Potentially one of the biggest reforms to Australia’s Medicare system since its inception will target about 10% of patients with multiple chronic and complex conditions in 10 primary health care regions over the next 2 years.
Applications will open in late 2016 for selection of general practices and Aboriginal medical services to participate in a national Health Care Home trial.
The $114 million trial, announced by Health Minister Sussan Ley, will be piloted in 10 Primary Healthcare Network (PHN) regions, including urban, regional and remote areas.
An Implementation Advisory Group and associated working groups have been established by the Australian Government Department of Health to work out details of the embryonic program, including payment methods, patient identification, guidelines, education and evaluation.
Medicare funding redirected
However, medical groups including the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association argue the trial is underfunded and the trial period too short. Concerns have also been raised about the patient group being too narrow.
Some PHNs also said they were unaware of the trial locations before they were announced in August.
The CEO of NSW PHN Nepean Blue Mountains, Lizz Reay, said PHNs were still trying to determine what their role would be.
“It’s early days for PHNs, so we’re waiting to see how it’s going to work,” she said. “… the trial itself is only focusing on [a small percentage] of patients with chronic disease, but it may … allow [practices] to be much more proactive in care of patients, particularly those that don’t turn up for checks. It [has] potential to significantly impact on public health. You have to start somewhere …”
Broad engagement important
Western Sydney (WentWest) PHN CEO Walter Kmet said many PHNs supported the concept of Health Care Homes and consumers were interested in the idea of a patient-centred medical home.
“Clearly, broad engagement in the concept as part of transformation in primary care is important and I would say that many PHNs, certainly ours, have been talking about the benefits with consumers for some time.”
Professor Mark Harris, Executive Director of the Centre for Primary Health Care and Equity at UNSW Australia, welcomed the program’s potential to support more systematic chronic disease management, improve health outcomes and reduce demand on hospital care.
However, he said the restricted scope of the trial, in terms of its population coverage, in comparison with similar initiatives in the US and New Zealand, may limit its population and health system impact. The level of engagement with the 10 PHNs was also an issue, he said.
“Overseas experience, especially in New Zealand, suggests that practices will need considerable support and change facilitation,” he said. “Interventions that have been shown to have greatest impact include practice population management such as outreach coaching and preventive care and use of community workers.“
Calls for more funding
RACGP President, Dr Frank Jones, said the college was concerned that practices involved in the trial would be expected to provide more services with the same amount of funding.
“In order to succeed, the trial must be properly resourced to support GPs and their teams to take on even more responsibility and to keep people out of hospital,” he said.
A spokesperson for the department said Health Care Home payments to GPs would be bundled together into periodic payments.
“This will encourage providers to be flexible and innovative in how they communicate and deliver care, and will ensure that the patient’s healthcare needs are regularly monitored and reviewed,” he said.
Patients would be assessed for trial enrolment based on who would benefit most from the new model, with services aimed at the one in five Australians with multiple chronic and complex conditions.
Eligibility based on complexity
The spokesperson said a patient identification process, to be undertaken by the GP, would use existing validated Australian and international risk stratification tools to identify patients requiring high levels of coordination and team care.
“Eligibility will be based on patient complexity, not on specific disease diagnoses,” the spokesperson said.
Practices will still be able to claim for services not related to a patient’s chronic disease, and patients will continue to have access to Medicare if they are unable to attend their Health Care Home and need to visit another GP, for example while they are travelling.
Asked if any further funds would be allocated on top of the redirected funds, the spokesperson said $21.3 million would be allocated over 3 years to establish design principles, IT systems and training needed to assist healthcare providers to transition to the new system.
