NACCHO Aboriginal Health : Does Health Care Homes mean healthier patients and a healthier Medicare ?

AMA Ley PM

” This has never been more important, with one in two Australians living with a chronic condition and one in five managing two or more.

This coincides with 20 per cent of patients making up over 60 per cent of Medicare costs.

That’s why we’re investing nearly $120 million to roll out the first stage of Health Care Homes, including over $90 million in payments to support patient care and $21 million for infrastructure, training and evaluation.

The first stage will initially benefit up to 65,000 patients across 200 GP clinics and Aboriginal Medical Services Australia-wide and will be evaluated to enable refinements to the model prior to a national rollout.”

PRIME MINISTER THE HON. MALCOLM TURNBULL MP and MINISTER FOR HEALTH AND AGED CARE THE HON. SUSSAN LEY MP MEDIA RELEASE

Photo above file image meeting last month PM, Health Minister and AMA President

The reality is that GPs cannot afford to deliver enhanced care to patients with no extra support,

“There is no new funding for the Health Care Homes trial. Money has been shifted from other areas of the health budget.

“If the Health Care Homes funding model is not right, GPs will not engage with the trial, and the model will struggle to succeed.”

AMA President, Dr Michael Gannon

Chronic care finds new home in Medicare Federal Government Press Release

The Turnbull Government is strengthening Medicare to deliver better health outcomes for Australians.

As one of our first priorities this term, we are today announcing the ten regions across the country that will participate in stage one of our revolutionary Health Care Homes model.

Health Care Homes is a better way of delivering Medicare for Australians with chronic illness.

It will give Australians a local health care team – led by their GP – that they can trust to coordinate their health care needs throughout the year to ensure patients remain happy, healthy and out-of-hospital.

Health Care Homes is a better way to remunerate general practice that recognises the commitment and diligence they show every day in managing time-consuming chronic conditions.

It will allow doctors and their teams to focus on delivering quality improvements to patient care when they need it, no matter how often it’s needed, without the rigid constraints of Medicare’s current feefor- service model.

This has never been more important, with one in two Australians living with a chronic condition and one in five managing two or more.

This coincides with 20 per cent of patients making up over 60 per cent of Medicare costs.

That’s why we’re investing nearly $120 million to roll out the first stage of Health Care Homes, including over $90 million in payments to support patient care and $21 million for infrastructure, training and evaluation.

The first stage will initially benefit up to 65,000 patients across 200 GP clinics and Aboriginal Medical Services Australia-wide and will be evaluated to enable refinements to the model prior to a national rollout.

This will include the Primary Health Network regions of: Western Sydney (NSW), Perth North (WA), Tasmania (TAS), Hunter New England and Central Coast (NSW), Brisbane North (QLD), South Eastern Melbourne (VIC), Adelaide (SA), Northern Territory (NT), Nepean-Blue Mountains (NSW) and Country South Australia (SA).

Health Care Homes is a model of primary care designed by – and long-campaigned for – by doctors.

A model of care that could have already been benefiting Australians with chronic disease, had Labor not deliberately ignored the recommendations of their own health reform commission in 2009.

No Government has invested more in Medicare than the Turnbull Coalition to ensure access to universal health care for all Australians.

We are determined to ensure every dollar lands as close to the patient as possible.

Does Health Care Homes mean healthier patients and a healthier Medicare ?

GP SUPPORT KEY TO SUCCESS OF HEALTH CARE HOMES

Welcoming today’s announcement of the 10 Primary Health Network Regions to conduct the Government’s trial of the Government’s Health Care Homes initiative, AMA President, Dr Michael Gannon, said that GPs must be properly resourced and supported to make the trial – and the concept – a success.

Dr Gannon said the Health Care Home is potentially one of the biggest reforms to Medicare in decades.

“The AMA is delighted that the Government is using the Health Care Home trial to launch its renewed commitment to general practice and primary care,” Dr Gannon said.

“We especially welcome the Prime Minister’s role in actively promoting this key plank of the Coalition’s health platform for the new term of Parliament.

“The AMA shares the Government’s vision for the Health Care Home, and we have been actively engaged in its development.

“Under the model, patients have a continuing relationship with a particular GP to coordinate the care delivered by all members of the patient’s care team.

“We know from overseas experience that the model has the potential to support better patient outcomes, and can help to keep patients out of hospital. It aims to provide more support for patients, particularly those with more serious chronic and complex conditions.

“Importantly, it recognises the fundamental role of a patient’s family doctor who can provide holistic and longitudinal care and, in leading the multidisciplinary care team, safeguard the appropriateness and continuity of care.”

