In this interview, Osana CEO Dr Kevin Cheng talks to Rebbeck Consulting Managing Director, Jay Rebbeck, about how Osana is applying the principles of population health management and value-based healthcare to create a pioneering new model of General Practice in Australia.
This interview first aired on 29 May at the 2018 National Primary Health Network Commissioning Showcase in Newcastle.
Here is the full interview transcript:
Dr Kevin Cheng’s Background
JAY REBBECK
I’m delighted to be joined today by Dr Kevin Cheng, the Founder and CEO of Osana and he’s going to tell us a little bit about the Osana journey and his plans for Osana over the coming years.
Can you start by telling us a little bit about your background in healthcare and your journey so far?
DR KEVIN CHENG
Sure Jay. I’m an Australian trained GP. I’ve got an interest in helping patients with long term health conditions and in more recent years I’ve been helping government and private healthcare companies build new models of healthcare.
Australia’s Healthcare Challenges
JAY REBBECK
What do you see are the biggest challenges in delivering high quality and financially sustainable healthcare in Australia over the coming decades?
DR KEVIN CHENG
The first thing that comes to mind is we’re going to run out of money. Treasury tells us that by 2046 we will sink all of our state revenues into healthcare so no more money for schools and highways and what-not.
I think predominantly our payment model is focussed on paying for activity most of the time and not really rewarding quality outcomes and also providing a way that we can invest more into prevention. Up to about a quarter of health care costs can be avoidable if we invest in primary, secondary and tertiary prevention.
The Osana Model
JAY REBBECK
So, what is Osana and how will it address the challenges that you’ve just outlined?
DR KEVIN CHENG
Osana is a primary care value-based service primarily focusing on delivering quality outcomes. We are going to share in the responsibility of patient outcomes that health system outcomes.
We are a service that focuses on being proactive about population health not just reacting to when patients get sick and we really want to reward clinicians to invest in good prevention and good quality care, what we call ’slow medicine’.
The Osana Patient Experience
JAY REBBECK
What will the experience be like for patients who are going through your clinics?
DR KEVIN CHENG
The experience for patients will feel different. They will not only get a GP but a team that will really focus on their prevention and make sure they are getting the best services and access to deliver the best outcome for them.
They will be able to experience a range of activities in the clinic like education classes, community events to really activate their understanding of health and to network with others and healthcare will be easy for them. They will be able to call their health assistant or GP. They can have consults for simple things over the phone or via video. We will go to them rather than necessarily patients coming to us.
The Osana GP Experience
JAY REBBECK
How do you think it’s going to feel different for GPs working in an Osanacare clinic?
DR KEVIN CHENG
We want the experience to be quite different for GPs actually. We want them to slow down and practice ‘slow medicine’, spend more time with less patients. We are paying GPs a salary to really separate from the pressures of fee-for-service.
The second is we are providing a clinical and non-clinical helper for each GP. So, in fact, they are direct reports to the GP. The GP runs a team that looks after a population proactively as much as possible and the role will be quite varied as well. At times they will be seeing patients – sometimes doing home visits, doing telehealth, they will be running patient classes, they will be having case conferences with specialists and running team meetings. So, we think the variety will be an important part of changing that experience for the GPs.
The Importance Of Value-Based Healthcare
JAY REBBECK
How do you define outcomes-based healthcare and why is it so important?
DR KEVIN CHENG
I’m a firm believer in the quadruple aims of healthcare improvement. So, we want to keep patients healthy, happy, make sure our staff are satisfied in working in a new model of care, and make sure it’s sustainable and cost effective for the health system at large.
More than anything I think it’s important we are all accountable for how taxpayer’s money is being used in the healthcare dollar.
How Osana Is Embracing Value-Based Healthcare
JAY REBBECK
How will the Osanacare model help us move towards outcomes-based healthcare?
