For Australian private health insurers
Persistent GI symptoms are already in your hospital claims.
Digestive-system care is a billion-dollar private-hospital category.2 Nerva gives your appropriately assessed members six weeks of digital brain-gut care, measured against the hospital benefits you actually pay.
- Australian-founded
- Published active-control RCT¹
- HIF member program live⁷
- Outcomes-based reporting infrastructure⁶
GI is already a material private-hospital category.
The category, in fund-paid benefits
AUD 1.69bn
in fund-paid benefits across 685,000+ privately insured digestive-system separations in 2024–25.2
- tied to scopes: 536,000+ endoscopy, gastroscopy and colonoscopy separations.2
- AUD 786m
- variation in repeat colonoscopy across local areas. 97% of scope episodes were same-day.3,2
- 18-fold
Not all GI spend is addressable, and not every scope is avoidable: these lower-bound figures establish a category worth investigating.2
Scaled to a book, approximately
- in digestive-system hospital benefits per hospital-covered life per year, across the industry's 12.79 million covered lives.2,9
- ≈AUD 130
- in fund-paid benefits per scope separation.2
- ≈AUD 1,470
Approximate: benefit figures are FY2024–25 HCP data, membership is APRA's March 2026 quarter, and both are industry-wide.2,9 The claims-feasibility session replaces these with your book's own numbers.
Functional GI does not live in one claims code.
A single IBS query misses the population: admitted-care claims are organised around the episode, not the member. We help funds cross three layers, then apply clinical safeguards before treatment.
01
Diagnosis and symptom signals
IBS and other DGBIs, abdominal pain, bloating, altered bowel habit.
02
Longitudinal care pattern
Repeated investigation and recurrent same-day GI care across 24 to 36 months.
03
Fund economics
Scopes, related hospital episodes and the benefits your fund actually paid.
The intersection
Your discovery cohort: members who appear in all three layers at once. That is what a single IBS code query can never return.
These are detection signals, not diagnoses: claims cannot show scope findings or symptom severity, so clinician confirmation stays in the loop.
Claims discover the opportunity. Clinicians decide who is eligible.
Claims discovery cohort
- Diagnosed functional GI disorders
- Recurring GI symptom presentations
- Linked scopes and same-day admissions
- Fund-paid benefits per member
Clinical treatment cohort
- Appropriate diagnosis confirmed
- Investigation complete, no alarm features
- Structural pathways excluded: IBD, coeliac disease, cancer and surveillance stay with their clinicians
- Significant ongoing symptoms
- Relevant cover, clinician confirmation
Six weeks of care, delivered in software.
Funds run heart, joint, weight and mental-wellbeing programs; persistent gut symptoms have had no equivalent. Nerva delivers guideline-recognised brain-gut behavioural care10 in software, with screening and escalation by humans.
- Intake
Eligibility and safety screening.
- Daily
One 15-minute session, six weeks.
- Tracking
Validated symptom measures.
- Maintenance
Flare support and re-engagement.
- Outcomes
Reporting on the agreed measures.
- Escalation
Back to the member's clinician.
Strong evidence for symptom improvement.
81% vs 63%1
of participants had clinically meaningful IBS symptom improvement at completion, compared with the active control, in a 244-adult randomised trial.
Randomised controlled trial · N=244 · active control · AJG 2025 Read the research →
- Nerva's core brain-gut behavioural technique showed efficacy similar to the low-FODMAP diet in a Monash randomised trial4
- Similar efficacy
- “Nerva presented the strongest overall evidence for improving IBS symptoms” among virtual GI solutions reviewed5
- PHTI, 2026
The boundaryNerva has strong evidence of symptom benefit. The Australian hospital-claims effect is what a fund partnership would test.
Partnership spotlight
Live in Australia, with HIF.
Since March 2025, eligible HIF members have accessed Nerva through their fund, with eligibility, activation and outcomes reporting running as a member health program.
- 300,000+ people have used Nerva worldwide8
- 20,000+ clinicians have referred patients8
- Monash research collaboration, Australian participants1,4
Program facts as at August 2026.7 Activation and outcome figures are shared with funds under discussion.
Built to run as a CDMP. Cleared for your procurement review.
