NACCHO #HealthElection16 : Coalition must back its Health Care Home vision for complex and chronic care with funding

AMA

The Health Care Home is potentially one of the biggest reforms we have seen to Medicare in decades, The AMA is keen to work with the Government to develop the model and make it a success.”

It is time for the Coalition to back its Health Care Home vision for complex and chronic care with a meaningful level of funding.

The Association welcomed the Government’s Health Care Home model of care, which could greatly improve outcomes for patients with complex and chronic illnesses, but warned it would be doomed to failure without greater investment.

AMA President Dr Michael Gannon

While the Government has allocated $21 million for a trial of the system, this is not directed at services for patients. The AMA President cautioned that, with GPs already under substantial financial pressure, the Government would have to make a much more significant commitment to the trial for it to be a success.

“At a time when medical practices are already struggling with the effects of the Medicare rebate freeze and other funding cuts, the Government seems to expect that GPs will be able to deliver enhanced care for patients with no extra support,” Dr Gannon said.

“This approach simply does not add up, and will potentially doom the model to failure. GP engagement is vital if these reforms are to be implemented.

“As the Chair of the Government’s Primary Health Care Advisory Committee, Dr Steve Hambleton, recently pointed out, if the funding model is not right, GPs will not engage with the concept.

“We want the Health Care Home model to work, but the Government needs to back it with appropriate funding.”

Under the model, patients suffering from complex and chronic health problems will be able to voluntarily enrol with a preferred general practice, and funding will be provided based on clinical need.

Dr Gannon said that as the population aged, more people were living with complex and chronic illnesses, placing increasing demands on the health system.

“GPs are at the frontline in caring for such patients, helping them to manage their health and stay out of hospital,” he said.

“A properly funded Health Care Home model has the potential to both improve the care they receive and save scarce health funds.”

It is understood that at April’s Council of Australian Governments meeting, the Commonwealth failed to win State and Territory agreement to redirect around $70 million a year from public hospital funding to support the Health Care Home trial, and the Budget failed to deliver equivalent funding in its place.

Dr Gannon said this suggested that the trial was now seriously underfunded.

“There is widespread support for the Health Care Home concept,” he said.

“General practice is the least expensive part of the health system and we know that with the right support GPs can do more to keep patients out of hospital and avoid unnecessary costs.

“However, international evidence shows that this requires investment and the Government is clearly failing on this score.”

Dr Gannon said he had taken the issue of greater investment in general practice to the very top of the Government.

“During a recent meeting with the Prime Minister, I made it clear that the Government needed to look at how it could better support quality general practice, and well targeted additional funding for the Health Care Home trial is part of that.”

Labor has announced it would commit $100 million over two years to support its own trial of a health care home.

“While there is not yet enough detail of what is included in Labor’s policy, there is no doubt that this is the type of initial investment that the Coalition needs to consider.” Dr Gannon said.

BACKGROUND FROM MARCH RELEASE

Coalition’s healthcare plan has pros and cons, say medical experts

Federal government’s ‘healthcare homes’ scheme gets a tick for better coordinated handling of the chronically ill but a fail on funding details

Medical experts have welcomed federal government plans to trial better coordinated healthcare for people suffering multiple chronic illnesses, but have questioned funding levels and when the program will be rolled out nationally.

On Thursday the health minister, Sussan Ley, announced a plan for “healthcare homes” – primary healthcare centres or GPs – to coordinate tailored care packages for patients with multiple chronic conditions. The cost of health services would be bundled into regular quarterly payments rather than patients paying on each visit.

Health minister says 5,700 items on the medical benefits schedule will be reviewed but Australian Medical Association warns patients’ costs could rise

The plan also proposes more data collection and use of digital health records to measure patients’ progress and share information between doctors.

The federal government would spend $21m on a two-year trial for 65,000 Australians to get individual healthcare plans in up to 200 medical practices from 1 July 2017.

A leaked Council of Australian Governments document suggests the package would be paid for by taking $70m a year from hospital funding over the next three years.

As many as one in five Australians live with two or more chronic health conditions, including diabetes, heart disease, cancer, arthritis and mental health, which require a range of health services including GPs and specialists.

Ley said the package was designed to tackle poor healthcare coordination which resulted from frequent users of the health system seeing as many as five GPs a year, which made falling through the cracks and ending up in hospital more likely.

Half of all potentially avoidable hospital admissions in 2013-14 were attributed to chronic conditions.

The Australian Medical Association’s president, Prof Brian Owler, said the AMA was pleased with the package but the announcement had a “major missing piece” because it did not include the amount and nature of funding for primary healthcare beyond the trial period.

He said other questions included: “How will the changes impact on existing Medicare chronic disease funding? How will the healthcare homes funding be administered and structured? What are the eligibility criteria for patients? What is the timing of the trial and the potential national rollout of the package?”

Labor and the Greens also criticised the government over funding.

The opposition spokeswoman on health, Catherine King, said “proposals to better manage chronic care are doomed unless the Turnbull government abandons its more than $2bn in cuts to general practice”.

The Greens leader, Richard Di Natale, said the package acknowledged the right problem but was “light on detail and funding”.

“Based on the minister’s comments this morning, a funding commitment equal to $340 per patient appears to be woefully inadequate,” he said. “It will still be cheaper for a patient to go to hospital than to see a physiotherapist.”

Council on the Ageing’s chief executive, Ian Yates, said the program would provide older Australians with healthcare packages tailored to their needs and coordinated by a trusted healthcare home of their choice.

“Health co-morbidities do tend to increase as we age, with people over 65 seeing a GP twice as often on average than younger people,” Yates said.

“Not only is it expensive, it’s stressful and exhausting finding specialists, filling prescriptions, visiting GPs and attending outpatient facilities, when each condition is too often treated in isolation from the others, with little coordination or communication between health providers.

“It also means that too often these chronic conditions can escalate quickly, resulting in the need for acute care and the trauma of hospitalisation that could have been avoided with better treatment earlier, and more pro-active primary care.”

The Public Health Association of Australia’s chief executive, Michael Moore, said that to make a real difference, prevention must be included in a comprehensive health package for people with chronic and complex health conditions.

“The single most important cause of chronic conditions is obesity. This needs to be addressed rather than waiting for the development of a chronic condition which then needs treatment,” Moore said.

 

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