DR KEVIN CHENG
We are really going to focus on outcomes, measuring outcomes and make sure that is really part of our DNA. We are going to be engaging with patients, importantly, to be partners in their healthcare – so really focusing on patient activation, education and making it easy and convenient so having a bus and providing tele-consults and going to see people in their homes and we are also providing GPs with a team – so every GP has a clinical helper and a non-clinical helper to really focus on prevention.
JAY REBBECK
From your personal perspective, what was the tipping point in making you realise that we just have to fundamentally move away from our fee-for-service model towards incentivising outcomes-based healthcare?
DR KEVIN CHENG
When I look at healthcare compared to other industries I’ve worked in, it seems to be completely opaque in terms of performance and transparency on outcomes. So that’s one big thing that I realise compared with other sales and service organisations and industries.
The second thing is when I talk to patients it’s actually quite challenging to navigate our health system, particularly with chronic health conditions. They don’t always fit into 10 and 15-minute appointments.
And thirdly, there is a huge opportunity to deploy more technology and up-to-date systems to make healthcare delivery a lot more relevant.
The Rollout Of Osana In Sydney And Nationally
JAY REBBECK
Great, so could you tell us a little bit about the three phases of the Osanacare rollout?
DR KEVIN CHENG
In phase one, what Osana is trying to do is to build and test a new model of care in a handful of clinics in Sydney.
In phase two we will be measuring outcomes week by week and from day one. We are going to be working with university partners and we’re going to be taking those outcomes to government to health insurers and also publishing our results.
The third phase is to move this model inter-state and hopefully have other GPs pick this up and be able to provide this to their patients.
JAY REBBECK
Assuming phase 1 is successful in creating that evidence base that shows that ‘slow medicine’ really does work, how are you going to scale the Osanacare model nationally?
DR KEVIN CHENG
First will be to invest up front in evaluation, making sure that we are collecting data properly from day one, sharing data back to our clinicians and also with our university partners along the way. Then, once we get runs on the board, is to take that to government and health insurers.
Second, we want to mobilise the medical community. We now have over 200 GPs that want to work under this model across the country and it’s really making sure that they are excited to lead the teams that help patients in the right way and over time we want enough attention and pull from clinicians who are wanting to work in this model.
Third is to change public opinion around what healthcare should feel like, principally by providing a different experience to healthcare.
Advice For PHNs Moving To Outcomes-Based Commissioning
JAY REBBECK
What three pieces of advice would you give to Primary Health Networks who are looking to embark on this brave new world of outcomes-based commissioning?
DR KEVIN CHENG
That change is a big one and change programs typically fail. So, I would say number one is to invest in clinical leaders who really know the front-line and can lead teams through that front-line change.
Number two is to invest in the skills required for population health management and how to be proactive about patient care rather than just reactive when patients are sick and turn up.
The third is to just do it – to test and learn, get real time feedback which I suppose is the best way to stand up a new model of care.
JAY REBBECK
Thank you so much for taking the time to share your experiences with us today. We really wish you the very best of luck in rolling out Osanacare. We’ll be watching your progress with great interest.
DR KEVIN CHENG
Thanks Jay. Cheers.
Footnotes
BIOGRAPHIES
Dr Kevin Cheng is an Australian trained GP specialising in chronic disease management and integrated care. He has worked as a doctor in Australia, Hong Kong, London and Africa in clinical and non-clinical roles, reforming health systems and delivering health improvements for patients. He also has a business background having advised international companies at McKinsey and Boston Consulting Group.
Jay Rebbeck is the Managing Director and Founder of Rebbeck, a Sydney based healthcare consultancy focussed on health system reform and healthcare commissioning. Jay is an international commissioning thought-leader with extensive experience and insights advising on healthcare commissioning reforms in both UK and Australia. Jay previously managed EY UK’s health commissioning team.
OSANA
Find out more about Osana here
ACKNOWLEDGMENTS
Thanks to Dr Kevin Cheng for taking time out for our interview. Thanks to Alex Ledger and Dr Tanya Pelly from Quantium Health Outcomes for putting us in touch with Kevin in the first place. And finally a big thankyou to cameraman / video editor extraordinaire Neil Harvey from RMK crew.
