Primary, IPN may shape Health Care Homes: Is this right?

Will corporate dominance of Health Care Homes trials hurt diversity?

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Two major corporate groups and Aboriginal Medical Services will account for about 75  percent of the Health Care Homes trials intended to shape the future of chronic disease management in primary care.

The government has allowed some $50 million for the Health Care Homes trials in the budget, apparently taking on board doctors’ concerns by delaying the roll-out and adopting a phased approach.

“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 budget announcement said.

But about half of the practices selected belong to two major corporates – Primary Health Care and IPN, which is part of the Sonic Health Care group – along with four from the Tristar group.

The dominance of the major corporates is a concern for doctors and Primary Health Network staff who say 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 the rising burden of chronic disease with greater efficiency and improved health outcomes.

The CEO of the Consumers Health Forum, Leanne Wells, said the large corporate presence raised questions about whether the approach would be tested across an adequate diversity of practices and whether the conclusions would apply to the wider general practice community.

“To be robust, the trials should allow for the HCH design to be tested in a variety of practice configuration and management models,” she said.

“We would be concerned that, without a diversity of participating practices, we end up with a model of care that only works for practices that have a particular type of corporate infrastructure and business model.”

“We know from evaluations for the US and NZ that primary care practice transformation is hard work and that a variety of patient centred medical home models are possible.  A one-size-fits-all approach is unlikely to deliver the best outcome.”

Ms Wells, whose organisation has been pushing the HCH development, said it was important to learn what impeded change, as well as what enabled it, so that policy could put in place the right incentives and programs to shift primary care towards a new system.

“However, on the positive side the keen involvement of the corporates would indicate that they see the funding model as workable.”

About 65,000 patients are expected to be enrolled in HCH trial practices across 10 PHN regions, in a scheme that Prime Minister Malcolm Turnbull promised would revolutionise Medicare.

However, the RACGP withdrew its support from the trials months ago, complaining the government’s version was half-baked and relied on inadequate capitation payments.

The AMA has backed the concept but agreed the scheme was “set up to fail” because of a funding shortfall.  Of the $110 million in funding, most is redirected from other chronic care MBS items.

The 200 practices taking part in the trials will receive one-off payments of $10,000 for set-up costs.

The government abandoned the original start date of this July for the two-year trial, heeding doctors’ concerns.

It has allowed $22 million for the trial in the current year, followed by allocations of $2.6 million in 2017-18 and $25.5 million in 2018-19. An additional $30 million is earmarked for community pharmacy to support the trial.

Minister for Indigenous Health Ken Wyatt said he was particularly pleased by the selection of 46 Aboriginal Medical Services, including community-controlled clinics.

The trials will be held in the PHN areas of Perth North, Adelaide, Country South Australia, Brisbane North, Western Sydney, Hunter, New England and Central Coast, South Eastern Melbourne, Nepean Blue Mountains, Northern Territory and Tasmania.