AUTUMN 2011 ISSUE : HEALTH INNOVATION

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1 AUTUMN 2011 ISSUE : HEALTH INNOVATION A DVA N C I N G H E A LT H C A R E I N T H I S I S S U E W e l c o m e A B O U T B U PA R e s e a r c h - Retinal scanning to detect CVD - Health coaching validated by RCT I n n o vat i o n - Detecting risk of heart failure before clinical symptoms - New low-cost IOL trial is showing promising results - Healthy weight for life - Reducing unwarranted healthcare variation PA R T N E R S P O T L I G H T - Garvan Institute of Medical Research N e ws - Australians concerned about care for the elderly - Improving veterans and war widows health - Australians turning to cyberspace to self diagnose - Drop the salt campaign

2 A DVA N C I N G H E A LT H C A R E W E LC O M E Bupa is committed to using its local and international expertise to improve the health of all Australians. Richard Bowden, Managing Director, Bupa Australia At Bupa, we take seriously our responsibility to support the more than three million Australians who put their health in our hands. We are proud to be an integral and active part of Australia s healthcare system, working towards better health outcomes for all. Over the next few years, Bupa will be investing more than $30 million in a number of initiatives aimed at reducing the burden of chronic disease in Australia, including health coaching, supporting clinical trials, and through patient education programs. The Bupa Health Foundation, with a focus on building better health for all Australians, is currently partnering with leading medical and research organisations on 60 programs nationally worth a combined investment of around $17 million. Across the world, healthcare is facing four key challenges: ageing populations, rising chronic illness, growth in demand for, and cost of, services, and an increasing desire by individuals to have more choice and control over their treatment and care. Health innovation has always been central to Bupa and we believe we can play a pivotal role in helping Australia successfully address these and other healthcare challenges. This inaugural issue of Advancing Healthcare shines the spotlight on how Bupa, together with our health partners, is using innovative thinking and approaches to help all Australians lead longer, healthier, happier lives. Richard Bowden, Managing Director, Bupa Australia A B O U T B U PA Bupa is a leading healthcare company in Australia and provides health cover to more than three million Australians through our trusted and respected brands, HBA, MBF and Mutual Community. Being part of Australian life for over 60 years, we understand the importance of helping Australians to manage their health for the longer term. Bupa extends beyond health insurance. We also provide aged care services with Bupa Care Services, health coaching with Bupa Health Dialog, corporate wellness services with PEAK Management and optical care with Blink Optical. We also provide the assurance of being part of a secure international family the Bupa Group which cares for over 33 million people across 190 countries. We ve drawn on this knowledge and expertise to provide Australians with better healthcare services, support and advice. We exist to help Australians live longer, healthier and happier lives. A dva n c i n g H e a lt h c a r e Subscribe to receive Bupa s Advancing Health e-newsletter. Contact: advancinghealthcare@bupa.com.au Bupa Australia Pty Ltd ABN Trading as HBA, MBF and Mutual Community P

3 R E S E A R C H R e t i n a l s c a n n i n g to d e t e c t C V D 2010 marked the close of a very exciting Bupa Health Foundationfunded research program conducted at the University of Melbourne s Centre for Eye Research Australia (CERA). The study looked at how a simple retinal scan could act as an early detector of cardiovascular disease (CVD). By studying the images of thousands of retinas over time, and tracking the development of heart disease and stroke, Professor Tien Wong and his team found that retinal blood vessel damage signalled early signs of CVD, allowing the possibility of intervention, awareness and improved self management while patients were still outwardly healthy. Angina, infarct, heart failure, transient ischemic attack (TIA) and stroke can all be notoriously debilitating once symptoms arise, so early diagnosis is crucial to improving individual health outcomes and quality of life. Successful reduction in CVD would also ease pressure on the health system and could save countless billions of dollars in health costs. Being fast, and importantly non-invasive and practical, a retinal scan should be available within two to five years and is capable of being integrated into routine optical tests. Professor Tien Wong Head, Retinal Vascular Imaging Centre, CERA Health coaching validated by RCT The efficacy and cost benefits of telephone health coaching have recently been reported in a randomised control trial published in the September 2010 issue of the prestigious New England Journal of Medicine. In the largest trial of its kind, involving more than 174,000 individuals, the study found that for Health Dialog s services: There was a 10.1% reduction in annual hospital admissions; The cost of delivering personal health coaches was considerably less than the savings it generated; Average medical and pharmacy costs were lower for those supported and coached. This is good news for up to 40,000 Bupa customers with chronic disease who will be offered telephone health coaching by Bupa Health Dialog, which began operating in Australia in November Bupa Health Dialog is a stand-alone Bupa company offering wellness, prevention and health coaching services to the not-for-profit, private and public sectors.

