Australia’s health system is facing unprecedented challenges, both in terms of workforce and financial pressure, in dealing with an expanding, ageing population with its associated burden of chronic conditions. The hospital system is experiencing increases in potentially preventable hospitalisations and general practice is facing the challenge of managing the growing complexity and multi-faceted needs of patients in a model of care that is funded for acute presentations and face to face consultations. A fundamental shift in the way care is delivered in the community is required in order to sustainably deliver better health outcomes particularly for those at risk of poor outcomes.
A Primary Health Care Advisory Group (PHCAG) was established by the Commonwealth, with its discussion paper Better Outcomes for People with Chronic and Complex Health Conditions released at the end of 2015. PHCAG had a number of key recommendations including the establishment of a new model of primary health care coined the Health Care Home. The Commonwealth responded to these recommendations with its Health Care Home policy in March 2016. The Health Care Home will co-ordinate all of the medical, allied health and out-of-hospital services required as part of a patient’s tailored care plan. Health Care Homes will be delivered by GP practices or Aboriginal Medical Services.
The model is underpinned by payment reform with the allocation of tiered bundled payments to practices depending on individual patient complexity. The expectation is that this change will enable providers to be flexible and innovative in how they communicate and deliver care, and will ensure that the patient’s health care needs are regularly monitored and reviewed. This signals a move away from the current face to face fee-for- service model for these eligible patients, except where a routine health issue does not relate to their chronic illness.
Internationally this model of care, often called the Patient Centred Medical Home, has produced improved health outcomes, along with a reduction in health care utilisation and costs.
Ten PHN regions have been identified for Stage One of the HCH trial. Stage One will run for two years from 1 July 2017, and involve the enrolment of 65,000 patients with chronic and complex conditions. Approximately 200 practices in the 10 PHN regions will be selected to transform to HCHs and trade in MBS chronic disease billings for a bundled payment model. An additional $21.3 million has been directed to support the roll out until 30 June 2019, along with $93 million in redirected MBS funding.
In early November 2016 the Expression of Interest for practices in the ten selected PHN regions was released. The target group are those Australians with multiple complex and chronic conditions comprising approximately 20 per cent of the population. There will be three tiers of chronic and complex patients enrolled into the HCH with different funding allocated according to need.
Two risk stratification tools will be utilised by practices to identify target patients who can then be allocated to the appropriate tier. Each practice will receive a one-off $10,000 grant, which is expected to contribute to the costs of participating and would include non-clinical time to train staff, complete risk stratification, enrol patients and provide enhanced in-hours access.
Enrolled patients will be able to continue to utilise usual MBS items for acute care unrelated to their chronic and complex conditions. Additionally the current MBS Team Care Arrangements will not change, with each tier still receiving the maximum of five allied health sessions per annum.
The Department of Health indicated 20 practices will begin Health Care Home services on 1 October 2017. Another 180 will begin on 1 December 2017. The list of practices can be viewed on the Department of Health website. Stage one will be evaluated with the final report due at the end of 2019.
More information regarding the Commonwealths Health Care home trial can be found on the Department of Health website.
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