Essay: Organisation and environmental analysis of Winnunga Nimmityjah Aboriginal Health Service

Introduction:
Winnunga Nimmityjah Aboriginal Health Service (WNAHS) is a community controlled medical service in Australian Capital Territory (ACT). This report analyses WNAHS and its operating environment from the marketing perspective and evaluates its marketing strategy (Unit 1: What everyone needs to know about marketing, 2016).
Description of organisation and industry:
WNAHS is one of 150 ‘Aboriginal community controlled health service across Australia, operated by local Aboriginal Community, to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management’ (NACCHO, 2016).
WNAHS has primarily societal marketing orientation. It provides a range of medical and health services to promote good health and healthy lifestyles, such as \’No more Boondah or Smoking cessation program\’ (Winnunga.org.au, 2016). \’It advocates for needs and wants of its consumers and wider community locally and nationally, for best practice standards in operational and governance areas of all Aboriginal health services\'(Winnunga.org.au, 2016 and Unit 1: What everyone needs to know about marketing, 2016).
In 28 years of service \’WNAHS is recognised through several awards, including the inaugural National Excellence Awards in Aboriginal and Torres Strait Islander Health for Excellence and Innovation in Community Health Outcomes – Winnunga Youth Diversion Program (2007), Leading Innovation in Community Engagement from the Medical Deans Australia and New Zealand’ (Winnunga.org.au, 2016).
Analysis of environment:
Company:
WNAHS is publicly funded not for profit organisation. It is the only Aboriginal health service in ACT, and is uniquely placed to provide comprehensive health service primarily to Indigenous people, but also to the wider community. WNAHS captures value through improved health outcomes for its consumers and Medicare rebates received for services provided.
A) Strengths:
Being controlled by the community elected board is a great advantage for WNAHS, allowing effective and efficient functioning without external interference. WNAHS is well staffed, enabling it to offer multidisciplinary services which includes General and Outreach Specialist Medical services, Dental services, nursing and midwifery care, Social and Community health services, Allied health services along with public health research, all at same premises and under single management. This is further supported by Information Technology, finance, accounting and human resources\’ department to create value for its consumers. This centre is open for all, and there is no out-of-pocket cost (bulk billed) to people making its value proposition attractive. This centre does not require appointment for General Practitioner (GP) care and is easily accessible in ACT with free onsite parking available.
B) Weakness and disadvantage:
WNAHS has to absorb the cost of providing service to certain marginalised group for e.g homeless people, refugees and many others who have no current Medicare card. There is no mechanism to register these services with Medicare which are also not rebatable through them. These non-remunerated and non-itemised services go unaccounted for within Medicare system and may not get included in key performance indicators (KPI) available to the government (Mbsonline.gov.au, 2016).
Medicare has a time-based payment system, and there are no rebates available for consultation longer than forty minutes (Mbsonline.gov.au, 2016). A proportion of consultations exceeds forty minutes time limit at WNAHS for its clients with complex needs. WNAHS claims lesser value rebates for these consultation (Mbsonline.gov.au, 2016). While WNAHS captures value through improved health outcomes for these services, optimal financial value is not captured.
WNAHS experiences relatively higher number of clients failing to attend booked specialist and allied health consultations. These services are not walk-in services unlike GP care. The service is perceived to be free and value perception is low. WNAHS has not been able to create value awareness for these services. This can cause difficulty in managing allocated valuable clinician time to people who could have used it.
Being a walk-in medical centre can have its disadvantages, sometimes the consumer\’s presenting to the centre can exceed the centre’s serving capacity at that particular time, creating long wait and dissatisfaction. Unlike the hospital, the centre has no mechanism or resource to triage and prioritise need-based care.
WNAHS does not have part-time positions for general medical practitioners which be challenging to recruit and retain clinicians.
C) Opportunities and Threats:
WNAHS consumer services grew by 8 % in 2015 (winnunga.org.au). This is an opportunity to expand services subject to available funding. There is bipartisan political support to improve Indigenous health (Humanrights.gov.au, 2016). Rising healthcare cost and Medicare rebate freeze (Daley and Wood, 2015), has led to increased demand for public health care services like WNAHS, while the staffing and resources remain the same. This threatens sustainability as discussed in detail below.
Customers:
‘Indigenous Australians experience a higher burden of disease than non-indigenous people, most of which is preventable and from chronic disease and injuries’(AIHW, 2016). ‘WNAHS’s customers are primarily indigenous people, 80 % of its clients in year 2104-2015, and 20% were either non-indigenous or their Indigenous status was unknown’(WNAHS, 2015). Above mentioned an 8% increase in 2015 led to average of 136 people receiving service daily (WNAHS, 2015).