4 I N N OVAT I O N D e t e c t i n g r i s k o f h e a rt fa i lu r e b e f o r e c l i n i c a l sy m p to m s For the past four years, researchers at Monash University s Centre of Clinical Research Excellence in Therapeutics have been using a simple blood test to detect heart failure before symptoms are evident. Initiated and funded by Bupa, SCREEN-HF is the world s first and largest study into brain natriuretic peptide (BNP) in people at risk but without symptoms of heart failure. The ethics approved study has followed over 4,000 Bupa (HBA) members in Victoria at high risk of heart failure, but without known disease, in order to determine whether the BNP hormone in their blood can predict the development of symptomatic heart failure. On the strength of the preliminary data, Bupa has become the first organisation in the world to implement a heart failure screening program, the BNP test, at no additional cost to selected high risk customers nationally, commencing in Victoria. Pending the final report showing a positive result, Bupa will advocate for the test to have Medicare listing to make it affordable for all Australians, said Bupa s Head of Medical Services, Dr Bert Boffa. While the final report is due for publication later this year, preliminary results have shown that in elderly people with higher BNP levels the heart muscle was not pumping well even though they had not yet noticed any clinical symptoms. N e w low- c o s t I O L t r i a l i s s h ow i n g p r o m i s i n g r e s u lt s Bupa has been instrumental in setting up a study that has the potential to reduce the cost of intraocular lens (IOL) used in cataract surgery by up to 90 per cent. The study, a collaboration led by Bupa, the Victorian State Government and other parties, has been comparing the clinical outcomes of the current high-cost IOL with a low-cost IOL produced by the Fred Hollows Foundation at one-tenth of the price. The good news is that preliminary results indicate that the IOLs are clinically equivalent. This study is a demonstration of the benefits of industry working in partnership with government and the not-for-profit sector to improve the quality and affordability of healthcare. Dr Bert Boffa, Head of Medical Services, Bupa H e a lt h y W e i g h t fo r L i f e The path to joint replacement for most people is long and painful but an innovative partnership between Bupa and Prima Health Solutions aims to help sufferers of hip and knee joint osteoarthritis either avoid the need for surgery, or reduce complications and improve recovery and rehabilitation should it be necessary. The Healthy Weight for Life Osteoarthritis Program, which targets multiple important and modifiable risk factors including excess weight and low muscle strength, is offered to eligible Bupa customers (BMI>30) at no additional cost. Designed to be offered through GPs, orthopaedic surgeons or rheumatologists, the 18-week program includes eating and exercise plans, online coaching and self-monitoring, and telephone motivation, support and advice.

5 I N N OVAT I O N R e d u c i n g u n wa r r a n t e d h e a lt h c a r e va r i at i o n With chronic disease affecting four in five Australians and representing almost 70 per cent of the nation s health expenditure, Bupa Health Dialog aims to help people better manage their health conditions while also reducing medical costs for both the individual and the healthcare system. Bupa Health Dialog s services, which are grounded in Health Dialog s more than 30 years of academic research, clinical excellence and evidence-based healthcare, include telephone health coaching, decision-support tools and health risk analytics. Bupa Health Dialog s analytics services address unwarranted variation by looking at the differences in care and treatment that individuals receive for comparable conditions that cannot be accounted for clinically. Analytics can also identify the individuals who are most likely to gain the greatest health benefit from preventive coaching. With a better understanding of healthcare needs and by reducing levels of unwarranted variation, it becomes possible to design healthcare provision to meet the needs of the population more efficiently, which improves patient outcomes and experiences, said Brett Comer, General Manager, Bupa Health Dialog. Visit bupahealthdialog.com.au for more information. Bupa Health Dialog offers evidence-based integrated care-management services across the continuum of supported self-care, chronic disease management and case management. Supported self-care Population health anylitics Case management Disease management Prevention and wellness promotion Evaluation of outcomes The continuum of supported self-care PA R T N E R S P OT L I G H T G a r va n I n s t i t u t e o f M e d i c a l R e s e a r c h The Bupa Health Foundation has been a proud partner of The Garvan Institute s osteoporosis research since 2005 with the aim of improving treatment rates and outcomes for people with osteoporosis. Often referred to as the silent disease, osteoporosis is a serious and disabling condition that affects around two million Australians and is estimated to cost the Australian healthcare system $7 billion a year. The Garvan Institute is at the forefront of research into the causes and treatment of osteoporosis, which, according to lead researcher Professor John Eisman, has long been underestimated, misdiagnosed and poorly treated. In 1989 The Garvan Institute commenced what is now the world s longest running longitudinal study of measurements in bone density of both men and women. Researchers have now observed the skeletons of two thirds of the people above the age of 60 in the central NSW town of Dubbo for over 20 years. Some of the important findings from the study have included that osteoporosis is much more prevalent in men than previously thought with almost one in three older men and one in two older women affected. The study also found that for those who suffer any type of fracture they are at high risk of repeated fractures and more likely to die prematurely. One of the most recent and exciting new findings of the study is that people taking bisphosphonates for the treatment of osteoporosis are not only surviving well but appear to be gaining an extra five years of life, said Professor Eisman. The research findings were recently published in the Journal of Clinical Endocrinology and Metabolism. Professor John Eisman, Director, Bone and Mineral Research Program, Garvan Institute of Medical Research

