Health Care Homes: the medical breakthrough we need
by Leanne Wells and Claire Jackson
The most significant development in Australia’s health system in a generation reaches a crunch point in Christmas week.
Long-awaited reform of primary health care services in the community is on the cards and central to this will be the GP. A minimum of 200 general practices have until next Thursday, 22 December, to express interest in a national trial for a reshaped primary health sector – a pilot of Health Care Homes, or HCH.
It is now widely accepted that Medicare as it currently works is failing to support the comprehensive care needed by many patients. A report to the Federal Health Minister by the Primary Health Care Advisory Group last year found that health services for Australians with chronic illness can be fragmented and often poorly linked with support services. These patients, such as those with diabetes, heart failure or chronic lung conditions, may require treatment from many different professionals, often working in different locations and in different parts of the health system.
It all makes for inconsistent and difficult communications, impinging on the quality and safety of patient care.
The Minister in April announced a trial of a new model of general practice – the HCH – which would allow patients with chronic disease to enrol with a single general practice to receive all their chronic disease care – face to face, and, if warranted, via phone and email advice. General practice Medicare funding would change to cover, for the first time, contact with patients and their families without a practice visit. The outcome, while potentially transformational for many patients and GPs, sits well within the expertise and organisational capabilities of Australian general practice, and the aspirations of patients.
It does however require a medical breakthrough: attitudinal change by both doctors and patients.
The HCH goal is that patients with high and complex needs would have wrap-round care, managed and provided by a GP-led team of health professionals whose routine communications with each other and the patient would focus on the patients’ requirements.
These transformed arrangements would be financed by a new payment system to the practice to provide the “bundled” care. Payments would range from $591 to $1795 a year depending on the level and complexity of care required.
On announcement, the concept attracted widespread and bipartisan support from most medical and consumer organisations.
Doctors and patients have used the current arrangements for many years. Given the scale of reforms, the significance of proposed changes in funding and enrolment, and the impact of developments like eHealth, it is not surpising that the trial has encountered suspicion and resistance.
There are practices who are eager to grasp the prospect of a service model that stimulates coordinated care and meets the reasonable expectations of 21st century care. They are keen to shape a new way of caring for their families, whilst acknowledging the challenges ahead. The model could mean enabling prosaic yet empowering developments like patients being able to make telephone and email checks about their care, or providing case managers to organise coordinated and follow-up care for chronic and complex health and social support.
The shift of practice to team-based care will mean the most appropriate team members can individualise patient care over time, under the oversight of the patient’s nominated GP.
More comprehensive care often means more accessible care. In New Zealand under similar conditions, up to 20 per cent of face-to-face visits to the doctor can be avoided.
It is frequently asserted that Australia’s health system is world’s best practice. That view may be more common among those who enjoy good health. The experience of frequent users, patients with chronic and complex conditions, reveals a less comforting picture.
According to an Australian Bureau of Statistics survey, nearly one in five patients say they have faced longer than acceptable waits to see the doctor, nearly a quarter report that GPs did not spend enough time with them.Significant numbers (one in eight) reported issues caused by lack of communication between health professionals.
HCH aims to support patients with chronic illness who otherwise might not find the right service or who experience duplication in services. It will spur the uptake of digital health and other technology that has the potential to improve the precision and personalisation of care and reduce treatment error.
HCH could also reduce the disempowered sense many frequent users of multiple health services experience.
HCH is about behaviour change for patients as well as doctors. By strengthening the focus of the health team on the individual needs of the patient and family, the care recipient is given the incentive to share in decision-making about their care. In order to improve their health, they must be active participants in their own care.
Australia’s HCH is based on international evidence of best practice, customised around the quality general practice most of us experience. It is exciting to some, challenging to others – but for our struggling health care system, it is an advance whose time has come. The foundations have been laid - let’s now mould it, build it and make it work.
This article first appeared in the opinion pages of The Australian on 16 December, 2016.