Dr Gannon said that GPs are managing more chronic disease, but in recent times their practices have faced substantial financial pressure due to the Medicare freeze and a range of other funding cuts.

“The reality is that GPs cannot afford to deliver enhanced care to patients with no extra support,” Dr Gannon said.

“There is no new funding for the Health Care Homes trial. Money has been shifted from other areas of the health budget.

“If the Health Care Homes funding model is not right, GPs will not engage with the trial, and the model will struggle to succeed.

“We urge the Government to provide new funding and resources for the trial, and lift the Medicare freeze and other burdens from GPs, in order to give this exciting primary care reform every chance of success,” Dr Gannon said.

The Australian Healthcare and Hospitals Association (AHHA) welcomes the Government’s commitment to Health

Care Homes and today’s unveiling of the program’s trial sites at Western Sydney Primary Health Network.

“The AHHA supports this reform aimed at providing better integrated care to Australians with chronic and complex conditions,” AHHA Chief Executive Alison Verhoeven said.

The AHHA urges the Government to ensure the Health Care Homes trial is provided with the funding and resources needed to succeed in delivering transformational change to the primary care system and to the care of all patients.

“The establishment of Health Care Homes across Australia was recommended by the Primary Healthcare Advisory Group to deliver continuity of care through coordinated services and a team-based approach according to the needs and wishes of the patients. It builds on the efforts of Primary Health Networks (PHNs) that are already implementing relevant services in their areas.”

“The establishment of Health Care Homes is a step in the right direction to resolving fragmented primary and acute care services for people with chronic conditions, but it will be important to get the funding balance right so that incentives promote value, not volume of services.

“However, the stated objectives cannot be achieved with inadequate funding and the investment proposed for this trial looks set to fall substantially short of requirements. Evidence from a number of sources suggests that funding of between $1300 and $2500 per person per annum would be required to truly deliver reform via a Health Care Home. There is much to be learned from previous coordinated care trials both in Australia and internationally about appropriate funding and incentives to promote quality care over volume.”

“The Health Care Homes package must be more than a one-size-fits-all approach. Chronic care reforms must be flexible, patient-centred and integrated with other reforms throughout the broader health sector, including the acute sector, and designed in partnership with the states and territories. Such initiatives have been shown to be most effective when primary care based population approaches are taken.

Ms Verhoeven said the trials would underscore the need for better primary health data and greater use of the My Health Record to support the design, implementation and evaluation of the reform. This requires the support of general practice, and national health statistics leadership to build a national minimum data set for primary care.

This must be shaped as a national data asset, not by commercial or niche sector interests.

“The data gathered by this trial must be used to launch Health Care Homes as a fully-resourced, integrated care program at the PHN level, aimed at improving the lives and health outcomes of Australians with chronic or complex conditions.”

Commitment to Health Care Homes welcomed – but more to do

The Royal Australian College of General Practitioners (RACGP) has welcomed the Federal Government’s progress in rolling out the first stage of the Health Care Homes pilot, with the announcement today of ten Primary Health Network (PHN) sites across Australia to take part in the trial.

The RACGP says commitment to the medical home model is a step in the right direction for the health of all Australians, however there remain particular concerns around the actual funding allocated to the Health Care Homes pilot.

Commenting on the announcement today, Dr Frank R Jones, President of the RACGP said that the announced $120 million in funding was not new money, and is actually being re-directed from other Medicare GP payments.

“The Prime Minister has today announced that nearly $120 million is being invested in the first stage of the Health Care Homes pilot. This is in reality $21 million from the Practice Incentive Program re-directed to infrastructure, training and evaluation, and $90 million of funding for some MBS chronic disease management items being cashed out of Medicare.

“This reallocation of funds does not represent genuine investment in the Health Care Home, and is instead a shuffling of existing expenditure,” said Dr Jones.

“In reality, the practices involved in the trial across Australia will 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,” Dr Jones said.

According to the RACGP’s calculations, an appropriately funded trial will require $100,000 on average per practice per annum – in addition to current funding for chronic disease management items and other MBS items. 

The RACGP has further recommended the Federal Government to extend the two year trial to five years, to allow proper implementation and evaluation.

“The overseas experience shows that outcomes from the medical home model improve over time. Extending the pilot to five years is crucial to fully test the model(s) in Australia and to understand what will and will not work for patients and the health system,” Dr Jones said. 

The RACGP has developed the first set of Standards for the Medical Home, to align with the RACGP Vision for general practice and a sustainable healthcare system.

 The Standards will be released at GP16, the RACGP conference for general practice in Perth, 29 September – 1 October 2016.

 

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