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Coalition of the willing
Phil Calvert

Recently, I had the opportunity to meet with Dwayne Crombie, Managing Director of Bupa's health insurance business. The reality is that physiotherapy is not really on his agenda.

That’s not all bad—we don’t want to be among his ‘sore points’. What we want to do is provide a compelling proposition for how we can contribute to improvement in the health system, and in cost-effective outcomes for patients. We need to develop a proposition in which we have common ground and an important stake in the outcome.

Among his key challenges is post-surgery rehabilitation. Bupa incurs significant costs in this area. In particular, the increasing utilisation of inpatient rehabilitation.

All good physios know that preparation is a key to great surgical outcomes. We know there is value in structured preparation, including patient education. We know there is value in prompt, structured post-surgery rehabilitation. Both of these should be clinically effective, delivered close to patients’ homes and cost-effective. In order to be able to propose alternate models of service delivery and funding, we need to be able to work with colleagues, and be willing to rigorously measure the effect of our shared interventions. Are you in a coalition of the willing? Are you willing to propose alternative models to the way care is currently delivered?

Many of us already have informal networks of professionals we work with—the people we trust, whom we refer to and who refer to us. Sometimes these are based on a shared clinical interest. Sometimes on our shared location.

Lots of us have moaned about the problems with our colleagues and pondered on improvements. My meeting with Dwayne makes me think that the time is ripe for change. If you think that your network has what it takes to collaborate, then the ball is firmly in your court.

You’ll need a ‘straw man’. Well, really a ‘stick man’—this is the core proposition of improvement that you think can be achieved. It needs to be something that you can test. You probably know the key elements of this already. It might involve a range of insurers and a single site. It may involve one insurer and different sites. You’ll need to flesh it out—make it the straw man you can pitch. It might not be in rehab, but still tackle a big-ticket problem.

In the current climate, better rebates are more likely to arise when we can shift the cost burden for insurers (whether they are in the private sector or are government).

If you’ve got a stick man that you’ve been building in your network, think about fleshing it out. If you need a hand, members of our policy team can probably help.

We need to be daring. We need to be actively making our case to funders for changes that benefit patients, and improve access to quality physiotherapy services as part of the orthopaedic journey.

Marcus Dripps, APAM
APA National President

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