Collaborators and Influencers:
WNAHS collaborates with, influences and gets influenced by other Indigenous health organisation through its membership of National Aboriginal Community controlled health organisation (NACCHO, 2016). It is directly influenced by and works along with Federal and ACT health departments and Medicare Australia while receiving funding from them, to create health services valued by its consumers. It collaborates with Canberra, Cavalry and Queanbeyan Hospitals to provide shared care and outreach specialist clinics. Similarly, it collaborates with other public and private health and medical organisation in and around ACT, such as with Capital Pathology and Universal Medical Imaging, which then provides bulk billed (no out-of-pocket cost) services for customers referred to them.
Competitors:
WNAHS is the only aboriginal health service in ACT and as such has competitive advantage. Community bulk billing medical centres’ compete for customers with WNAHS.
Context:
A) Political:
WNAHS is directly affected by the federal and local health policy. The recent extension of controversial Medicare rebate freeze until 2020 has a direct impact on WNAHS’s earnings and the value it captures through service provided (ABC News, 2016). The proposed but now withheld removal of the incentive for pathology and radiology impacts its collaborator\’s ability to continue bulk billed service to the consumers (ABC News, 2016). General practice co-payment, which has now been abandoned, risked WNAHS ability to offer existing services (ABC News, 2016). It is noticeable that despite the bipartisan commitment to closing the gap in Indigenous health (Coag.gov.au, 2016), there are no alternative arrangements for WNAHS or similar organisation (Mbsonline.gov.au, 2016).
B) Economic:
Financial constraints related to slower economic growth, ageing population, medical science, technology improvements and rising public expectations of the health system have put relentless pressure on the health budget (Daley and Wood, 2015). As mentioned earlier, Australian government has extended Medicare rebate freeze until 2020 hoping to repair the budget deficit (Daley and Wood, 2015), despite reports of no significant increase in healthcare spending over last few years(AIHW,2016).
WNAHS in exchange of service it provides its consumers, accepts the rebate directly on their behalf from Medicare, without charging and any co-payment or gap fee i.e bulk bills. While private medical centres may charge co-payment to offset this loss of income, this is not an option or a policy for WNAHS.This reduces income for WNAHS while adding extra pressure to accommodate clients who are now unable to attend private medical practices.WNAHS’s ability to attract federal and local government funding to build infrastructure and capacity is variable and depends on several factors including general economy of the country, governing party’s policy, public demand, election year etc.
C) Social:
‘People with higher incomes live longer and have better health, on average, than do people with lower incomes and which has a direct correlation with their level of education and employment status’ (AIHW, 2016).
The majority of clients attending WNAHS, share similar health-related social disadvantage as reported nationally for Indigenous people (AIHW, 2016), namely lower education and income, poor employment status, adverse lifestyle factors (nutrition, activity, tobacco and alcohol use) affect health outcomes of its consumers.
D) Technological:
WNAHS uses a computer-based system to register, record, refer, request and receive results and communication. It uses up to date software technology ‘Communicare’ to run and provide its services (Telstrahealth.com, 2016). It has a positive
outlook towards electronic health record (Digitalhealth.gov.au, 2016). However, it is a challenge for the WNAHS to keep up to date with rapid technological advances in health technologies as is for other centres.
E) Legal:
The federal and ACT health law governs and regulates the organisation and the health professionals are governed by the Health practitioner National law (Ahpra.gov.au, 2016).Several other law applies for e.g related to Medicare, taxation, and not for profit status (ACNC.gov.au, 2016). Any changes directly impacts operation of WNAHS.
F) Environmental:
WNAHS possibly is indirectly affected by the ecological environment with regards to nature services it needs to provide (for example increased demand for asthma care related to environment pollution).
Data collection methods:
WNAHS uses practice management software called ‘Communicare’ to register and keep patient records, prescribe, request and receive electronic results and coordinate billing to Medicare (Telstrahealth.com, 2016). This consumer management software is also used to maintain database, analyse data, consumer segmentation and report status of KPI\’s including generating market and consumer insights (Telstrahealth.com, 2016). It generates health data used to report to government agencies (Telstrahealth.com, 2016). MYOB software is used for finance and accounting purposes (Myob.com, 2016). Further secondary data is received from federal and ACT department of health, Primary health Network, NACHO among others. WNAHS’s Public health unit regularly conducts surveys with regard to customer needs and feedback to generate primary market and consumer insights.
Segmentation, Targeting, and Positioning:
WNAHS is committed to Closing The Gap (CTG) (Coag.gov.au, 2016) initiative in Indigenous health and targets Indigenous people, to provide health services. Indigenous people have a higher burden of illness and are likely to die younger than other Australians (Aihw.gov.au, 2016).
