IPN and Primary snap up Health Care Homes

3 minute read

TheHill

By

Julie Lambert

Good budget news has been marred by a revelation that two corporates have won the lion’s share of the Health Care Homes trials

The government has stumped up some $50 million for the Health Care Homes trials and delayed the roll-out, apparently taking on board doctors’ concerns.  The surprise, however, is that it has awarded 50 per cent of the trials to the two biggest corporate chains.

“Working closely with GPs and other health professionals, the government is progressing the implementation of the Health Care Homes trial with 20 practices to commence 1 October 2017 and the remaining 180 to commence 1 December 2017,” the government said in its budget announcement.

But about half of the 200 practices selected belong to two major corporates – Primary Health Care and IPN, part of the Sonic Health Care group.

“This is quite a problem in terms of a range of practices taking part in the trials. The corporates are only a small part of the landscape,” a source close to the project told The Medical Republic.

With the two corporates winning such a large slice of the tenders, many independent practices that have been actively developing patient-centred “medical home” models had missed out.

The Health Care Home concept has been embraced by the government as the way to deal with a rising burden of chronic disease with greater efficiency and better health outcomes.

The RACGP was initially enthusiastic but, to the Health Department’s fury, it withdrew its support from the trials months ago, complaining the government’s version was half-baked and underfunded, relying on inadequate capitation payments.

The government abandoned the original start date of this July for the two-year trial.

It has allowed $22 million for the trial in the current year, followed by allocations if $2.6 million in 2017-2018 and 25.5 million in 2018-19. An additional $30 million is allocated for community pharmacy to support the trial.

RACGP President Dr Bastian Seidel said last night the government had stated it would use the additional time allowed for the Health Care Homes trial to collaborate with the profession to get the concept “right”.

“I’m also pleased Minister  (Greg) Hunt has agreed to extend the Medicare Benefits Review for three years with a view of permanency,” Dr Seidel said.

“When I called for an Independent Medicare Authority in my speech at the National Press Club in March this year, I argued that we need to continuously assess the value of Medicare item numbers to patients, clinicians and the public.”

Dr Seidel was also pleased that the government had heard the college’s call to fund practice-based research networks.

“The initial $5 million funding to kick start these networks signals a pivot towards preventative health research that will build a knowledge base for the profession and help us build a healthy Australia.”

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Glenn Rosendahl
Glenn Rosendahl
6 years ago

‘Health care homes’ (disease, acute sickness and injury care institutions) have been around for a long time. Another name for them is ‘hospitals’. In Australia they have been ‘public’ – funded and operated by the State governments, or ‘private’ – funded and operated as commercial businesses associated with private insurers. And, substantially, for patients who must stay in care for more than 12 hours, typically overnight. So there is an integrated ‘hotel business’.
What the corporates can now – with ‘health care home’ funding – is to develop a ‘day hospital’ – ‘clinical outpatient’ – model of care, with integrated interval care for complex and chronic illness, institutions significantly staffed by nurses, nurse practitioners and allied health in the hospital model; the medical (GP) staff acting as ‘hospitalists’; in other words – general physicians. It is a role they will rapidly need to re-acquaint themselves with. Otherwise it will be taken over – holus bolus – by nurse practitioners. Another section will provide ‘Emergency Department’ services for their patients. The State Governments will loudly applaud, as their own public hospital Emergency Departments can be run down – to be run by a skeleton staff.
In the late 1980’s it was the corporates that engineered the dismantling of private primary care. Essentially we moved to ‘bulk-billing’. It may be in the late 2010’s that the corporates will dismantle what is left of ‘small group’ primary care. The payment for ‘primary care’ will be increasingly funnelled through large community health care centres – ‘Health care homes’ – in block and capitation funding. How efficient and clinically competent these will be remains to be seen. But the majority of Australians will put up with whatever is available – whatever is provided – so long as it is ‘bulk-billed’.
Over time the Federal and State governments will rationalise their funding models, and the clinical association between the ‘Health Care Homes’ and the public hospitals. Whether ‘private primary care’ on the ‘fee for service model’ will continue to exist – remains to be seen.

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