The chronic disease management wrapper is dietitian-led and configured with each fund; each element maps to the Health Insurance Business Rules' requirements for a chronic disease management program.11
- Written plan: a referring dietitian confirms the diagnosis and approves it
- Consent before the program unlocks; no consent, no enrolment
- Specified services: the six-week program, screening, tracking and escalation
- Coordination and outcomes reported back for the dietitian's planned review
- Privacy Act and APPs; consent-first invitation; agreed-format fund reporting; SOC 2 documentation for procurement
How you offer the program, as a CDMP benefit, a member health program or an Extras item, is a product decision, not a rebuild. Australia-wide dietitian referrals are how members already arrive.8
Start with your claims, not our assumptions.
We work with your team to identify the eligible cohort, understand its current hospital use and set a break-even hurdle before a pilot begins.
- Stage 01
Claims feasibility
Define the cohort, its current hospital use and a break-even hurdle from your data.
- Stage 02
Co-designed pilot
Agree eligibility, governance, outcomes, comparison method and commercial terms.
- Stage 03
Scale decision
Expand, modify or stop using pre-agreed rules.
The commercial shape
Pay only for members who activate, with an optional component linked to an agreed symptom outcome while local claims evidence is generated.
Break-even is a formula your team fills in, not a figure we assert. The feasibility session fills in your numbers before any pilot is scoped.
When we'd tell you not to run this
Cohorts too small to measure: aggregate reporting and a claims read-out need scale, and we would rather say so first.
Funds that need guaranteed utilisation reductions before a pilot: the Australian hospital-claims effect is exactly what the pilot tests.
Funds without longitudinal claims capability: the identification and evaluation both depend on linking a member's claims over time.
Programs premised on unconfirmed regulatory treatment: how your fund classifies and offers the program is your product and governance decision.
Where is functional GI showing up in your claims?
A short working session across health programs, claims and clinical governance: map the signals, connect them to paid hospital events, and decide whether a retrospective analysis is worth running.
Common questions from fund teams.
Does Nerva replace gastroenterology or dietetic care?
No. Nerva complements existing care. Diagnosis, prescribing, procedures and complex management stay with the member's clinicians; Nerva delivers the brain-gut behavioural layer and routes members back when clinical review is needed.
How does an Australian pilot work?
Claims-sizing comes first. A pilot follows only if the numbers are credible, on pre-agreed terms.
References
- Anderson, Ellen J.; Peters, Simone L.; Gibson, Peter R.; Halmos, Emma P. Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome. The American Journal of Gastroenterology 120(2):p 440-448, February 2025. DOI: 10.14309/ajg.0000000000002921
- Department of Health and Aged Care, Hospital Casemix Protocol Annual Report 2024–25: privately insured digestive-system separations and fund-paid hospital and in-hospital medical benefits, Australian private-day and private-other rows, AR-DRG version 11.0 only. Suppressed small cells omitted, so totals are lower bounds.
- Australian Commission on Safety and Quality in Health Care, Atlas Focus Report: Colonoscopy: repeat colonoscopy within three years varies 18-fold across local areas; some early repeat procedures are clinically necessary. The variation supports investigation, not a presumption of waste.
- Peters, S. L.; Yao, C. K.; Philpott, H.; Yelland, G. W.; Muir, J. G.; Gibson, P. R. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 2016;44(5):447–459.
- Peterson Health Technology Institute. Virtual Gastrointestinal Care Solutions Assessment. March 2026.
- Mindset Health participation in the CMS ACCESS Model, 2026: outcomes-based arrangements in the musculoskeletal and behavioural health tracks in US Original Medicare. Cited here as outcomes-measurement and reconciliation infrastructure; it is not evidence of Australian coverage or savings.
- HIF and Mindset Health member health program partnership, current as at August 2026. Program details, activation and outcomes figures are available to funds under discussion.
- Internal Nerva platform figures, August 2026.
- APRA, Quarterly private health insurance statistics, March 2026: 12.79 million Australians held hospital cover and funds paid AUD 4.75 billion in hospital benefits in the quarter. The per-covered-life figure divides FY2024–25 HCP digestive-system benefits by March-2026-quarter membership, so it is approximate and period-mismatched by construction.
- Lacy, B. E. et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. The American Journal of Gastroenterology, 2021: gut-directed psychotherapies, including gut-directed hypnotherapy, are recommended treatment options for IBS.
- Private Health Insurance (Health Insurance Business) Rules (Cth), legislation.gov.au F2018L00718: the elements of a chronic disease management program, including a written plan, patient consent, specified services and coordination by a suitable person. How a fund classifies and offers any program is that fund's own product and governance decision.
Nerva complements existing clinical care and does not replace a gastroenterologist, dietitian or psychologist. Program availability through a fund depends on that fund's own rules, product governance and clinical review.