Health Care Homes starved of cash and time

With VPE seemingly inevitably approaching, what lessons can the abandoned trial teach us?

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The final analysis of Health Care Homes was released earlier this week, just over a year after the somewhat controversial patient registration trial wound up.

Given Health Minister Mark Butler’s comments at the AMA conference earlier this month though, there’s reason to believe its ghost will rise in the form of voluntary patient enrolment.

The Health Care Homes initiative, which ran for four years in total, saw participating practices receive bundled payments for patients with chronic health conditions, provided the patient was willing to “enrol” with the practice.

Patients were sorted into three complexity tiers, and practices received the largest payments for the most complex patients.

The economic idea underpinning the scheme was that the non-specific payments would help practices deliver non-MBS fee-for-service funded aspects of care.

It was, however, plagued with issues from the very beginning.

As detailed in the postmortem released this week, practices that pulled out of the Health Care Home trial were most likely to do so in the patient-recruitment phase, the first stage of the program.

By the time the trial ended, fewer than half of the 227 practices that had been recruited remained enrolled.

The most common reasons for practices withdrawing from the trial in the first stage included misunderstanding the expectations of the trial, concerns with the software involved and the high administrative burden of enrolling a patient.

IT setup in particular was a stumbling block.

Although each practice received a $10,000 incentive grant to help it cover the cost of installing the risk stratification tool software, ongoing licensing and maintenance costs and staff training, many practices reported having to dig into their own pockets to complete the setup.

The actual set-up costs were not quantified in the evaluation, but at least one practice said it had spent the $10,000 “probably many times over” when factoring in staff training time.

“For future initiatives, incentive payments should aim to meet the costs of participation,” the report reads.

“Set-up costs can be reduced by tackling some issues system-wide rather than each practice resolving the issues individually.

“An example is compatibility of new critical software with existing software.”

Compatibility indeed: the report also said the risk stratification software, which was critical to Health Care Homes as a project, was not developed alongside industry vendors, leading to poor interoperability.

“For future initiatives, integration of critical software, such as risk stratification, with practice clinical management systems should be considered early, and relevant vendors engaged early to make this work,” one recommendation reads.

Issues with installing and using the software took up so much time that many practices reported being unable to actually develop a new model of care in the initial recruitment stage.

This had significant downstream effects.

“Most practices turned to working on their models after patient enrolment closed,” the report said.

“Practices reflected that they needed time before enrolling patients to set up as a Health Care Home, particularly for practice staff to jointly identify changes they would make and commit to them.”

On the patient end, the people who were most prepared to enrol tended to already have a long-standing or trusting relationship with their doctor.

Interestingly, a key reason why patients would opt out of enrolment was that they wanted more one-on-one time with their regular GP.

Ultimately, the reviewers said, patients needed a stronger value proposition to commit to enrolment as an initiative, and in future models time should be factored in for them to build confidence in a wider primary care team.

Health Care Homes is dead. Long live voluntary patient enrolment.