With the HCH trials now starting, backers are hoping trickle-down benefits will soon become evident
Australian general practices with patient-centred care models similar to Health Care Homes have reported benefits for their whole patient populations, not just the chronic disease patients targeted for intervention.
The Health Care Homes trials backed by the federal government are due to begin this month at 20 practices, with another 180 scheduled to come on board by December.
Dr Eleanor Chew, a Queensland GP and clinical lead of integrated care at Sonic Clinical Services, said the trickle-down effects were evident at IPN practices in Sydney and Victoria which started offering Wellnet chronic-disease management programs last year.
The key was whole-of-practice change for team-based care, although the challenge was for GPs to lead the transition, Dr Chew told a recent webinar on Health Care Homes.
“The structure is there, we’ve got nurses and care coordinators. There’s more focus on patient engagement and ensuring patients’ individual needs are met. That leakage is across the board.”
In the two-year HCH trial, up to 65,000 patients with at least two chronic or complex conditions will be eligible for enrolment by their GP. Practices will receive bundled, tiered payments for coordinating “wrap-around” care, including services from allied health and other providers.
Walter Kmet, Chief Executive of the WentWest PHN, which has been steering patient-centred care trials for chronic disease patients in the western Sydney region, said the positive side-effects had been identified early on.
“We started this many years ago (asking) how do we transform the model of care for the whole practice, so all of that population within the practice benefits,” he said.
It was a way to throw off the limitations of the fee-for-service payment system and maintain best practice, he said.
“But leadership is needed at the GP level. It’s not just going to happen by itself.
“There’s a whole stream of work that PHNs do with practices around how they can effectively provide all the items of service relevant to the needs of that patient. That’s a financial benefit as well as a patient benefit,” he added.
Dr Ged Foley, Head of Sonic Clinical Services, said the 33 IPN practices in the HCH trial would add capacity through the program.
“Within the HCH we’ve got nurses and care coordinators, but they are going to be doing other practice processeses as well. So, you give these skills to practices.
“They become better at chronic disease management across the board.”
On the question of the tax treatment of HCH payments, Dr Steve Hambleton, who headed the primary health care advisory group that worked on HCH, said payments would be structured “in the normal way”, but the distribution would be different.
How much the GP received would be worked out between the doctor and the practice, he said.
“It is not the practice paying the practitioner to see a patient. That’s the problem we recognised straight away,” he said.
“The intention is that both will be better off.
“Some practices have said, we will put aside a pool of funds, just in case the primary doctor doesn’t see the patient and someone else does. Certainly, the practice nurse will have a role, and other parties could help the doctor do their job.”