WNAHS segments consumers with regard to their Indigenous status (Demographic segmentation) and offers them Medicare rebated health checks annually. Consumers identified at first presentation through self-declaration during registration then offered health check by Nurse and a Doctor. Annual checks thereafter are offered through software generated reminder-recalls, creating ongoing relationships. The organisation positions itself by ensuring a practice nurse led and doctor supported clinic for this specific group is available every day.
Historically Indigenous Australians have had culture and spiritual gender assigned roles in the society (Indigenousaustralia.info, 2016). The larger segment is further sub-segmented into Men’s and Women’s group. WNAHS Social health wing organises Men\’s group and Women\’s group to attract these sub-segments to use its services (NSW Department of Community Services, (2016).
WNAHS also segments its consumers based on specific illness and consumer need or in other words does benefit based segmentation, for example, Patients with Diabetes. It maintains a database of its registered Diabetic clients who are targeted via scheduled reminders and serviced through designated Diabetes clinics. Further, positioning is done by ensuring the all the needs of such clients are addressed on the same day and improving its value proposition, to which clients are more receptive. Clients see a Diabetes educator, Optometrist, Podiatrist, Dietitian, Aboriginal Health worker along with Doctor and Diabetes specialist (if needed) on the same day. Similar approaches are used to run child health clinic and youth clinic(Demographic segmentation), and smoking cessation clinics(Behaviour segmentation).Women\’s health clinic offers pap smears to women and two yearly mammograms to women between fifty and seventy years of age midwife run clinics offer pregnancy-related care (Healthdirect.gov.au, 2016). Demographic segmentations are attractive as has specific Medicare payments for the services and there are annual incentives based on outcome (Mbsonline.gov.au,2016). Such value proposition addresses their needs and are therefore also attractive for the consumers.
The value proposition is communicated to the targeted segments through newsletters and social media, website and handouts and posters at reception. Value is captured through improved health outcomes for consumers and Medicare rebates and incentives (Mbsonline.gov.au,2016).
WNAHS segments and engages different business on basis of services it offers (Business to Business), for example, radiology, pathology, Medicare, NACCHO and department of health etc.
Evaluation:
WNAHS’s micro and macro environment favor its societal marketing orientation. It is well supported by its community elected board, multidisciplinary staff, and central location, to create and offer culturally and socially appropriate health service to Indigenous and marginalised people in ACT.This is strengthened by support from local and federal health department and its collaboration with health and medical related services in ACT
WNAHS’s Public health unit captures, and reports quarterly data including consumers’ number, Medicare billing and KPI’s regarding services to the health professionals in a team meeting. This data is then compared with earlier quarters and previous years discussed and analysed to find areas for improvement. Public health unit also informs clinicians about missed opportunity to care for chronic diseases, missed appointments, average waiting times for consumers and any new government policy related changes. Further primary research data obtained through client surveys at WNAHS’s to improve consumer insights.
WNAHS also uses an up to date management information system further helping its consumer market insights along with information available from secondary sources.This allows for segmentation and differentiated services to its consumers .
The robust growth in its consumer number recently confirms well-functioning of its marketing strategy. The unpredictable flow of clients, being a walk- in-centre can be challenging to manage, especially if a large volume of clients arrive at the same time. Further, the booked but unattended specialist appointments causes value loss. Text reminders, phone calls to clients a day before to remind consumers of their appointments to minimise has worked to a certain extent. Improving communication strategy to create value awareness will help minimise loss of these valuable resources.
The political and economic environment in its business to business marketing context could be the biggest challenge to how WNAHS creates, captures and sustains value in the future. The extended Medicare rebate freeze cumulatively diminishes the value captured by WNAHS and can risk its sustainability. This along with the inability to claim for and report the services provided for longer consultation above the highest time limit allowed by Medicare and inability to claim for services provided to people without or inactive Medicare card worsens its ability to capture value. Federal and local government support towards CTG somewhat offset this loss. In long-term, WNAHS needs to work with its collaborators namely NACCHO, to communicate this disadvantage with government and to ensure alternative arrangement is available to compensate for the value lost and to support sustainability. Further, if the Medicare incentive to radiology and pathology collaborators is removed, they may start charging co-payments to referred consumers, adversely affecting WNAHS.
Growth in annual services poses opportunities and challenges, any consideration expansion needs to be realistic and sustainable with appropriate government funding.
Conclusion:
WNAHS is adequately placed and is well supported by its internal and external environment to continue with its societal marketing orientation. Its marketing strategy is reasonably successful as documented by the growth of its consumer number and services. This process is enabled by its use of management information system and primary and secondary research data available which allows for informed decision-making to create and capture value. The Medicare rebate freeze, its inability to capture value from certain services it provides and appropriately addresses consumer\’s failed attendance can be a threat to WHAHS\’s sustainability. It hence needs to develop a strategy and use its collaborators and influencers to communicate this loss with political establishment to improve its ability to capture value.
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