6 N E W S Au s t r a l i a n s c o n c e r n e d a b o u t c a r e f o r t h e e l d e r ly Au s t r a l i a n s t u r n i n g to c y b e r s pac e to s e l f - d i ag n o s e Care for the elderly, shortage of hospital beds and waiting times in emergency departments are the aspects of the current public healthcare system Australians are most concerned about, according to the latest Bupa HealthWatch Poll. While there is little difference in the levels of concern between Australians living in capital cities versus those living in regional and rural Australia, the latter expressed the most concern about the shortage of doctors; waiting times to see a specialist; and the difficulty with getting an appointment to see a GP. When comparing the results of this year s Poll with Bupa s 2009 HealthWatch Survey, it appears that there has been a shift in concern away from lack of funding for healthcare by Government to aspects of healthcare delivery. Visit bupa.com.au to download the Bupa HealthWatch Poll report. Bupa to help improve veterans a n d wa r w i d ow s h e a lt h Veterans and war widows with chronic disease will benefit from a new partnership between the Department of Veterans Affairs and Bupa Health Dialog that aims to help them better access co-ordinated community-based care. Bupa Health Dialog has won the tender to deliver major elements of the Department of Veterans Affairs fouryear $152.7 million Co-ordinated Veterans Care Program. Drawing on Health Dialog s world-leading analytics services, Bupa Health Dialog will identify those veterans and war widows with chronic health conditions who are most at risk of hospitalisation and whom would benefit from an enhanced level of healthcare and management. Australians are potentially risking their health by relying on unreliable online information to self-diagnose medical conditions, warns Bupa s Dr Christine Bennett. According to the recent Bupa Health Pulse international healthcare survey, of the nearly 80 per cent of Australians who go online for health information, nearly half (47%) look for information to make a self-diagnosis while 70 per cent use the internet to research medicines. Australians also have a desire to use online sources to help them manage their own health, with 61 per cent of respondents supportive of having access to a secure internet site where they can access their own medical records and test results online. The survey also found that more than half (56%) of Australians would like to be able to book a doctor s appointment online, while 52 per cent would like to order repeat prescriptions online. While the internet can empower people to make better informed choices about their health it can also mislead, which may result in people dismissing serious symptoms or commencing inappropriate treatments, said Dr Bennett. It is essential that people access online health information from high-quality, credible websites and that they speak with their doctor if they have any serious concerns. Visit bupa.com.au to download the Bupa Health Pulse report. D r o p t h e s a lt c a m pa i g n Dr Stan Goldstein, Head of Clinical Advisory, Bupa. Getting across to men just how bad salt is for their health was the focus of a recent debate hosted by The George Institute for Global Health as part of World Salt Awareness Week. Attendees of the debate, chaired by Dr Stan Goldstein, Bupa s Head of Clinical Advisory, heard about the large body of evidence showing the negative impact of salt on health and how it contributes to high blood pressure, which kills thousands of Australian men each year mostly through premature strokes, heart attacks and heart failure. Excess salt is also implicated in a range of other serious illnesses including stomach cancer, kidney disease, osteoporosis and asthma. Australian adults eat an average of nine grams of salt each day; much more than the one gram or so needed and far more than is healthy, explained Professor Bruce Neal, Senior Director at The George Institute and Chairman of the Australian Division of World Action on Salt and Health (AWASH).