers a strategic exploration into how health funds can leverage risk-sharing agreements with OHSI providers to significantly reduce outlays. This PHInsight focuses on crafting targeted incentives that align provider behaviour with fund goals, driving cost efficiencies and enhancing policyholder value. Through in-depth analysis and practical case studies, learn how innovative contracting can pave the way for sustainable health service delivery and financial health.

    How you might use the report?


    • Start thinking about risk sharing models for future reference
    • Let us know what you think of these (somewhat bold) calls and give us some guidance if you influence our direction on this crucial topic